Palliative care is an interdisciplinary model of care with the overarching goal of improving quality of life for patients with serious illness through symptom management, provision of psychosocial support, elicitation of preferences and aiding decision-making. Prior studies have demonstrated that specialist palliative care is associated with decreases in treatment intensity and improvements in quality of life, but have also suggested that existing heterogeneity among palliative care teams may be associated with variability in their effectiveness. Early integration of specialist palliative care for patients with advanced cancer has been recommended by the American Society of Clinical Oncology. However, as hospitals race to implement palliative care programs to meet these guidelines, there is little evidence to guide them as to which ingredients are necessary for effective care delivery. The proposed research will target this important knowledge gap by 1) quantifying the association between use of specialist palliative care and end-of-life quality metrics in cancer care, 2) examining whether differences in specialist palliative care implementation (as measured by key variables reflecting team attributes and operational characteristics) are associated with improvements in quality metrics and 3) using qualitative research methods to understand how programs operationalize care delivery within different hospital settings. This project will create and utilize a novel data source that combines nationwide patient and hospital-level data, detailed data on palliative care programs and valid information on receipt of specialist palliative care. Quantitative analyses of this unique dataset will be followed by in-depth site visits to six select palliative care programs; together, these data will be used to develop an actionable roadmap that may be used to refine existing palliative care programs and inform implementation of future programs to ensure effective delivery of palliative care for patients with cancer. This project represents an important advance in understanding the role of palliative care specialists in cancer care, as prior work has focused on whether specialist palliative care is associated with improved outcomes, while this work will focus identifying the conditions under which specialist palliative care may achieve improved outcomes.
Over 600,000 people die from cancer each year in the United States and many more suffer from other serious illnesses that may benefit from specialist palliative care. By identifying modifiable factors that influence effectiveness of specialist palliative care delivery, this project will directly inform policies for palliative care programs, cancer centers and hospitals to enable and ensure the delivery of effective palliative care for all patients with cancer.
