Clinical trial NCT03330509: Effectiveness of the Supportive and Palliative Care Review Kit (SPARK) for Cancer Patients in the Acute Hospital
Official title: Effectiveness of the Supportive and Palliative Care Review Kit (SPARK) for Cancer Patients in the Acute Hospital
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Health Services Research
Keywords: Palliative care
Consultation model
Lead sponsor: National Cancer Centre, Singapore
Sponsor class: OTHER
Collaborators: name: Singapore General Hospital
name: Duke-NUS Graduate Medical School
First posted: 2017-11-06
Enrollment: 7514
Sex: ALL
Minimum age (years): 21
Maximum age (years): 110
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
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.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief 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.


Eligibility criteria: Inclusion Criteria:

* All patients admitted under the care of the medical oncology team in Singapore General Hospital will be included.

Exclusion Criteria:

* Patients below 21 years old.

Primary outcomes:
measure: Hospital length of stay
timeFrame: 6 months
Secondary outcomes:
measure: Number of days from hospital discharge to hospital readmission
timeFrame: 30 days
measure: Referral to palliative care services
timeFrame: 6 months
Other outcomes:
Locations:
city: Singapore
country: Singapore
facility: National Cancer Centre Singapore
Study officials:
References:
citation: Nickolich MS, El-Jawahri A, Temel JS, LeBlanc TW. Discussing the Evidence for Upstream Palliative Care in Improving Outcomes in Advanced Cancer. Am Soc Clin Oncol Educ Book. 2016;35:e534-8. doi: 10.1200/EDBK_159224.
citation: Hui D, Bruera E. Models of integration of oncology and palliative care. Ann Palliat Med. 2015 Jul;4(3):89-98. doi: 10.3978/j.issn.2224-5820.2015.04.01.
citation: Yang GM, Zhou S, Xu Z, Goh SS, Zhu X, Chong DQ, Tan DS, Kanesvaran R, Yee AC, Neo PS, Cheung YB. Comparing the effect of a consult model versus an integrated palliative care and medical oncology co-rounding model on health care utilization in an acute hospital - an open-label stepped-wedge cluster-randomized trial. Palliat Med. 2021 Sep;35(8):1578-1589. doi: 10.1177/02692163211022957.