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Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach

Abstract

Purpose  

To prospectively compare outcomes and processes of hospital-based early palliative care with standard care in surgical oncology
patients (N = 152).

Methods  

A randomized, mixed methods, longitudinal study evaluated the effectiveness of a hospital-based Pain and Palliative Care Service
(PPCS). Interviews were conducted presurgically and at follow-up visits up to 1 year. Primary outcome measures included the
Gracely Pain Intensity and Unpleasantness Scales and the Symptom Distress Scale. Qualitative interviews assessed social support,
satisfaction with care, and communication with providers. Survival analysis methods explored factors related to treatment
crossover and study discontinuation. Models for repeated measures within subjects over time explored treatment and covariate
effects on patient-reported pain and symptom distress.

Results  

None of the estimated differences achieved statistical significance; however, for those who remained on study for 12 months,
the PPCS group performed better than their standard of care counterparts. Patients identified consistent communication, emotional
support, and pain and symptom management as positive contributions delivered by the PPCS.

Conclusions  

It is unclear whether lower pain perceptions despite greater symptom distress were clinically meaningful; however, when coupled
with the patients’ perceptions of their increased resources and alternatives for pain control, one begins to see the value
of an integrated PPCS.

  • Content Type Journal Article
  • Pages 1-11
  • DOI 10.1007/s11136-011-0065-7
  • Authors
    • Gwenyth R. Wallen, National Institutes of Health Clinical Center, Building 10, Room 2B14, 10 Center Drive, Bethesda, MD 20892, USA
    • Karen Baker, Pain and Palliative Care Service, National Institutes of Health Clinical Center, 10 Center Drive, 2-1733 MSC 1517, Bethesda, MD 20892, USA
    • Marilyn Stolar, United BioSource Corporation, 430 Bedford Street, Suite 300, Lexington, MA 02420, USA
    • Claiborne Miller-Davis, National Institutes of Health Clinical Center, Building 10, Room 2B14, 10 Center Drive, Bethesda, MD 20892, USA
    • Nancy Ames, National Institutes of Health Clinical Center, Building 10, Room 2B14, 10 Center Drive, Bethesda, MD 20892, USA
    • Jan Yates, Shenandoah University, 348 Renaissance Drive, Martinsburg, WV 25403, USA
    • Jacques Bolle, National Institutes of Health Clinical Center, 5207 Dorset Avenue, Chevy Chase, MD 20815, USA
    • Donna Pereira, Palliative Care Department, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037, USA
    • Diane St. Germain, National Institutes of Health, National Cancer Institute, 6130 Executive Boulevard, Bethesda, MD 20892, USA
    • Daniel Handel, Pain and Palliative Care Service, National Institutes of Health Clinical Center, 10 Center Drive, 2-1733 MSC 1517, Bethesda, MD 20892, USA
    • Ann Berger, Pain and Palliative Care Service, National Institutes of Health Clinical Center, 10 Center Drive, 2-1733 MSC 1517, Bethesda, MD 20892, USA