Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS – a randomized clinical trial

Mie Nordly; Kirstine Skov Benthien; Eva S. Vadstrup; Geana P. Kurita; Annika B. von Heymann-Horan; Hans von der Maase; Christoffer Johansen; Helle Timm; Jakob Kjellberg; Per Sjøgren

doi:10.1177/0269216318811269

Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS – a randomized clinical trial

Mie Nordly^*, Kirstine Skov Benthien, Eva S. Vadstrup, Geana P. Kurita, Annika B. von Heymann-Horan, Hans von der Maase, Christoffer Johansen, Helle Timm, Jakob Kjellberg, Per Sjøgren

^*Corresponding author for this work

Department of Clinical Medicine

9 Citations (Scopus)

Abstract

Background: The focus of specialized palliative care is to improve quality of life for patients with incurable cancer and their relatives including an increased opportunity to make their own choice of place of care and death. Aim: To investigate whether a systematic fast-track transition from oncological treatment to specialized palliative care at home for patients with incurable cancer reinforced with a psychological dyadic intervention could result in more time spent at home and death at home. Secondary aims were to investigate effects on quality of life, symptomatology and survival. Design: A prospective, single-centre, randomized controlled trial (Clinicaltrials.gov: NCT01885637). Setting/participants: In all, 340 patients with incurable cancer and no or limited antineoplastic treatment options. Results: No statistically significant difference was found regarding number of deaths (4%, p = 0.460) and time spent at home (3%, p = 0.491). The secondary outcomes indicated that the intervention resulted in improved quality of life (−11.6 ± 25.5, p = 0.005, effect size = −0.44, 95% confidence interval = −0.77; −0.11), social functioning (−15.8 ± 31.4, p = 0.001, effect size = −0.50, 95% confidence interval = −0.84; −0.17) and emotional functioning (−9.1 ± 21.2, p = 0.039, effect size = −0.43, 95% confidence interval = −0.76; −0.10) after 6 months. A linear mixed-effect regression model confirmed a possible effect on emotional and social functioning at 6 months. Regarding survival, no differences were found between groups (p = 0.605). No adverse effects were seen as consequence of the intervention. Conclusions: The main findings indicated that the intervention had no effect on time spent at home or place of death. However, the intervention resulted in a weak improvement of quality of life, social functioning and emotional functioning after 6 months.

Original language	English
Journal	Palliative Medicine
Volume	33
Issue number	2
Pages (from-to)	135-149
ISSN	0269-2163
DOIs	https://doi.org/10.1177/0269216318811269
Publication status	Published - 2019

Keywords

Cancer
home care services
palliative care
psychological intervention
quality of life
randomized controlled trial

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/0269216318811269

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Nordly, M., Skov Benthien, K., Vadstrup, E. S., Kurita, G. P., von Heymann-Horan, A. B., von der Maase, H., Johansen, C., Timm, H., Kjellberg, J., & Sjøgren, P. (2019). Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS – a randomized clinical trial. Palliative Medicine, 33(2), 135-149. https://doi.org/10.1177/0269216318811269

Nordly, M, Skov Benthien, K, Vadstrup, ES, Kurita, GP, von Heymann-Horan, AB, von der Maase, H, Johansen, C, Timm, H, Kjellberg, J & Sjøgren, P 2019, 'Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS – a randomized clinical trial', Palliative Medicine, vol. 33, no. 2, pp. 135-149. https://doi.org/10.1177/0269216318811269

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title = "Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS – a randomized clinical trial",

abstract = "Background: The focus of specialized palliative care is to improve quality of life for patients with incurable cancer and their relatives including an increased opportunity to make their own choice of place of care and death. Aim: To investigate whether a systematic fast-track transition from oncological treatment to specialized palliative care at home for patients with incurable cancer reinforced with a psychological dyadic intervention could result in more time spent at home and death at home. Secondary aims were to investigate effects on quality of life, symptomatology and survival. Design: A prospective, single-centre, randomized controlled trial (Clinicaltrials.gov: NCT01885637). Setting/participants: In all, 340 patients with incurable cancer and no or limited antineoplastic treatment options. Results: No statistically significant difference was found regarding number of deaths (4%, p = 0.460) and time spent at home (3%, p = 0.491). The secondary outcomes indicated that the intervention resulted in improved quality of life (−11.6 ± 25.5, p = 0.005, effect size = −0.44, 95% confidence interval = −0.77; −0.11), social functioning (−15.8 ± 31.4, p = 0.001, effect size = −0.50, 95% confidence interval = −0.84; −0.17) and emotional functioning (−9.1 ± 21.2, p = 0.039, effect size = −0.43, 95% confidence interval = −0.76; −0.10) after 6 months. A linear mixed-effect regression model confirmed a possible effect on emotional and social functioning at 6 months. Regarding survival, no differences were found between groups (p = 0.605). No adverse effects were seen as consequence of the intervention. Conclusions: The main findings indicated that the intervention had no effect on time spent at home or place of death. However, the intervention resulted in a weak improvement of quality of life, social functioning and emotional functioning after 6 months.",

keywords = "Cancer, home care services, palliative care, psychological intervention, quality of life, randomized controlled trial",

author = "Mie Nordly and {Skov Benthien}, Kirstine and Vadstrup, {Eva S.} and Kurita, {Geana P.} and {von Heymann-Horan}, {Annika B.} and {von der Maase}, Hans and Christoffer Johansen and Helle Timm and Jakob Kjellberg and Per Sj{\o}gren",

year = "2019",

doi = "10.1177/0269216318811269",

language = "English",

volume = "33",

pages = "135--149",

journal = "Palliative Medicine",

issn = "0269-2163",

publisher = "SAGE Publications",

number = "2",

}

TY - JOUR

T1 - Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care

T2 - DOMUS – a randomized clinical trial

AU - Nordly, Mie

AU - Skov Benthien, Kirstine

AU - Vadstrup, Eva S.

AU - Kurita, Geana P.

AU - von Heymann-Horan, Annika B.

AU - von der Maase, Hans

AU - Johansen, Christoffer

AU - Timm, Helle

AU - Kjellberg, Jakob

AU - Sjøgren, Per

PY - 2019

Y1 - 2019

N2 - Background: The focus of specialized palliative care is to improve quality of life for patients with incurable cancer and their relatives including an increased opportunity to make their own choice of place of care and death. Aim: To investigate whether a systematic fast-track transition from oncological treatment to specialized palliative care at home for patients with incurable cancer reinforced with a psychological dyadic intervention could result in more time spent at home and death at home. Secondary aims were to investigate effects on quality of life, symptomatology and survival. Design: A prospective, single-centre, randomized controlled trial (Clinicaltrials.gov: NCT01885637). Setting/participants: In all, 340 patients with incurable cancer and no or limited antineoplastic treatment options. Results: No statistically significant difference was found regarding number of deaths (4%, p = 0.460) and time spent at home (3%, p = 0.491). The secondary outcomes indicated that the intervention resulted in improved quality of life (−11.6 ± 25.5, p = 0.005, effect size = −0.44, 95% confidence interval = −0.77; −0.11), social functioning (−15.8 ± 31.4, p = 0.001, effect size = −0.50, 95% confidence interval = −0.84; −0.17) and emotional functioning (−9.1 ± 21.2, p = 0.039, effect size = −0.43, 95% confidence interval = −0.76; −0.10) after 6 months. A linear mixed-effect regression model confirmed a possible effect on emotional and social functioning at 6 months. Regarding survival, no differences were found between groups (p = 0.605). No adverse effects were seen as consequence of the intervention. Conclusions: The main findings indicated that the intervention had no effect on time spent at home or place of death. However, the intervention resulted in a weak improvement of quality of life, social functioning and emotional functioning after 6 months.

AB - Background: The focus of specialized palliative care is to improve quality of life for patients with incurable cancer and their relatives including an increased opportunity to make their own choice of place of care and death. Aim: To investigate whether a systematic fast-track transition from oncological treatment to specialized palliative care at home for patients with incurable cancer reinforced with a psychological dyadic intervention could result in more time spent at home and death at home. Secondary aims were to investigate effects on quality of life, symptomatology and survival. Design: A prospective, single-centre, randomized controlled trial (Clinicaltrials.gov: NCT01885637). Setting/participants: In all, 340 patients with incurable cancer and no or limited antineoplastic treatment options. Results: No statistically significant difference was found regarding number of deaths (4%, p = 0.460) and time spent at home (3%, p = 0.491). The secondary outcomes indicated that the intervention resulted in improved quality of life (−11.6 ± 25.5, p = 0.005, effect size = −0.44, 95% confidence interval = −0.77; −0.11), social functioning (−15.8 ± 31.4, p = 0.001, effect size = −0.50, 95% confidence interval = −0.84; −0.17) and emotional functioning (−9.1 ± 21.2, p = 0.039, effect size = −0.43, 95% confidence interval = −0.76; −0.10) after 6 months. A linear mixed-effect regression model confirmed a possible effect on emotional and social functioning at 6 months. Regarding survival, no differences were found between groups (p = 0.605). No adverse effects were seen as consequence of the intervention. Conclusions: The main findings indicated that the intervention had no effect on time spent at home or place of death. However, the intervention resulted in a weak improvement of quality of life, social functioning and emotional functioning after 6 months.

KW - Cancer

KW - home care services

KW - palliative care

KW - psychological intervention

KW - quality of life

KW - randomized controlled trial

U2 - 10.1177/0269216318811269

DO - 10.1177/0269216318811269

M3 - Journal article

C2 - 30415608

AN - SCOPUS:85059673987

SN - 0269-2163

VL - 33

SP - 135

EP - 149

JO - Palliative Medicine

JF - Palliative Medicine

IS - 2

ER -

Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS – a randomized clinical trial

Abstract

Keywords

UN SDGs

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