Jenna M Evans1,2, Marnie Mackinnon1, Jose Pereira3,4,5,6,7, Craig C Earle8, Bruno Gagnon9, Erin Arthurs1, Sharon Gradin1, Sandy Buchman10,11, Frances C Wright12,13. 1. Integrated Care Unit, Cancer Care Ontario, Toronto. 2. DeGroote School of Business, McMaster University, Hamilton. 3. Academic Family Medicine Division, College of Family Physicians of Canada, Mississauga. 4. School of Medicine, Faculty of Health Sciences, Queen's University, Kingston. 5. Division of Palliative Care, Department of Family Medicine, University of Ottawa, Ottawa. 6. Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton. 7. Pallium Canada, Ottawa. 8. Institute for Clinical and Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto. 9. Department of Family Medicine and Emergency Medicine, Cancer Research Centre, Laval University, Quebec City. 10. The Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto. 11. Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto. 12. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto. 13. Department of Surgery, Faculty of Medicine, University of Toronto, Toronto.
Abstract
OBJECTIVE: With increasing evidence from controlled trials on benefits of early palliative care, there is a need for studies examining implementation in real-world settings. The INTEGRATE Project was a 3-year real-world project that promoted early identification and support of patients with cancer who may benefit from palliative care. This study assesses feasibility, stakeholder experiences, and early impact of the INTEGRATE Project METHODS: The INTEGRATE Project was implemented in four cancer centers in Ontario, Canada, and consisted of interdisciplinary provider education and an integrated care model. Providers used the Surprise Question to identify patients for inclusion. A mixed methods evaluation of INTEGRATE was conducted using descriptive data, interviews with providers and managers, and provider surveys. RESULTS: A total of 760 patients with cancer (lung, glioblastoma, head and neck, gastrointestinal) were included. Results suggest improvement in provider confidence to deliver palliative care and to initiate the Advanced Care Planning (ACP) conversation. The majority of patients (85%) had an ACP or goals of care (GOC) conversation initiated within a mean time to conversation of 5-46 days (SD 20-93) across centers. A primary care report was transmitted to family doctors 48-100% of the time within a mean time to transmission of 7-54 days (SD 9-27) across centers. Enablers and barriers influencing success of the model were also identified. CONCLUSIONS: A standardized model for the early introduction of palliative care for patients with cancer can be integrated into the routine practice of oncology providers, with appropriate education, integration into existing clinical workflows, and administrative support.
OBJECTIVE: With increasing evidence from controlled trials on benefits of early palliative care, there is a need for studies examining implementation in real-world settings. The INTEGRATE Project was a 3-year real-world project that promoted early identification and support of patients with cancer who may benefit from palliative care. This study assesses feasibility, stakeholder experiences, and early impact of the INTEGRATE Project METHODS: The INTEGRATE Project was implemented in four cancer centers in Ontario, Canada, and consisted of interdisciplinary provider education and an integrated care model. Providers used the Surprise Question to identify patients for inclusion. A mixed methods evaluation of INTEGRATE was conducted using descriptive data, interviews with providers and managers, and provider surveys. RESULTS: A total of 760 patients with cancer (lung, glioblastoma, head and neck, gastrointestinal) were included. Results suggest improvement in provider confidence to deliver palliative care and to initiate the Advanced Care Planning (ACP) conversation. The majority of patients (85%) had an ACP or goals of care (GOC) conversation initiated within a mean time to conversation of 5-46 days (SD 20-93) across centers. A primary care report was transmitted to family doctors 48-100% of the time within a mean time to transmission of 7-54 days (SD 9-27) across centers. Enablers and barriers influencing success of the model were also identified. CONCLUSIONS: A standardized model for the early introduction of palliative care for patients with cancer can be integrated into the routine practice of oncology providers, with appropriate education, integration into existing clinical workflows, and administrative support.
Authors: Simen A Steindal; Andréa Aparecida Goncalves Nes; Tove E Godskesen; Alfhild Dihle; Susanne Lind; Anette Winger; Anna Klarare Journal: J Med Internet Res Date: 2020-05-05 Impact factor: 5.428