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Summary of the research plan
Background: In the care of advanced incurable cancer patients medical oncologists play a sentinel role in not only providing tumour directed treatment, but also in identifying and treating palliative care needs. In busy oncological clinics and more pronounced in resource restricted settings, the integration of palliative care procedures in daily practise however is challenging. Models of integrated oncology and palliative care are developing, one important is the ESMO designated centers incentive program providing 13 criteria’s. However this is linked to substantial institutional commitments, which might not be rapidly feasible on the necessary time. Therefore the provision of clinical practise tools to integrate specific palliative care procedures into daily practise of medical oncologists and testing their effects on patient reported outcomes, tumour control including anticancer treatment toxicities and also health services costs seems timely and appropriate. These interventions can be summarized under promoting of illness understanding, multidimensional symptom assessment and management, indication criteria of chemotherapy in palliative intention, care plans to promote continuity of care in support networks and proactive end of life preparation including family members.
Aim: The joint research program between Romania and Switzerland focuses on 5 institutions in Romania and one institution in Switzerland. The research hypothesis is that the provision of tailored clinic practice tools, based on prior epidemiological data in each institution, can improve outcomes.
Methods: The research plan includes collection of real-practice patient-based data, development of tailored educational & clinical practice tools interventions based on these results, and testing for feasibility and collection of information about preliminary efficacy on the levels patient reported outcomes, tumor control, and costs.
First a workshop for protocol finalization will be conducted in Romania including the 5 institutions and the principle investigators, this to ensure development of research capacities.
The second phase will include for 6 months in all 5 institutions collection of patient needs with validated tools for symptoms, but also the other for key interventions, collected by a research nurse locally spending 30 minutes per patient, who are selected randomly. Parallel the palliative outcome scale will be validated according to standard procedures and formal translation.
In the third phase, data will be analyzed and a second workshop of two days conducted in Romania, including all participant research personal and selected European leaders of medical oncology in palliative care. Decisions will be made about which tailored interventions are provided in each institution.
In the fourth phase these interventions will be implemented as pilot projects, mainly focusing on feasibility, led by the local institutions, supported by experts in palliative care education and in medical oncology, utilizing also the international network of educators in oncological palliative medicine (ESMO palliative care working group and international association of hospice and palliative care). Examples of interventions are the use of pain intensity, presence of depression, and weight loss (%) in every patient seen by medical oncologists. Another example includes the documentation of the goals of anticancer treatment including pre-chemotherapy evaluation of cancer-related symptoms and patient-rated importance of expected toxicities. Another example may encompass the provision of a care plan coordinating also home care services and continuity of care with the oncologist. The educational effects will be tested by knowledge tests to assure effectivity.
In a fifth phase information about preliminary efficacy will be collected based on patient reported outcomes, tumour control and chemotherapy toxicities and also health services used to extrapolate costs.
In the final phase this data will be also analyzed and discussed in a third workshop, where it will be decided on potential intervention trials for exploring effectiveness of new clinical practice tools and palliative care procedures webbed in medical oncology care.
Expected impact: It is foreseen to publish several manuscripts based on this research, guided by investigators from Romania. The results will provide the basis for further implementation research of tailored interventions of palliative care procedures provided by medical oncologists.