Using Process Indicators to Monitor Documentation of Patient-Centred Variables in an Integrated Oncology and Palliative Care Pathway-Results from a Cluster Randomized Trial.

Abstract

Simple SummaryThe body of research from randomized controlled trials (RCTs) demonstrates that palliative care (PC) alongside anticancer treatment improves patient and caregiver outcomes, e.g., tolerance to treatment, symptom control, and satisfaction with care. This results from integrating the patient-centred focus of PC with the traditional tumour-directed focus in oncology. This integration represents a complex intervention affecting how people work. We have investigated clinicians’ adherence to requested documentation of four important patient-centred study indicators (EGOC; symptom assessment, weight and GP report) in our ongoing RCT on PC integration. Results from 435 consultations; first oncological (start last chemotherapy-line), palliative and oncological consultations during chemotherapy showed that registration percentage differed across consultations; 94.8% in the palliative (83.3–100%), 65.8% (62.5–75.0%) and 69.2% (57.0–84.3%) in the oncological consultations. Results were not satisfactory and call for strict pre-study optimization strategies to promote integration and handle organizational, professional and individual barriers towards a more patient-centred focus.Background. Despite robust evidence from randomized controlled trials (RCTs) demonstrating clinical and patient-reported benefits of integrated oncology and palliative care, the tumour-centred focus is predominant. This single–centre process evaluation monitors documentation of required patient-centred variables during an RCT. Methods. Performance status, patient self-reported symptoms, weight and summaries to general practitioners were assessed from June 2017 to July 2020 in three consultation types: first oncological after study inclusion and palliative and oncological consultations during chemotherapy. Descriptive statistics were used to monitor if the pre-defined program fulfilment of ≥85% documentation was reached. Results. 435 consultations were monitored in 76 patients; 60.5% males, 86.8% with GI cancers; 76 (17.5%) were from the first oncological consultations, 87 (20.0%) and 272 (62.5%) from palliative or subsequent oncological consultations. Program fulfilment differed across consultation types with 94.8% in the palliative consultations (83.3–100%), relative to 65.8% (62.5–75.0%) and 69.2% (57.0–84.3%) for first and subsequent oncological consultations over time, respectively. Use of self-reported symptoms was consistently lower in the oncological consultations. Conclusions. The documentation level of required core variables was not satisfactory, notwithstanding their high clinical relevance and continuous reminders during study. Pre-trial optimization strategies are paramount to promote integration and reduce professional and personal barriers towards a more patient-centred focus.