Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer

医学 缓和医疗 生活质量(医疗保健) 专业 随机对照试验 肺癌 物理疗法 家庭医学 远程医疗 医疗保健 远程医疗 护理部 内科学 经济增长 经济
作者
Joseph A. Greer,Jennifer S. Temel,Areej El‐Jawahri,Simone Rinaldi,Mihir Kamdar,Elyse R. Park,Nora Horick,Kedie Pintro,Dustin J. Rabideau,Lee H. Schwamm,Josephine Feliciano,Isaac S. Chua,Konstantinos Leventakos,Stacy M. Fischer,Toby C. Campbell,Michael W. Rabow,Finly Zachariah,Laura C. Hanson,Sara Martin,Maria J. Silveira,Laura Shoemaker,Marie Bakitas,Jessica R. Bauman,Lori Spoozak,Carl Grey,Leslie Blackhall,Kimberly Curseen,Sean O’Mahony,Melanie Smith,Ramona L. Rhodes,Amelia Cullinan,Vicki A. Jackson,Chardria Trotter,Emily Gallagher Medeiros,Brooke A. Calton,Heather A. Carlson,Leslie Cartagena,Michelle S. Diop,Theresa Evans,James G. Jackson,Karen O’Brien,Laura A. Petrillo,Jennifer S. Shin,Ilene Browner,Nathaniel Gray,Mark Awad,James A. Tulsky,Kelly J. Christensen,Laura S. Rhee,Jacob J. Strand,Devin Gilhuly,Nicole Rondinelli,J. Anthony Seibert,Jonathan Treem,Kate Schueller,Gregory Allen,Collin M. Blakely,Matthew A. Gubens,Paul Lindenfeld,Claire M. Mulvey,Natalie Young,William Dale,Joanna Luna,Eric Mecusker,Jeanine Moreno,Carey Ramirez,Sari Williams,Seán Gaffney,Cynthia S. Kelly,Kyle Lavin,Wade T. Iams,Samuel G. Robbins,Greg Kalemkerian,Ruth Lagman,Kyle Neale,Chirag Patel,Renato V. Samala,Elizabeth Weinstein,Susan McCammon,Richard E. Taylor,Rodney Tucker,Marcin Chwistek,Molly Collins,Martin J. Edelman,Julia Judd,Leigh Kinczewski,Kathleen Murphy,Dylan Sherry,Marie Welsh,Christian T. Sinclair,Elizabeth Wulff‐Burchfield,Jennifer Gabbard,Tiffany M. Statler,N. Timmins,Dio Kavalieratos,Jane Lowers,Tammie E. Quest,Elaine Chen,Giulia LaBellarte,Nisha Mohinda,Natalie K. Munger,Michelle Munroe,Jyoti D. Patel,Eytan Szmuilowicz,Julia H. Vermylen,Caitlin Holt Siropaides,Christopher G. Ahern,Emily G. Kobin,Maxwell T. Vergo,Matthew Wilson
出处
期刊:JAMA [American Medical Association]
被引量:9
标识
DOI:10.1001/jama.2024.13964
摘要

Importance Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care. Objective To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non–small cell lung cancer (NSCLC). Design, Setting, and Participants Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers. Intervention Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits. Main Outcomes and Measures Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48. Results By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P < .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions. Conclusions and Relevance The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery. Trial Registration ClinicalTrials.gov Identifier: NCT03375489
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