February 2018

In this Issue: Improving Cancer Care
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Palliative Care Intervention for Newly Diagnosed VA Outpatients with Lung Cancer

Feature Article

Palliative care improves the quality of life of patients for problems associated with serious illness through the prevention and relief of suffering by early identification, assessment, and treatment of pain and other physical symptoms including psychological and spiritual needs. Initiating early palliative care shortly after lung cancer diagnosis may provide an opportunity to improve this aspect of care. Lung cancer is the second most common cancer treated within the VA healthcare system, and is the leading cause of cancer-related death among Veterans.

A pilot study was conducted to test the feasibility and acceptability of a nurse-led, telephone-based palliative care intervention to improve the delivery of care for Veterans with newly diagnosed lung cancer. The pilot allowed for the development and refinement of study protocols – and demonstrated that patients were highly satisfied with the intervention.  Investigators contemporaneously conducted interviews with VA oncology and palliative care providers to assess their perceptions about integrating oncology and palliative care using a nurse. Collectively this data informed the ongoing clinical trial (2016-2020). This three-site randomized control trial will determine the efficacy of the nurse-led model of care on improving patients' quality of life, symptom burden, and satisfaction of care.

Investigators are recruiting patients (n=138) with a lung cancer diagnosis and treatment other than sole surgical resection regardless of disease stage at the Puget Sound Health Care System, Birmingham, and Portland VAMCs. Patients are randomized to the intervention (palliative care plus usual care) or usual care. Patients randomized to the intervention receive phone calls from a registered nurse over 12 weeks. The nurse assesses and manages symptoms in collaboration  with patients’ clinicians, conducts patient education regarding lung cancer treatment, initiates goals of care conversations, and helps coordinate care. Primary outcome measures include quality of life, symptom burden, and patient satisfaction with care. Secondary outcome measures include the effect of the intervention on patient activation to discuss treatment preferences with their clinician, clinician knowledge of patients' goals of care, and interdisciplinary resource use.

Impact: This study will help VA provide personalized, proactive, patient-driven healthcare, thereby improving access and health outcomes for patients newly diagnosed with lung cancer. This innovative model of care is efficient and provides an alternative to traditional clinic-based outpatient palliative care without requiring new clinical infrastructure and practices. If the study demonstrates efficacy, the next step is widespread implementation of the nurse-led intervention across VA facilities.

Principal Investigator:  Lynn F. Reinke, PhD, ARNP, is part of HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA.

Publications:

Reinke L, Vig E, Tartaglione E, et al. Protocol and pilot testing: The feasibility and acceptability of a nurse-led telephone-based palliative care intervention for patients newly diagnosed with lung cancer. Contemporary Clinical Trials. January 2018;64:30-34.

Tartaglione E, Vig E, and Reinke L. Bridging the cultural divide between oncology and palliative care subspecialties: Clinicians’ perceptions on team integration. American Journal of Hospice and Palliative Medicine. December 2017; Epub ahead of print.

Aslakson R, Reinke L, Cox C, et al. Developing a research agenda for integrating palliative care into critical care and pulmonary practice to improve patient and family outcomes. Journal of Palliative Medicine.  April, 2017;20(4):329-343.

Palliative Care Intervention for Newly Diagnosed VA Outpatients with Lung Cancer project abstract