Neoplasms, Palliative Care
Conditions
Keywords
SPARKLE-2
Brief summary
Advanced cancer patients often experience significant physical and emotional symptoms, which can lead to frequent hospital visits and reduced quality of life. Although palliative care can help manage these symptoms and improve well-being, it is often introduced too late. A proactive symptom monitoring model, SPARKLE-2 aims to identify patients who need palliative care earlier by regularly checking their symptoms using a simple questionnaire. Patients with concerned symptoms will receive timely support from the palliative care team, with the goal of improving their quality of life, reducing unnecessary hospital admissions, and helping more patients receive care in the community rather than in hospital. In the earlier SPARKLE-1 study, it showed the improvement of patients' physical wellbeing. SPARKLE-2 seeks to test the effectiveness among advanced cancer patients with unplanned hospital visits while simultaneously collecting data on real-world implementation.
Detailed description
To evaluate the effectiveness of SPARKLE-2, we will conduct randomized controlled trial comparing clinical outcomes at 3 months between patients receiving usual care and intervention. For longer-term impact of palliative care, we will also measure patient outcomes at 6, 9, and 12 months. To evaluate ways to improve implementation, the Consolidated Framework for Implementation Research (CFIR) will be used to systematically identify processes that influence implementation outcomes. The specific aims and hypotheses of this mixed methods study are: 1. Assess the effectiveness of SPARKLE-2 on health-related quality of life and healthcare utilization among patients with advanced cancer. We hypothesize that the SPARKLE-2 group compared to the usual care group participants will have better health-related quality of life, better health status, earlier palliative care utilisation, and less acute healthcare utilisation. 2. Assess implementation processes of SPARKLE-2. We will assess acceptability, appropriateness, and feasibility through a structured survey among healthcare providers. Also, we will assess fidelity through completion rate of IPOS screening questionnaires and compliance with clinical response pathways. Implementation costs will be captured from the healthcare system's perspective prospectively using an activity-based costing approach. 3. Assess contexts and mechanisms that bring about SPARKLE-2 outcomes. We will interview patients, caregivers and healthcare providers who were involved in SPARKLE-2 to explore their perspectives on factors, including facilitators and barriers, that bring about intervention effects.
Interventions
BEHAVIORALSPARKLE-2
Patients will receive a Short Message Service (SMS) text on their phone every 2 weeks, inviting them to complete a self-reported online six-item Integrated Palliative care Outcome Scale (IPOS) questionnaire over a period of 12 months. If a patient records higher scores on any IPOS symptom domains, a programme coordinator will then make a phone call to the patient for further assessment of symptoms and concerns identified. If indicated, the programme coordinator would then initiate management of the symptoms and concerns according to structured clinical management protocols.
Sponsors
National Cancer Centre, Singapore
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to 120 Years
Healthy volunteers
No
Inclusion criteria
* Inclusion criteria for patients: 1. 21 years old or older 2. Diagnosed of advanced cancer diagnosis, defined as metastatic or recurrent/ progressive Stage III/IV solid tumour 3. Has an unplanned hospital admission and expected to be discharged home 4. Able to speak English or Mandarin Chinese or Malay 5. Able to provide informed consent Additional inclusion criteria for patient participants of semi-structured interviews are: 6. Enrolled in the SPARKLE-2 RCT, whether randomized to the SPARKLE intervention or usual care group and regardless of fidelity to trial procedures. * Inclusion criteria for caregivers: 1. 21 years old or older 2. Self-endorsing or identified by an enrolled patient as a spouse/partner, relative or friend who knows them well and who provides support due to their cancer 3. Able to speak English or Mandarin Chinese or Malay 4. Able to provide informed consent * Inclusion criteria for healthcare providers: 1. 21 years old or older 2. Healthcare professional who is involved in the clinical care of patients with advanced cancer for at least 50% of their work hours 3. Able to provide informed consent 4. Involved in the processes of the SPARKLE-2
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quality of life score measured using the Functional Assessment of Chronic Illness Therapy - Palliative (FACIT-Pal) | 12 weeks. | FACIT-Pal is a 46-item measure with a quality-of-life scale (4 domains: physical, emotional, social, and functional well-being) and a palliative care subscale. It has demonstrated internal consistency, reliability and validity for persons with advanced cancer. Quality of life is scored on a scale of 0 to 184, with higher scores indicating better outcomes. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of life score measured using the Functional Assessment of Chronic Illness Therapy - Palliative (FACIT-Pal) | Every 12 weeks from baseline, till the point of patient death, or till week 48, whichever is earlier. | The proposed FACIT-Pal assessment schedule is to evaluate longitudinal changes in quality of life over time. |
| Palliative care concerns measured using the Integrated Palliative Care Outcomes Scale (IPOS) | Every 2 weeks from baseline, till the point of patient death, or till week 48, whichever is earlier. | IPOS is a brief measure of palliative care problems, covering physical and psychological symptoms, social and spiritual issues, communication, information needs, and practical concerns. Each item is rated on a Likert scale of 0 to 4. Higher scores indicate that symptoms and concerns affect the person more. IPOS has been translated to Chinese and validated in Singapore. |
| Health states measured using the EuroQOL Group 5-Dimension Health-related Quality of Life Measurement (EQ-5D-5L) | Baseline, 12 weeks, 18 weeks, 27 weeks, and 48 weeks. | EQ-5D-5L contains a 5-item descriptive system measuring 5 dimensions: mobility, self-care, usual activities, pain/ discomfort, anxiety/ depression; a visual analogue scale measuring overall health status. The tool has been validated in Singapore. |
| Acute healthcare utilization. | Baseline until death or end of the study, up to 48 weeks. | Frequency of Emergency Department (ED) visits. |
| Inpatient healthcare utilization and the intervention's impact on inpatient healthcare utilization. | Baseline until death or end of the study, up to 48 weeks. | Number of hospital admissions. |
| Healthcare expenditure associated with patient care and the economic impact on intervention. | Baseline until death or end of the study, up to 48 weeks. | Total hospital charges. |
Countries
Singapore
Contacts
CONTACTGrace Meijuan YANG, MD, MPH, PhD
CONTACTJess Ng Hiv Choo
STUDY_CHAIRGrace Meijuan YANG, MD, MPH, PhD
National Cancer Centre, Singapore
Outcome results
None listed