Care Plus Study: A multi-site implementation of early palliative care in routine practice to improve health outcomes and reduce hospital admissions for people with advanced cancer.

Intervention: Usual oncology care + Care Plus. Care Plus involves standardised early palliative care introduced at key transition points in the cancer illness trajectory. The Care Plus palliative care consultation involves a discussion with patients and their caregiver about their individual needs, including assessment of physical, psychological, social and practical needs. The approximate duration of each consultation is between 30 minutes and 1 hour. The introduction of Care Plus will be developed, implemented and evaluated in three tertiary cancer treatment centres in the following order: (1) St Vincent's Hospital Melbourne, (2) Peter MacCallum Centre and (3) Lyell McEwin Hospital. This design stipulates 'control' periods when usual oncological care is observed, and the process of implementing Care Plus itself which includes phases of planning, engagement, intervention (practice change) and evaluation. This study will target five types of advanced cancers across the three participating sites. The study population consists of adults with one of the five targeted advanced cancers who present to the three participating sites at the time or within 6 weeks of reaching a cancer-specific 'transition point' (e.g. multiday admission with metastatic disease). The five cancer types and definition of their corresponding transition points will be nominated, and defined by key clinicians at each site. During the implementation of Care Plus (intervention arm), ALL patients with targeted advanced cancers reaching transition point will continue to receive usual oncological care + Care Plus. Care Plus involves palliative care consultation within 6 weeks of the transition point, with follow-up occurring at a minimum monthly for 3 months +/- an additional 3 month bolster as needed (determined by the treating palliative care specialist in consultation with patient and their caregiver). Care Plus is delivered by specialist palliative care consultants, or certified nurse practitioners/clinical nurse specialists. The care provided will be personalized based upon patient and caregiver need, including review of symptoms, psychological distress, additional community supports required, informational needs, illness understanding, discussion of prognosis, preferences for care, advance care planning, GP case conference. Care Plus is provided face-to-face upfront, with follow-up face-to-face or by telephone as needed. Caregivers are invited to participate in consultations. All Care Plus consultations will be recorded using the domains of PC-NAT for auditing, and cross-checked against a medical record audit of outpatient visits and GP case conferences.