Implementation and Evaluation of a Program Aimed at Facilitating Palliative Care Conversations

Cancer is one of the leading causes of death worldwide. In the care of people with cancer, it is essential to pay sufficient attention to individual care needs and quality of life. One component of non-cancer-directed care, care aimed at addressing symptoms independent of the cancer or tumor, may be palliative care. Palliative care can be initiated at any point along the disease trajectory and can therefore be provided simultaneously with tumor-directed care. When initiated in a timely manner, palliative care can significantly improve the quality of life of both the person living with a life-threatening condition and their family. Pain management and attention to physical, psychosocial, and spiritual needs are central to this approach. Research shows that people with cancer develop palliative care needs well before the terminal phase. Communication about care needs, and palliative care in particular, is therefore essential for the timely initiation of palliative care. However, to date, palliative care is often initiated too late or not at all, frequently resulting in suboptimal care during the final months of life. Communication about palliative care is postponed or avoided by both healthcare professionals and people with cancer. Efforts are being made at various levels to make palliative care more discussable and to initiate it in a timely manner. At present, however, these efforts primarily focus on the role of healthcare services and professionals. By focusing solely on healthcare providers, palliative care has not yet been fully integrated as a standard component of oncological practice. The literature indicates that, in addition to barriers, there are also opportunities at the level of the person with cancer when it comes to initiating a conversation about palliative care with their physician, provided that adequate support is available. The health promotion approach, which focuses on the role of various personal and environmental factors in stimulating healthy behavior, is well suited to addressing this need for change in patient-initiated communication about palliative care. Health promotion makes use of theoretical behavioral models, for which evidence demonstrates that their application leads to more effective behavioral interventions and successful behavior change. These models have also been shown to be promising in promoting behaviors related to palliative care and in enhancing patient empowerment.

Sex

All

Minimum age

18 Years

Inclusion Criteria (physician):

* Oncologist (medical oncologist, radiation oncologist, etc.), radiologist, organ specialist, nuclear medicine physician, ASO
* The physician regularly interacts with people with advanced cancer
* The physician is employed in an oncology hospital department

Exclusion Criteria (physician):

* The physician works mostly (\>50% of the time) in a hospital not involved in this study

Inclusion Criteria (healthcare provider - potential implementer):

* Healthcare provider (e.g., study coordinator, oncology coach) or another hospital staff member (e.g., administrative staff)
* The implementer regularly interacts with people with advanced cancer

Exclusion criteria (healthcare provider - potential implementer):

\- Physician participating in My Care, My Voice

Inclusion Criteria (patient):

* The participant is an adult (18 years or older)
* The participant has been diagnosed with advanced (i.e., non-curable) cancer (no curative treatment ongoing or planned). Participants receiving life-prolonging treatment are included.
* The participant is aware of their diagnosis and treatment options as determined by their physician
* The participant has known their initial diagnosis for more than one month
* The participant is able to participate in a Dutch-language study
* The participant is competent and able to voluntarily consent to participate in this study
* The participant is hospitalized or receiving outpatient care

Exclusion Criteria (patient):

* Estimated survival prognosis by the physician is longer than 5 years
* The participant is in a follow-up trajectory or in remission according to the physician
* The participant is already receiving specialized palliative care known to the treating physician

• BACKGROUNDScherrens AL, Cohen J, Mahieu A, Deliens L, Deforche B, Beernaert K. The perception of people with cancer of starting a conversation about palliative care: A qualitative interview study. Eur J Cancer Care (Engl). 2020 Sep;29(5):e13282. doi: 10.1111/ecc.13282. Epub 2020 Jul 1. PMID 32613675
• BACKGROUNDScherrens AL, Beernaert K, Deliens L, Lapeire L, De Laat M, Biebuyck C, Geboes K, Van Praet C, Moors I, Deforche B, Cohen J. Identification of the most important factors related to people with cancer starting a palliative care conversation: A survey study. Psychooncology. 2022 Nov;31(11):1843-1851. doi: 10.1002/pon.6039. Epub 2022 Oct 9. PMID 36131548