Patricia Moreno, Ph.D.

“Palliative care is patient-centered care for patients with serious illness that aims to manage symptoms and functional limitations, clarify treatment goals, and facilitate transitions in care. Although palliative care is often confused with hospice, a component of palliative care that is incorporated at end of life, palliative care should be integrated with cancer treatments from the point of stage IV diagnosis for patients with metastatic solid tumors.” said Dr. Moreno.

The goals of the study are to identify patient, provider, and cultural factors that influence whether or not palliative care is integrated in the care of Hispanic/Latino patients with metastatic cancer, as well as develop and test an intervention to increase patient engagement and facilitate early integration of palliative care. The intervention will consist of a culturally-adapted, psychoeducational resource that will provide valuable information about palliative care and be personalized based on each patient’s individual symptom profile and supportive care needs using the Sylvester Comprehensive Cancer Center EHR-integrated patient symptom monitoring system, My Wellness Check.

The study will provide the opportunity to understand how My Wellness Check can support conversations between providers and patients regarding patients’ unique care needs and the benefits of palliative care. The intervention will be tested at University of Miami Sylvester Comprehensive Cancer Center-affiliated clinics that serve large English- and Spanish-speaking Hispanic/Latino populations with metastatic cancer.

“Increasing access to high quality, guideline-concordant palliative care alongside cancer treatments such as chemotherapy and radiation is crucial to effectively managing symptoms and side-effects, enhancing quality of life, and ensuring Hispanic/Latino patients live as well as possible following the diagnosis of stage IV cancer,” said Dr. Moreno.

Early integration of palliative care has been scientifically proven to improve outcomes for patients with metastatic cancer, including symptom management, health-related quality of life and satisfaction with care. Early palliative care also increases hospice enrollment and reduces unnecessary treatments at end of life and hospital admissions to the emergency department and intensive care unit. The American Society of Clinical Oncology and National Comprehensive Cancer Center Network now recommend the integration of palliative care early, alongside prescribed medical treatments in patients with metastatic cancer.

However, the majority of patients only receive palliative care late in the disease trajectory, which is at or near end of life. Health disparities in access to palliative care also persist by race/ethnicity and socioeconomic status.

Hispanic/Latino patients with metastatic cancer are less likely to receive palliative care and experience a worse health-related quality of life and symptom burden compared to non-Hispanic/Latino White patients. Hispanics/Latinos may also experience various challenges in their interactions with the health care system, including low health literacy, language barriers, and structural and perceived discrimination.

Effective patient-provider communication is needed to facilitate early integration of palliative care in Hispanic/Latino patients with metastatic cancer. Key factors include clear and concise information about palliative care and its benefits as well as patient-provider relationships that are built on a foundation of trust. To date, little is known about how to effectively engage patients and their families so that they are empowered participants in discussions related to the benefits and potential inclusion of palliative care in their treatment. This new study will explore the factors that influence patient empowerment in conversations about palliative care.

Focus groups and usability testing will inform the development of the psychoeducational intervention. A pilot randomized controlled trial will evaluate outcomes in the early phases of palliative care introduction and referral, including the effects on health-related quality of life, patient-provider communication, shared decision-making, beliefs/attitudes regarding palliative care, and patient satisfaction. Results from the intervention will also guide the development of a full-scale randomized controlled trial that will evaluate the effects of the intervention on the rate and timing of palliative care referrals and their impact on health outcomes.

Written by Veronica Bustabad

Published on November 29, 2021