Does educating patients about the Early Palliative Care Study increase preferences for outpatient palliative cancer care? Findings from Project EMPOWER.

Abstract

Objectives Randomized controlled trials, especially the Early Palliative Care Study (Temel et al., 2010), have shown that early outpatient palliative cancer care can improve quality of life for patients with advanced cancer or serious symptoms. However, fear and misconceptions drive avoidance of palliative care. Drawing from an empowerment perspective, we examined whether educating patients about evidence from the Early Palliative Care Study would increase preferences for palliative care. Methods A sample of 598 patients with prostate, breast, lung, colon/rectal, skin, and other cancer diagnoses completed an Internet-mediated experiment using a between-group pre-post design. Intervention participants received a summary of the Early Palliative Care Study; controls received no intervention. Participants completed baseline and post-test assessments of preferences of palliative care. Analyses controlled for age, gender, education, cancer type, presence of metastases, time since diagnosis, and baseline preferences. Results As hypothesized, the intervention had a favorable impact on participants’ preferences for outpatient palliative cancer care relative to controls (d=1.01, p<.001), while controlling for covariates. Intervention participants came to view palliative care as more efficacious (d=0.79, p<.001) and less scary (d=0.60, p<.001) and exhibited stronger behavioral intentions to utilize outpatient palliative care if referred (d=0.60, p<.001). Findings were comparable in patients with metastatic disease, those with less education, and those experiencing financial strain. Conclusions Educating patients about the Early Palliative Care Study increases preferences for early outpatient palliative care. This research has implications for future studies aimed at improving quality of life in cancer by increasing palliative care utilization.

Preference for Palliative Care in Cancer Patients: Are Men and Women Alike?

“…Using a different cut off to define low education (bachelors or higher), Hoerger et al reported no relationship between educational attainment and PC preference. 11 Like our cohort, theirs included a relatively small number of participants with low educational attainment. Future research on more educationally diverse samples is needed to further examine the relationship between educational attainment and attitudes toward PC.…”

“…10 Women with cancer are more likely to have do-not-resuscitate orders 4 and more likely to prefer PC. 11 Similarly, educational attainment is another important determinant of EOL attitudes and health behaviors. 12 Patients with fewer years of education are more likely to believe that their incurable cancer can be cured 13 and are more likely to receive ineffective, burdensome treatments at the EOL.…”

Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials

“…In fact, when patients, families, and clinicians discuss referrals to specialty palliative care, the elephant in the room is a collective fear that there could be tradeoffs between length and quality of life [17]. Patients, families, and clinicians often view palliative care as synonymous with, if not fostering, death, characterizing it variously as the grim reaper service [18,19], giving up [20,21], abandonment [22,23], death row [24], and a death panel [25,26].…”

Early Integrated Palliative Care and Reduced Emotional Distress in Cancer Caregivers: Reaching the “Hidden Patients”

“…This study highlights the need for oncology clinicians to discuss the medical evidence for palliative care with patients, caregivers, and colleagues. Although most of the general public does not know what palliative care is, they fear it . In a prior randomized study, explaining the medical evidence of early integrated palliative care led 75% of patients with cancer to experience more favorable attitudes toward palliative care .…”

“…Although most of the general public does not know what palliative care is, they fear it . In a prior randomized study, explaining the medical evidence of early integrated palliative care led 75% of patients with cancer to experience more favorable attitudes toward palliative care . Patients and caregivers who are reluctant to accept palliative care referrals may be encouraged to know that palliative care visits may benefit both parties; indeed, what people are scared to try themselves they are often willing to do for the benefit of a loved one .…”