Effectiveness of the Supportive and Palliative Care Review Kit (SPARK) for Cancer Patients in the Acute Hospital

Health Services Research Clinical Trial

Official title:

Effectiveness of the Supportive and Palliative Care Review Kit (SPARK) for Cancer Patients in the Acute Hospital

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03330509
• Other study ID #: NRSMFSP17101
• Status: Completed
• Phase: N/A
• Start date: December 1, 2017
• Est. completion date: December 30, 2021

Study information

• Verified date: April 2022
• Source: National Cancer Centre, Singapore
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Introduction

There is a rising need for palliative care services in Singapore due to a rapidly ageing population and an increasing incidence of cancer. Current existing resources are inadequate - novel models of care are needed to expand access to palliative care without requiring significantly more specialist palliative care manpower.

Oncologist-driven referrals to a palliative care consultation service is the norm worldwide, including Singapore. This results in variable access to palliative care due to differences in referral practices. Palliative care involvement is also often delayed. In this study, the investigators propose to test Supportive and Palliative care Review Kit (SPARK) - a novel integrated model of care in which the palliative care team co-rounds with the medical oncology team.

Specific Aims and Hypothesis

This study aims to evaluate the impact of SPARK compared to usual care. The study investigators hypothesize that SPARK will result in more advanced cancer patients having access to palliative care, and at the same time operate at lower net cost. The study investigators also hypothesize that the improved efficiency of SPARK will result in shorter hospital length of stay for stage 4 cancer patients.

Methods

A cluster randomized trial with step wedged design will be used to compare SPARK to usual care. Data will be collected on health services utilization and access to palliative care services. Net costs will also be compared between SPARK and usual care. Semi-structured interviews with patients and healthcare professionals will be used to explore differences in experiences of healthcare provision between both models of care.

Importance

Singapore has a rising prevalence of cancer patients who require palliative care input, but only a minority are able to access it at present. If the SPARK model of care proves to be a scalable and cost-effective way of expanding access to palliative care, more cancer patients can benefit from palliative care.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 7514
• Est. completion date: December 30, 2021
• Est. primary completion date: June 30, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 21 Years to 110 Years

Eligibility

Inclusion Criteria:

• All patients admitted under the care of the medical oncology team in Singapore General Hospital will be included.

Exclusion Criteria:

• Patients below 21 years old.

Related Conditions & MeSH terms

• Health Services Research

Intervention

Other:
• SPARK intervention
An integrated model of care (SPARK care) in which the palliative care team co-rounds with the medical oncology team, supporting them in their delivery of basic palliative care, seamlessly stepping in and out to deliver specialist palliative care directly to patients when needed.

Locations

Country	Name	City	State
Singapore	National Cancer Centre Singapore	Singapore

Sponsors (3)

Lead Sponsor	Collaborator
National Cancer Centre, Singapore	Duke-NUS Graduate Medical School, Singapore General Hospital

Country where clinical trial is conducted

Singapore, 

References & Publications (2)

Hui D, Bruera E. Models of integration of oncology and palliative care. Ann Palliat Med. 2015 Jul;4(3):89-98. doi: 10.3978/j.issn.2224-5820.2015.04.01. Review. — View Citation

Nickolich MS, El-Jawahri A, Temel JS, LeBlanc TW. Discussing the Evidence for Upstream Palliative Care in Improving Outcomes in Advanced Cancer. Am Soc Clin Oncol Educ Book. 2016;35:e534-8. doi: 10.14694/EDBK_159224. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Hospital length of stay	Dates of hospital admission and discharge will be collected to measure hospital length of stay	6 months
Secondary	Number of days from hospital discharge to hospital readmission	Date of hospital discharge and date of subsequent hospital admission, if any, will be collected to measure this outcome	30 days
Secondary	Referral to palliative care services	Presence of referral to hospital palliative care consult service, home hospice or other palliative care services will be recorded	6 months