INSTANT
Research type
Research Study
Full title
Improving access to enhanced supportive care (ESC) and acute oncology (INSTANT)
IRAS ID
253131
Contact name
Gillian Heap
Contact email
Sponsor organisation
The Christie NHS Foundation Trust
Duration of Study in the UK
2 years, 0 months, 0 days
Research summary
Research Summary
Many patients with advanced cancer access palliative care too late in the treatment trajectory or not offered any palliative care support. Despite the evidence demonstrating that early access to palliative care services can improve symptoms, reduce acute hospital admissions, and enable patients to make choices about their end of life care. In response The Christie has established an Enhanced Supportive Care (ESC) team. The service provided by the ESC clinic has not been subjected to rigorous evaluation, using prospective data collection methods with validated patient-centred and economic outcome measures.
Objectives:
1. To explore the patients 'and caregivers experience of the ESC clinic and the care received and the fulfilment of patients’ needs
2. To evaluate the impact of ESC clinic on patients outcomes (such as Health Related Quality Of Life (HRQOL), symptoms, emotional wellbeing and confidence of managing their condition)
3. To examine the relationship between ESC attendance and other aspects of the patients care (for example the frequency/number of unplanned hospital visits and emergency admissions, length of hospital stay and survival data)To address objective 1-3 patients who are over 18 and have been referred to the ESC clinic and their caregivers will be recruited from clinic. Participants will be asked to complete a baseline questionnaire prior to attending the clinic and complete follow-up at 4 and 12 weeks after initial consultation. 30-40 participants will be randomly selected and invited to take part in an interview.
To address objective 4 this will be obtained from clinical records of patients consent to this.
Summary of Results
The aim of the study was to explore the impact of the Enhanced Supportive Care (ESC) service at a specialist cancer centre on patient and caregiver outcomes and experience. Patients who received care under the ESC service completed questionnaires at the time of their first consultation, and at 4 and 8 weeks. The questionnaires explored patients quality of life (QOL), symptoms, experience of ESC and service use. A sample of patients were also interviewed to explore their experiences in more detail. Caregivers completed QOL and needs assessment at the same time points. The results for patients showed some improvements in QOL and anxiety, reduction in some symptoms, improvement in some areas of control, self-management and coping, an increase in problems being addressed and some improvements in hospital usage. Patients were generally satisfied with the ESC service but suggested areas for improvement. Fewer improvements were noted for caregivers however they did report a decrease in unmet needs.
Overall, the ESC service had positive impacts on various patient and caregiver reported outcomes. There were also positive impacts in service use. Increasing awareness of ESC with a view to engaging patients at an earlier stage may further improve satisfaction and patient outcomes.REC name
North West - Preston Research Ethics Committee
REC reference
19/NW/0122
Date of REC Opinion
15 Apr 2019
REC opinion
Further Information Favourable Opinion