The PACES Study: A controlled before and after pragmatic trial of a cancer clinic–based intervention to increase early referral to specialist palliative care.
Notice bibliographique
Résumé
6501 Background: Early referral to specialist palliative care (SPC) can improve symptom and quality of life outcomes that matter most to cancer patients during the late stage of their illness. We tested a multifaceted oncologist-facing intervention (Palliative Care Early and Systematic) in the real-world setting of a busy cancer clinic for its ability to increase the proportion of patients who receive early SPC (defined as SPC ≥90 days before death). Methods: This is a pragmatic controlled before-and-after study performed in 18 outpatient cancer clinics in two tertiary cancer centers in neighboring metropolitan cities. The control city was chosen to match as closely as possible the intervention city for population size, characteristics, and health services availability. Adults deceased from colorectal cancer (CRC) between April 2017 to December 2020 residing in either the intervention or control city. Decedents who did not visit an oncologist in the year prior to death were excluded as they were unlikely to have received the intervention. Patients who died ≤120 days after diagnosis with CRC were excluded as providers would have had insufficient time to implement the intervention. In the baseline phase (April 2017 to December 2018) patients received usual care. In the intervention phase (April 2019 to December 2020), new clinical practice guidelines and resources were implemented to increase early SPC referrals by oncologists. These changes included: a) systematically screening patients attending treatment clinics for unmet PC needs and alerting the primary oncologist, b) addition of a community-based palliative clinical nurse specialist to handle increased referrals and enhance communication and co-management of patient needs among providers, and c) implementation of templated ‘shared care’ letters (all providers and patient) to improve awareness of patients’ needs. The primary outcome was the proportion of CRC decedents who received early SPC. Results: 695 decedents were included: 341 in the baseline phase (153 control, 188 intervention) and 354 in the intervention phase (145 control, 209 intervention). From baseline to intervention, in the intervention arm, the proportion of decedents who received early SPC increased from 45% to 57%; in the control arm the proportion decreased from 48% to 44% (17% difference in differences; 95%CI -2% to 32%; P=0.03). Conclusions: A multifaceted intervention aimed at increasing oncologists’ awareness of their patients’ appropriateness for early SPC increased by 17% the proportion of patients receiving early SPC as compared to controls. Additional research is needed to determine if in a real-world clinical setting further increasing the proportion of patients receiving early PC beyond 57% is feasible, and to understand the role of screening and alerting for oncologists.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,003 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,004 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».