Effectiveness of the Supportive and Palliative Care Review Kit (SPARK) for Cancer Patients in the Acute Hospital
Condition: Health Services Research
Study type: Interventional

Summary: 
      Introduction

      There is a rising need for palliative care services in Singapore due to a rapidly ageing
      population and an increasing incidence of cancer. Current existing resources are inadequate -
      novel models of care are needed to expand access to palliative care without requiring
      significantly more specialist palliative care manpower.

      Oncologist-driven referrals to a palliative care consultation service is the norm worldwide,
      including Singapore. This results in variable access to palliative care due to differences in
      referral practices. Palliative care involvement is also often delayed. In this study, the
      investigators propose to test Supportive and Palliative care Review Kit (SPARK) - a novel
      integrated model of care in which the palliative care team co-rounds with the medical
      oncology team.

      Specific Aims and Hypothesis

      This study aims to evaluate the impact of SPARK compared to usual care. The study
      investigators hypothesize that SPARK will result in more advanced cancer patients having
      access to palliative care, and at the same time operate at lower net cost. The study
      investigators also hypothesize that the improved efficiency of SPARK will result in shorter
      hospital length of stay for stage 4 cancer patients.

      Methods

      A cluster randomized trial with step wedged design will be used to compare SPARK to usual
      care. Data will be collected on health services utilization and access to palliative care
      services. Net costs will also be compared between SPARK and usual care. Semi-structured
      interviews with patients and healthcare professionals will be used to explore differences in
      experiences of healthcare provision between both models of care.

      Importance

      Singapore has a rising prevalence of cancer patients who require palliative care input, but
      only a minority are able to access it at present. If the SPARK model of care proves to be a
      scalable and cost-effective way of expanding access to palliative care, more cancer patients
      can benefit from palliative care.
    


Intervention name(s): SPARK intervention
Intervention type(s): Other
Intervention description(s): An integrated model of care (SPARK care) in which the palliative care team co-rounds with the medical oncology team, supporting them in their delivery of basic palliative care, seamlessly stepping in and out to deliver specialist palliative care directly to patients when needed.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: A stepped-wedge design will be used for this study, unblinded due to practical challenges of blinding. There will be 4 teams (clusters) within the DMO inpatient service, each comprising a team of senior consultant physicians, middle level and junior doctors, and oncology nurses. This follows current team structures. During the intervention period, a palliative care physician and nurse will join the team as integrated members.
The study will be conducted over 20 months from November 2017 to June 2019, with each cluster crossing over from 'usual care' to 'spark intervention' at 4-month intervals. Each cluster will be randomly assigned a specific timing of crossing over.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Palliative care; Consultation model