The Effects of an Oncology Nurse-Led, Primary Palliative Care Intervention on Illness Understanding Among Patients with Advanced Cancer: A Secondary Analysis of the CONNECT Randomized Clinical Trial (SCI906)

Objectives 1. Describe the range of illness understanding among patients with advanced cancer and limited life expectancies. 2. Evaluate the impact of an oncology nurse-led primary palliative care intervention on illness understanding in this population. Background Patients with advanced cancer often have inaccurate expectations about prognosis. Specialty palliative care improves illness understanding. To date, the impact of primary palliative care on illness understanding has not been studied. Research Objectives To assess whether an oncology nurse-led primary palliative care intervention plus standard oncology care improves illness understanding compared to standard oncology care alone among advanced cancer patients Methods Secondary analysis of a cluster randomized trial conducted at 17 oncology clinics. Monthly oncology nurse-led primary palliative care visits focused on emotional support, symptom management, care coordination, and advance care planning. Adult patients with advanced solid tumors and ECOG status ≤ 2 for whom the oncologist "would not be surprised if died within one year" were enrolled. Baseline and 3-month questionnaires included validated illness understanding questions about curability, life expectancy, treatment intent, and terminal illness acknowledgement. Odds of correct illness understanding at 3 months were adjusted for baseline responses and patient demographic and clinical characteristics. Results Among 457 patients, there was no difference in correct illness understanding at 3 months between intervention and standard care groups: 48.8% versus 45.9% for curability (aOR =1.03, 95% CI 0.59-1.78, p=0.904); 12.8% versus 11.4% for life expectancy (aOR =1.15, 95% CI 0.59-2.22, p=0.684); 24.6% versus 33.3% for treatment intent (aOR =0.76, 95% CI 0.44-1.27, p=0.290); 53.6% versus 44.7% for terminal illness acknowledgement (aOR =1.28, 95% CI 0.81-2.00, p=0.288). Conclusion An oncology nurse-led primary palliative care intervention had no effect on illness understanding for advanced cancer patients. Implications for Research, Policy, or Practice Additional work is needed to identify primary palliative care approaches that improve illness understanding among patients with advanced cancer.