Neoplasms
Conditions
Keywords
Community health services, Models, organizational, Referral and consultation, Palliative medicine, Terminal care
Brief summary
The overall aim of this project is to deliver better health care services through improved coordination of cancer care within specialist care (at the local hospital Orkdal Hospital) and community care (13 municipalities in the Orkdal region, Norway), and between these two levels in the health care system. The Orkdal model is developed and will be implemented and evaluated within cancer care. Cancer patients living in one of the 12 municipalities participating in the formal collaboration Samhandlingsenheten i Orkdalsregionen (SIO), or the municipality of Oppdal, having metastatic and/or loco-regional disease will be included in the study. Carers and health care providers will be included as well. Results from this project will be transferable to other parts of Norway and/or to other countries as well as to patients with other diagnoses causing complex conditions, such as chronic heart-, lung- and neurological disease.
Detailed description
This study will be a prospective controlled observational pre-post study. The intervention consists of three parts: a standardised care pathway, an educational programme and information to general public, patients and their carers. Data from patients, carers and health care providers (physicians, nurses and nurse assistants) will be collected before the model is implemented (pre-intervention part) and after final implementation (post-intervention part). In addition, a comparison with a similar patient population, carers and health care providers will be conducted. A local hospital in the county of Romsdal and community care in the same region will be used as control. Added January 2020: The study was in 2018 extended to also evaluate the effect of implementing advance care planning in the county of Møre and Romsdal. Møre and Romsdal started implementation of advance care planning in January 2018. The evaluation of advance care planning in Møre and Romsdal has the same endpoints as the evaluation of the Orkdal model trial. Added December 17th, 2021: Inclusion of participants (patients, carers and healthcare professionals) is from Sept 2018 to March 2021. Follow-up ends in Sept. 2022.
Interventions
OTHERintegrated palliative care program
a standardised care pathway, an educational programme and information to general public, patients and their carers
Sponsors
The Coordination Unit in the Orkdal region (SIO)
Helse Møre og Romsdal HF
Norwegian University of Science and Technology
St. Olavs Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
(Patients): * Advanced loco-regional disease and/or metastatic cancer disease * For the intervention group in the Orkdal region: Inhabitant of one of the following thirteen districts: Surnadal, Halsa, Rindal, Hemne, Orkdal, Frøya, Hitra, Snillfjord, Agdenes, Meldal, Rennebu, Skaun, and Oppdal * For the intervention group in the Romsdal region: Inhabitiant of one of the following nine districts: Aukra, Molde, Eide, Vestnes, Sunndal, Fræna, Midsund, Nesset, Rauma * Acceptance of participation, based on information about the study and that participation is voluntary. Documented by a signed consent form. * Able to comply with the study procedures * Able to read and write Norwegian Inclusion criteria (Carers) (a carer a person identified as such by the patient) * the patient is eligible for the study * the patient has given his or her consent to allow the study nurse to approach the carer to participate in the study * the patient has identified the carer to be approached * acceptance of participation, based on information about the study and that participation is voluntary. Documented by a signed consent form. Inclusion Criteria (Health care providers) * has accepted to participate in the study * Acceptance of participation, based on information about the study and that participation is voluntary. Documented by an electronically signed consent form.
Exclusion criteria
(Patients): * Receiving anti-cancer treatment with curative intent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| carers' health related quality of life (HRQOL) 6 months after patient's death | 3 years | as measured by the total score of the RAND-Short Form-36 |
| proportion of patient's time spent at home the last 3 months of life | 3 years | time in days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of home deaths | 3 years | — |
| Use of tumor directed treatment the last 3 months of life | 3 years | radiotherapy and chemotherapy |
| change over time in health care providers' knowledge and skills | 3 years | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Patient reported health-related quality of life | 3 years | measured by the total score of the European Organisation for the Research and Treatment of Cancer Core Quality of Life Questionnaire EORTC QLQ C15 |
| distribution of health care services usage | 3 yeart | between specialist and community care |
| place of death | 3 years | if place of death is in accordance with patients' wish as reported at inclusion |
| total cost per patient | 3 years | — |
| share of specialist and community care costs | 3 years | — |
Countries
Norway
Outcome results
None listed