Standardised Early Palliative Care For Patients With Aggressive Haematological Malignancies

Education on the rationale for and design of the study will be provided to the haematology department at Austin Health. This will be provided as a single one hour online session delivered by a palliative care physician in which the project rationale, study design and role of palliative care services will be discussed. Session attendance will be recorded. Additional sessions will be provided for those unable to attend this session. Patients who meet the eligibility criteria will receive standardised early palliative care referral. Prior to enrolment patients will be advised of the role of palliative care in helping to control patients physical and emotional symptoms associated with their diagnosis and in helping to provide advice regarding advanced care planning. They will be advised that palliative care physicians and/or nurses will review them at 4 weekly intervals and provide a comprehensive assessment at each time point (Weeks 0,4,8,12). Patients who decline to participate in the study or who are not eligible can continue to access palliative care support. Participants will be asked to provide written informed consent. Patient participants will be asked to nominate a primary caregiver. Patient participants will be reviewed at weeks 0, 4, 8 and 12. Additional reviews will be provided as required outside of these time points based on patient need. Each review will include a review of the patient's current medical conditions, physical symptoms, emotional symptoms and goals of care. Interventions will be implemented to address each of these domains and response to each will be recorded at subsequent reviews. Interventions will depend on patient need and may include medication changes, referral to other services including psychology, spiritual care, community palliative care, physiotherapy, occupational therapy, radiation oncology or interventional radiology. It is anticipated that initial reviews will take 1 hour and subsequent reviews between 30 minutes to 1 hour. The initial review will be face-to-face. Subsequent reviews may be completed face-to-face or via telehealth depending on the patient's condition. All efforts will be made to minimise additional travel for the patient. Patient and primary caregivers will be asked to complete quality of life assessment surveys prior to initial palliative care review (t= 0 weeks) and at weeks 4, 8, 12 and 16. Patient records will be audited to assess baseline demographics, symptoms and interventions to ensure that adequate palliative care reviews are completed. At the end of the mandated study visits patients can either be discharged from the service or continue to be seen based on clinician assessment and patients need. Patients may be referred to external community palliative care services if required. We will analyse health care resource utilisation for enrolled participants at the primary hospital only. These data will be compared to historical matched controlled data. Clinical haematologists will be asked to complete a survey prior to enrolment of the first patient patient participant and following completion of all patient and primary caregiver data collection. These surveys relate to attitudes toward palliative care services and referral practices.