An early palliative care pathway may lead to improvements in care for patients with advanced colorectal cancer, as well as help patients and their family caregivers better understand the role of palliative care. These study results were published in the Canadian Journal of Nursing Research.
“Patients with advanced colorectal cancer specifically experience high symptom burden such as pain, and other challenges such as obstruction and nutrition,” the study investigators explained. Early palliative care involvement has been linked to multiple benefits for patients with advanced cancers.
This patient-oriented study examined the implementation of the Palliative Care Early and Systematic (PaCES) program in Alberta, Canada. The PaCES program was implemented in January 2019 to provide or enhance certain early palliative care services for patients with advanced colorectal cancer at 3 or more months prior to death. The study was a qualitative analysis based on semi-structured telephone interviews with patients with advanced colorectal cancer and caregivers.
The study included 7 patients and 5 family caregivers who were treated and/or received support after implementation of the early palliative care pathway; a second cohort comprised 15 patients and 7 family caregivers who were treated and/or received support prior to the care pathway implementation. Although the focus was on the responses of participants in the “after-implementation” cohort, the “prior-to-implementation” cohort was interviewed for comparison.
Themes identified as important aspects of early palliative care included care coordination, coping with advanced cancer, engagement of patient and family, and perception of palliative care and advanced care planning.
In terms of their perceptions of palliative care, some participants in the prior-to-implementation cohort seemed to be confused about palliative care and associated it with life and death. In the after-implementation cohort, most of the participants considered it to be supportive and perceived it as encompassing quality of life.
Care coordination and communication with health care providers also appeared to be poor for some participants in the prior-to-implementation cohort. However, in the after-implementation cohort, care coordination was reported to be better. Among patients in this cohort was a perception that involvement of multiple members of the care team enabled participants to feel supported. Similar sentiments were expressed regarding involvement of the family physician.
Advance care planning reportedly was not discussed among most participants in the prior-to-implementation cohort. However, most participants in the after-implementation cohort reported having discussed advance care planning, with the palliative care nurse playing a key role in these discussions.
“Early palliative care delivered by a specialist palliative care nurse may improve advanced cancer care, including an improved understanding and acceptance of early palliative care,” the study investigators concluded.
Ahmed S, Naqvi SF, Sinnarajah A, McGhan G, Simon J, Santana MJ. Patient & caregiver experiences: qualitative study comparison before and after implementation of early palliative care for advanced colorectal cancer. Can J Nurs Res. Published online March 7, 2022. doi:10.1177/08445621221079534