Abstract
BackgroundPatients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late.The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life.MethodsObservational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues. 3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis.ResultsEight PCPs were trained. Patient recruitment was a challenge for PCPs who feared to impose additional loads on their patients. PCPs became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life.ConclusionsWhile the intervention was acceptable to PCPs, recruitment was a challenge and a follow up trial was not deemed feasible using the current design but PCPs reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life.Trial registrationThe ethics committee of the canton of Geneva approved the study (2018–00077 Pilot Study) in accordance with the Declaration of Helsinki.
Highlights
IntroductionPresentations, program 1:40 pmWhat challenges when caring for Ice breaking, expectations severe cancer patient as GP?1:50 pm Witness of a patient’s husband catch attention expressing experience of palliative care for his wife at home 2:00 pmWhat is a “good” death?Clarification of expectations and fears2:30 pm Project presentationPresentation of project steps, inclusion criteria, material (questionnaires, etc), network and resourcesHow to explain the project to my patient?Training of recruitment process
Presentations, program 1:40 pmWhat challenges when caring for Ice breaking, expectations severe cancer patient as GP?1:50 pm Witness of a patient’s husband catch attention expressing experience of palliative care for his wife at home 2:00 pmWhat is a “good” death?Clarification of expectations and fears2:30 pm Project presentationPresentation of project steps, inclusion criteria, material, network and resourcesHow to explain the project to my patient?Training of recruitment process
While the intervention was acceptable to primary care physician (PCP), recruitment was a challenge and a follow up trial was not deemed feasible using the current design but PCPs reported a change in paradigm about palliative care
Summary
Presentations, program 1:40 pmWhat challenges when caring for Ice breaking, expectations severe cancer patient as GP?1:50 pm Witness of a patient’s husband catch attention expressing experience of palliative care for his wife at home 2:00 pmWhat is a “good” death?Clarification of expectations and fears2:30 pm Project presentationPresentation of project steps, inclusion criteria, material (questionnaires, etc), network and resourcesHow to explain the project to my patient?Training of recruitment process. Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late. Primary care physicians (PCPs) mostly deliver the diagnosis, patients are referred to oncologists for management and treatment planning [2] During this period there is often a loss of contact between patients and PCPs. When cancer becomes life-limiting and unlikely to be cured, oncological treatments may no longer be appropriate and a transition back to the PCP usually occurs [2]. A palliative care approach is introduced in the last weeks or days of life of patients, advanced directives are poorly defined, and psychological and spiritual needs are minimally supported [3, 4] This suggests PCPs could be involved much earlier to assess and manage the multidimensional needs of these patients. Patients’ spiritual needs have to be recognised and considered [8,9,10]
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