Abstract
BackgroundThe focus of Specialized Palliative Care (SPC) is to improve care for patients with incurable diseases and their families, which includes the opportunity to make their own choice of place of care and ultimately place of death.The Danish Palliative Care Trial (DOMUS) aims to investigate whether an accelerated transition process from oncological treatment to continuing SPC at home for patients with incurable cancer results in more patients reaching their preferred place of care and death. The SPC in this trial is enriched with a manualized psychological intervention.Methods/DesignDOMUS is a controlled randomized clinical trial with a balanced parallel-group randomization (1:1). The planned sample size is 340 in- and outpatients treated at the Department of Oncology at Copenhagen University Hospital. Patients are randomly assigned either to: a) standard care plus SPC enriched with a standardized psychological intervention for patients and caregivers at home or b) standard care alone. Inclusion criteria are incurable cancer with no or limited antineoplastic treatment options.DiscussionPrograms that facilitate transition from hospital treatment to SPC at home for patients with incurable cancer can be a powerful tool to improve patients’ quality of life and support family/caregivers during the disease trajectory. The present study offers a model for achieving optimal delivery of palliative care in the patient’s preferred place of care and attempt to clarify challenges.Trial registrationClinicaltrials.gov Identifier: NCT01885637
Highlights
The focus of Specialized Palliative Care (SPC) is to improve care for patients with incurable diseases and their families, which includes the opportunity to make their own choice of place of care and place of death
The present study offers a model for achieving optimal delivery of palliative care in the patient’s preferred place of care and attempt to clarify challenges
Similar preferences were reported in a retrospective Danish survey, which indicated that the majority of cancer patients in the palliative care phase preferred to die in their own home (81%); the reported preference for dying at home decreased towards time of death (64%) [11]
Summary
The DOMUS trial is a comprehensive RCT in incurable cancer patients – to our knowledge the first of its kind - including outcomes from the individual patient and closest relative, as well as healthcare research of economy and organization. Based on the retrospective data and our clinical experience, we anticipate that thorough and proper information about SPC at home will create agreement in the majority of cases Another issue of discussion in the DOMUS trial has been to define the inclusion criteria. In addition to the expressed wish (and agreement between patient and closest relative) to be cared for at home, we have selected the inclusion criteria “incurable cancer with limited or no antineoplastic treatment left” (List of Inclusion and exclusion criteria of the DOMUS study). In addition to national importance of the study it has great international relevance, since high quality evidence from RCTs is sparse in palliative care, and no RCTs with an accelerated transition from oncological treatment to continuing SPC at home in patients with incurable cancer have previously been published. Made suggestions, revised, and approved the final manuscript
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