Engagement, Advance Care Planning, and Hospice Use in a Telephonic Nurse-Led Palliative Care Program for Persons Living with Advanced Cancer

SIMPLE SUMMARY: Persons living with advanced cancer have significant symptoms and psychosocial needs that often result in visits to the Emergency Department. We enrolled persons living with advanced cancer in a 6-month program to receive telephone calls from nurses to help manage their symptoms, coordinate care, and explore their values and goals for future care (advance care planning). About half of the subjects completed the 6-month program, a quarter died or enrolled in hospice, 19% were lost to follow-up, and 9% withdrew from the program. White patients and those with fewer symptoms were more likely to withdraw. Eighty-three percent of all patients completed some advance care planning, and 80% of patients received hospice care prior to death. ABSTRACT: Persons living with advanced cancer have intensive symptoms and psychosocial needs that often result in visits to the Emergency Department (ED). We report on program engagement, advance care planning (ACP), and hospice use for a 6-month longitudinal nurse-led, telephonic palliative care intervention for patients with advanced cancer as part of a larger randomized trial. Patients 50 years and older with metastatic solid tumors were recruited from 18 EDs and randomized to receive nursing calls focused on ACP, symptom management, and care coordination or specialty outpatient palliative care (ClinicialTrials.gov: NCT03325985). One hundred and five (50%) graduated from the 6-month program, 54 (26%) died or enrolled in hospice, 40 (19%) were lost to follow-up, and 19 (9%) withdrew prior to program completion. In a Cox proportional hazard regression, withdrawn subjects were more likely to be white and have a low symptom burden compared to those who did not withdraw. Two hundred eighteen persons living with advanced cancer were enrolled in the nursing arm, and 182 of those (83%) completed some ACP. Of the subjects who died, 43/54 (80%) enrolled in hospice. Our program demonstrated high rates of engagement, ACP, and hospice enrollment. Enrolling subjects with a high symptom burden may result in even greater program engagement.