In a study reported in JCO Oncology Practice, Sigler et al found that an oncology nurse–led primary palliative care intervention known as CONNECT did not increase realistic illness expectations among patients with advanced cancer.
Study Details
The study involved adults with advanced solid tumors who oncologists felt were likely to die within 1 year, recruited from 17 medical oncology clinics within the UPMC Hillman Cancer Center Network from July 2016 through October 2019. Patients were randomly assigned to the intervention group or standard oncology care.
The intervention included monthly visits designed to promote realistic illness expectations by eliciting and addressing patient concerns and goals for their medical care, as well as empowering patients and families to engage in discussions with oncologists about treatment options and preferences. Questionnaires at baseline and 3 months included questions about life expectancy, treatment intent, and terminal illness acknowledgment. Analysis of realistic illness expectations at 3 months was adjusted for baseline responses, patient demographic and clinical characteristics, and intervention dose (number of visits in intervention group).
Illness expectations are difficult to change among patients with advanced cancer. Additional work is needed to identify approaches within oncology practices that foster realistic illness expectations to improve patient decision-making.— Sigler et al
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Key Findings
A total of 457 patients (94.5% White) completed both questionnaires, including 211 in the intervention group and 246 in the standard-care group.
At 3 months, there were no significant differences between the intervention and standard-care groups with regard to realistic expectations for life expectancy (12.8% vs 11.4% acknowledged life expectancy of months, adjusted odds ratio [OR] = 1.15, 95% confidence interval [CI] = 0.59–2.22, P = .684); treatment intent (24.6% vs 33.3% answered “no” to treatment intent to get rid of cancer, adjusted OR = 0.76, 95% CI = 0.44–1.27, P = .290); or terminal illness acknowledgment (53.6% vs 44.7%, adjusted OR = 1.28, 95% CI = 0.81–2.00, P = .288).
Adjusted odds ratios did not differ markedly in analyses adjusting for variation in clinic sites (1.18, P = .67 for life expectancy; 0.68, P = .07 for treatment intent; and 1.39, P = .13 for terminal illness acknowledgment) or intervention dose (1.06, P = .89 for life expectancy; 0.62, P = .12 for treatment intent; and 1.00, P = .99 for terminal illness acknowledgment).
The investigators concluded, “Illness expectations are difficult to change among patients with advanced cancer. Additional work is needed to identify approaches within oncology practices that foster realistic illness expectations to improve patient decision-making.”
Lauren E. Sigler, MD, of the Emory Palliative Care Center, Emory University School of Medicine, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported by the National Cancer Institute and Palliative Research Center at the University of Pittsburgh. For full disclosures of the study authors, visit ascopubs.org.
