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| Name | Class |
|---|---|
| Patient-Centered Outcomes Research Institute | OTHER |
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This research study is evaluating whether primary palliative care is an alternative strategy to specialty palliative care for improving quality of life, symptoms, mood, coping, and end of life outcomes in patients with acute myeloid leukemia (AML).
Patients with newly diagnosed AML confront a sudden and life-threatening diagnosis, requiring an immediate disruption of their life and an urgent hospitalization to begin therapy. During their hospitalization for chemotherapy, patients with AML often experience difficult physical symptoms that negatively impact their quality of life and physical function. Patients with AML also experience significant psychological distress as they combat the abrupt onset of illness, uncertainty regarding their prognosis, physical and social isolation during hospitalization, and complete loss of independence. The abrupt onset of these symptoms can be distressing to both the patient and their family and friends (also called "caregivers").
Research has shown that early involvement of a team of clinicians specializing in lessening (or "palliating") these physical and emotional symptoms and helping patients and their caregivers cope with AML improves their quality of life and experience with their illness. This team is called "specialty palliative care" and consists of physicians and advanced practice providers who work closely and collaboratively with the oncology team to care for patients and caregivers. Research has also shown that training oncology clinicians to incorporate palliative care skills into their practice, called "primary palliative care," is an alternative strategy to having specialty palliative care clinicians care for patients with leukemia.
The purpose of this study is to determine whether specialty palliative care or primary palliative care is the best way to improve the quality of life and experience of patients with AML and their caregivers. This study will randomly assign hospitals to deliver either specialty palliative care or primary palliative care for patients with AML. Participants in this study will receive either specialty or primary palliative care during their hospital stays based upon which strategy their hospital has been assigned to. Participants assigned to specialty palliative care will be care for by both oncology and palliative care clinicians during their hospital stays for AML. Participants assigned to primary palliative care will be cared for by oncology clinicians who have been trained in palliative care during their hospital stays for AML.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Specialty Palliative Care | Experimental | - Participants will complete baseline self-report assessments at the time of informed consent |
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| Primary Palliative Care | Experimental | - Participants will complete baseline self-report assessments at the time of informed consent |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Specialty Palliative Care | Behavioral | Participants assigned to specialty palliative care will be cared for by both oncology and palliative care clinicians during their hospital stays for AML. |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of Life (QOL) | Establish that primary palliative care is non-inferior to specialty palliative care in patient-reported quality of life (QOL) as measured by the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leukemia) over 12 weeks. Higher scores on FACT-Leukemia (range 0-176) indicate a better QOL. | Over 12 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Patient Quality of Life (QOL) | Assess whether primary palliative care is non-inferior to specialty palliative care with respect to patient-reported quality of life (QOL) as measured by the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leukemia). | Up to 2 Weeks |
| Patient Depression Symptoms |
| Measure | Description | Time Frame |
|---|---|---|
| Patient Prognostic Understanding | Compare patient prognostic understanding between those receiving primary palliative care and specialty palliative care based on the Prognostic Awareness Impact Scale (PAIS). The PAIS items that focus on the likelihood of cure will be used to compare prognostic understanding. Patients will report the likelihood of cure of their leukemia on a Likert's scale. Prognostic understanding will be dichotomized into likely cure versus. unlikely cure and compared between the two groups. |
Inclusion Criteria:
Patient Inclusion Criteria
Caregiver Inclusion Criteria
Exclusion Criteria:
- Patient Exclusion Criteria
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Areej El-Jawahri, MD | Contact | 617-724-4000 | ael-jawahri@partners.org | |
| Chardria S Trotter, MPH, MBA | Contact | CTrotter@mgh.harvard.edu |
| Name | Affiliation | Role |
|---|---|---|
| Areej El-Jawahri, MD | Massachusetts General Hospital | Principal Investigator |
| Jennifer Temel, MD | Massachusetts General Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Alabama - Birmingham | Recruiting | Birmingham | Alabama | 35294 | United States |
The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to Sponsor Investigator or designee. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
Data can be shared no earlier than 1 year following the date of publication
Contact the Partners Innovations team at http://www.partners.org/innovation
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| Primary Palliative Care | Behavioral | Participants assigned primary palliative care will be cared for by oncology clinicians who have been trained in palliative care during the hospital stays for AML. |
|
Assess whether primary palliative care is non-inferior to specialty palliative care with depression symptoms as measured by the Hospital Anxiety and Depression Scale (HADS). Higher scores on HADS depression subscale (range 0-21) indicate greater depression symptoms. |
| Up to 12 Weeks |
| Patient Anxiety Symptoms | Assess whether primary palliative care is non-inferior to specialty palliative care with anxiety symptoms as measured by the Hospital Anxiety and Depression Scale (HADS). Higher scores on HADS anxiety subscale (range 0-21) indicate greater anxiety symptoms. | Up to 12 Weeks |
| Patient Post-Traumatic Stress Disorder (PTSD) Symptoms | Assess whether primary palliative care is non-inferior to specialty palliative care with respect to post-traumatic stress (PTSD) symptoms as measured by the Post-Traumatic Stress Checklist-Civilian version. Higher scores on the Post-Traumatic Stress Checklist (range 17-85) indicate greater PTSD symptoms. | Up to 12 Weeks |
| End-of-Life (EOL) Communication | Assess whether primary palliative care is non-inferior to specialty palliative care with respect to patient reported end-of-life (EOL) communication measured by the Prognostic Awareness Impact Scale (PAIS). The PAIS includes an item that measures patient self-report of communication about their wishes if they were dying (yes vs. no). | Up to 12 Weeks |
| End-of-Life (EOL) Care | Assess whether primary palliative care is non-inferior to specialty palliative care with respect to chemotherapy administration in the last 30 days of life based on documentation from the Electronic Health Record. | Last 30 days of life |
| Caregiver Quality of Life (QOL) | Assess whether primary palliative care is non-inferior to specialty palliative care with respect to caregiver quality of life measured by the Caregiver Oncology QOL Questionnaire (CARGOQOL). Higher scores on CARGOQOL (range 0-100) indicate better QOL. | Up to 12 Weeks |
| Caregiver Burden | Assess whether primary palliative care is non-inferior to specialty palliative care with respect to caregiver burden measured by the Caregiver Reaction Assessment (CRA). Higher scores on the CRA (range 24-120) indicate greater caregiving burden. | Up to 12 Weeks |
| Caregiver Depression Symptoms | Assess whether primary palliative care is non-inferior to specialty palliative care with respect to caregiver depression symptoms measured by the Hospital Anxiety and Depression Scale (HADS). Higher scores on HADS depression subscale (range 0-21) indicate greater depression symptoms. | Up to 12 Weeks |
| Caregiver Anxiety Symptoms | Assess whether primary palliative care is non-inferior to specialty palliative care with respect to caregiver anxiety symptoms measured by the Hospital Anxiety and Depression Scale (HADS). Higher scores on HADS anxiety subscale (range 0-21) indicate greater anxiety symptoms. | Up to 12 Weeks |
| Up to 24 weeks |
| Patient Coping | Compare patient coping between those receiving primary palliative care versus specialty palliative care using the Brief Cope. Higher scores on the domains of the Brief Cope indicate higher use of coping strategies. | Up to 24 weeks |
| Hospitalization | Compare hospitalization in the last 30 days of life between those receiving primary palliative care versus specialty palliative care. | Last 30 days of life |
| Intensive Care Unit (ICU) Admissions | Compare intensive care unit admissions in the last 30 days of life between those receiving primary palliative care versus specialty palliative care. | Last 30 days of life |
| Hospice Utilization | Compare hospice utilization between those receiving primary palliative care versus specialty palliative care. | Last 30 days of life |
| Hospice Length of Stay | Compare hospice length of stay between those receiving primary palliative care versus specialty palliative care. | Last 30 days of life |
| Patient Symptom Burden | Compare patient symptom burden between those receiving primary palliative care versus specialty palliative care using the revised Edmonton Symptom Assessment Scale (ESAS-R). Higher scores on ESAS-R (range 0 - 100) indicate greater symptom burden. | Up to 24 weeks |
| Patient Perception of Care | Compare patients' perception of patient-centeredness of care between those receiving primary palliative care versus specialty palliative care using the Patient Perception of Patient-Centeredness of Care (PPPC). Higher scores indicate greater satisfaction with care. | Up to 24 weeks |
| Caregiver-Reported End-of-Life (EOL) Communication | Compare caregiver-reported end-of-life (EOL) communication between those receiving primary palliative care versus specialty palliative care measured by the Prognostic Awareness Impact Scale (PAIS). The PAIS includes an item that measures patient self-report of communication about their wishes if they were dying (yes vs. no). | Up to 24 weeks |
| Caregiver Prognostic Understanding | Compare caregiver prognostic understanding between those receiving primary palliative care versus specialty palliative care based on the Prognositic Awareness Impact Scale (PAIS). PAIS items that focus on likelihood of cure will be used to compare prognostic understanding. | Up to 24 weeks |
| Caregiver Coping | Compare caregiver coping between those receiving primary palliative care versus specialty palliative care using the Brief COPE. Higher scores on the domains of the Brief Cope indicate higher use of coping strategies. | Up to 24 weeks |
| Stanford University | Recruiting | Stanford | California | 94305 | United States |
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| University of Colorado Denver I Anschutz Medical Campus | Recruiting | Denver | Colorado | 80204 | United States |
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| University of Miami | Recruiting | Miami | Florida | 33146 | United States |
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| Moffitt Cancer Center | Recruiting | Tampa | Florida | 33612 | United States |
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| Emory University | Recruiting | Atlanta | Georgia | 30322 | United States |
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| Northwestern University | Recruiting | Evanston | Illinois | 60208 | United States |
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| Indiana University | Recruiting | Bloomington | Indiana | 47405 | United States |
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| Johns Hopkins University | Recruiting | Baltimore | Maryland | 21218 | United States |
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| Massachusetts General Hospital | Recruiting | Boston | Massachusetts | 02115 | United States |
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| Dana-Farber Cancer Institute | Recruiting | Boston | Massachusetts | 02215 | United States |
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| Mayo Clinic | Recruiting | Rochester | Minnesota | 55905 | United States |
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| University of Rochester | Recruiting | Rochester | New York | 14627 | United States |
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| University of North Carolina at Chapel Hill | Recruiting | Chapel Hill | North Carolina | 27599 | United States |
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| Duke University | Recruiting | Durham | North Carolina | 27708 | United States |
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| Ohio State University | Recruiting | Columbus | Ohio | 43210 | United States |
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| Oregon Health & Science University | Recruiting | Portland | Oregon | 97239 | United States |
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| University of Pennsylvania | Recruiting | Philadelphia | Pennsylvania | 19104 | United States |
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| Fred Hutchinson Cancer Center | Recruiting | Seattle | Washington | 98109 | United States |
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| University of Wisconsin | Recruiting | Madison | Wisconsin | 53715 | United States |
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| ID | Term |
|---|---|
| D015470 | Leukemia, Myeloid, Acute |
| ID | Term |
|---|---|
| D007951 | Leukemia, Myeloid |
| D007938 | Leukemia |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
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