Translation and evaluation of a lung cancer palliative care intervention for community practice.

Abstract

77 Background: A notable gap in the evidence-base for outpatient palliative care (PC) for cancer is that most trials were conducted in specialized centers with limited translation and further evaluation in “real-world” settings. Health systems are desperate for guidance on effective, scalable models. The purpose of this study was to determine the effects of a nurse-led PC intervention (PCI) for patients with non-small cell lung cancer (NSCLC) and their family caregivers (FCGs) in a community-based setting. Methods: Two-group, prospective sequential, quasi-experimental design with phase 1 (usual care) followed by phase 2 (intervention) conducted at three Kaiser Permanente Southern California sites. Participants included patients with stage 2 - 4 NSCLC and their FCG. Standard measures of quality of life included FACT-L, FACIT- SP12, City of Hope Family QOL; other outcomes were distress, healthcare utilization, caregiver preparedness and perceived burden. Results: Patients in the intervention cohort had significant immediate improvements in three (physical, emotional, and functional well-being) of the five quality of life (QOL) domains at 1 month that were sustained through 3 months compared to usual care (p < .01). Caregivers in the intervention cohort had improvements in physical (p = .04) and spiritual well-being (p = .03) and preparedness (p = .04) compared to usual care. There were no differences in distress or health care utilization between cohorts. Conclusions: Our findings suggest that a research-based PC intervention can be successfully adapted to community settings to achieve similar, if not better, QOL outcomes for patients and FCGs compared to usual care. Nonetheless, additional modifications to ensure consistent referrals to PC and streamlining routine assessments and patient/FCG education are needed to sustain and disseminate the PCI. Clinical trial information: NCT02243748.