A Shared Care Approach for Seriously Ill Cancer Patients Between General Practice, Discharge Department and a Specialist Palliative Care Team

NCT ID: NCT00594971

Last Updated: 2011-01-11

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: NA
• Total Enrollment: 270 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2008-04-30
• Study Completion Date: 2010-11-30

Brief Summary

Background:

Approximately one third of all deaths in Denmark are caused by cancer. Both Danish and international research shows that the majority of terminally ill cancer patients wish to die at home. In Denmark only about 25% has this wish fulfilled. The General Practitioner (GP) has traditionally had the full responsibility for the palliative care of terminally ill cancer patients. In recent years changes have been made to the organisation of palliative care: some hospitals have set up specialised palliative care teams and in some areas of Denmark hospices have been established.

Recent research defines a problem when it comes to communication between the hospital and general practice when the patient is being discharged. This is often done in a way that can cause the patient to feel "left in limbo", especially if it is not completely clear to the patient and his or her relatives who has the responsibility for the palliative care.

Objective:

1. To describe consequences for patients, relatives and health care professionals of three different ways of organising palliative care

2. To collect data which describes patients who are candidates to a shared care approach between general practice and a specialised palliative care team

3. To collect data which describes the palliative phase (place of death and palliative care, admissions to hospital, involvement of GP and district nurse etc.)

4. To describe terminally ill cancer patients and their relatives expectations of the health care system

270 terminally ill cancer patients will be invited to take part in the study. Data will be collected by interview with patients and questionnaires for patients, relatives and involved health care professionals.

Detailed Description

The intervention in the study is of organisational character. The patients will be randomised into two groups (groups B and C). A group of usual care patients will be included primary to the intervention (group A). The groups are:

A. Usual discharge with regular discharge letter to the GP. The GP, together with the community nurse, is responsible for the palliative care, including referral to a specialist palliative care team, hospice, hospital, etc., if necessary

B. Discharge with referral to a specialist palliative care team. This is a patient-centred shared care model in which the palliative team helps to organise the patient's treatment and care

C. Discharge with extra effort put into improving the communication between the hospital and the GP. The GP will receive a phone call from the doctor who is discharging the patient, a detailed discharge letter, written information about the patient's type of cancer and acute oncological symptoms, name and phone number of the community nurse and name and phone number of a specialist in palliative medicine, who can be contacted for advice. This is a shared care model, where focus is on supporting the health care professionals.

Conditions

Palliative Care; Neoplasms

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: FACTORIAL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

B

90 terminally ill cancer patients will be referred to a specialist palliative care team at time of discharge.

Group Type: OTHER

Referral to a specialist palliative care team.

Intervention Type: OTHER

Discharge with referral to a specialist palliative care team. This is a patient-centred shared care model in which the palliative team helps to organise the patient's treatment and care.

C

90 terminally ill cancer patients will be discharged from hospital with extra effort put into improving the communication between the hospital and the primary sector.

Group Type: OTHER

Organisational intervention

Intervention Type: OTHER

A shared care approach in which extra effort is put into improving the communication between the hospital and the primary sector.

A

90 terminally ill cancer patients will be discharged from hospital, receiving usual care.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Organisational intervention

A shared care approach in which extra effort is put into improving the communication between the hospital and the primary sector.

Intervention Type: OTHER

Referral to a specialist palliative care team.

Discharge with referral to a specialist palliative care team. This is a patient-centred shared care model in which the palliative team helps to organise the patient's treatment and care.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

In order to be included the patients have to be diagnosed as suffering from terminal cancer. The patients should also:

1. Be 18 years or older

2. Be able to speak and write Danish fluently

3. Give written and spoken consent

4. Be able to manage in their own home, with or without the help of carers and district nurses

5. Be informed about the diagnosis, also that it is incurable

6. Be registered as suffering from a terminal illness or fulfil the criteria for this -

Exclusion Criteria

Patients are excluded if they:

1. Have a low level of cognitive skills, which makes it difficult for them to fill in a questionnaire

2. Are residents of a nursing home at the time of inclusion

3. Are receiving oncologic treatment which requires attending an out-patients clinic regularly

4. Already have established contact with a specialist palliative care team at the time of inclusion -

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Research Unit for General Practice, Aarhus University

OTHER

Sponsor Role: collaborator

Aarhus University Hospital

OTHER

Sponsor Role: collaborator

University of Aarhus

OTHER

Sponsor Role: lead

Responsible Party

Research Unit for General Practice, Aarhus University

Principal Investigators

Frede Olesen, Professor

Role: STUDY_DIRECTOR

Research Unit for General Practice, Aarhus University

Other Identifiers

ISRCTN15273887

Identifier Type: -

Identifier Source: secondary_id

15273887

Identifier Type: -

Identifier Source: org_study_id