Lung cancer is the second most common cancer treated within VA and is the leading cause of cancer related death among Veterans. Lung cancer is of particularly interest within VA because of the high prevalence of current and past tobacco consumption. The care of patients with lung cancer has been demonstrated to be heterogeneous. The Office of Quality and Performance (OQP) recently assessed the quality of lung cancer care within VA including palliative care measures, e.g. outpatient pain screening. Findings indicate the national rate for initial pain screening is 70% with large variation among sites (2%-100%). These measures recognize that delays in delivery of palliative care in the treatment of lung cancer likely results in unnecessary symptom burden and poorer quality of life. Palliative care is "an approach that improves the quality of life of patients for problems associated with life-threatening illness through the prevention and relief of suffering by early identification, assessment, and treatment of pain and other symptoms, physical, psychological and spiritual." Palliative care is supportive care integrated into curative care, independent of stage of illness. The conceptual tenets of palliative care services are concordant with being Veteran-centric and align with VA and the Office of Nursing Services T21 initiatives to maximize physical, mental, and social functioning of Veterans and improve their quality of life. Despite guideline recommendations to integrate palliative care into curative care, the majority of patients do not receive palliative care service until all curative options are exhausted. Initiating early palliative care shortly after lung cance diagnosis may provide an opportunity to improve this aspect of care. The purpose of this study is to test the feasibility and acceptability of delivering a nurse-led telephone- based interventio that includes the early provision of palliative care to improve patient-centered outcomes for Veterans with newly diagnosed lung cancer. This nurse led intervention will focus on patients across the spectrum of stages of disease and is designed to estimate the effect size of the intervention to improve patient quality life, symptom burden and satisfaction of care. In addition, using validated instruments, we will assess the potential effect size of the intervention on qualit of provider communication and on clinician knowledge of patient preferences for life sustaining therapies. The results of this pilot study will inform a future randomized clinical trial to test te efficacy of the intervention on a larger scale.
The aims of this project are to assess the feasibilty of recruiting patients and delivering a nurse-led telephone based palliative care intervention for patients with newly diagnosed lung cancer and to assess if among patients with newly diagnosed lung cancer, we can estimate the effect of a nurse-led telephone based palliative care intervention on quality-of-life, symptom burden and patient satisfaction. Patients meeting entry criteria will be randomized to the intervention arm, palliative care plus usual care or the usual care arm. Patients randomized to the intervention arm will receive usual oncologic care and phone calls from a nurse. Outcomes measures will be collected at baseline, and 3 months. The study will be performed at the VA Puget Sound Health Care System. We will recruit individuals (n=40) with lung cancer over 1 year. The primary objective is to test the feasibility and acceptability of the intervention, and recruitment of subjects. We will estimate the effect of nurse-led telephone based palliative care intervention to improve quality-of-life, symptom burden and patient satisfaction.
My research focus is on improving the delivery of end-of-life care for patients with advanced, life-limiting illnesses, in particular among patients with lung cancer and COPD. I specifically have an interest in clinicians'communication skills and symptom management. I have significant experience recruiting patients for clinical trials and observational studies of patients with lung cancer and COPD. I recently completed a NRI funded pilot study assessing the palliative care needs of Veterans newly diagnosed with lung cancer. As part of this study we examined the VAs capacity to meet the needs of these patients. The result of the pilot study serves as the key motivator for this proposal, as this work identified several unmet physical and psychosocial needs of Veterans newly diagnosed with lung cancer. These findings support the need for integrating outpatient palliative care services into routine care for Veterans.