title: Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach.
abstract: OBJECTIVE
  To prospectively compare outcomes and processes of hospital-based early palliative care with standard care in surgical oncology patients (N = 152).
  
  
  METHODS
  A randomized, mixed methods, longitudinal study evaluated the effectiveness of a hospital-based Pain and Palliative Care Service (PPCS). Interviews were conducted presurgically and at follow-up visits up to 1 year. Primary outcome measures included the Gracely Pain Intensity and Unpleasantness Scales and the Symptom Distress Scale. Qualitative interviews assessed social support, satisfaction with care, and communication with providers. Survival analysis methods explored factors related to treatment crossover and study discontinuation. Models for repeated measures within subjects over time explored treatment and covariate effects on patient-reported pain and symptom distress.
  
  
  RESULTS
  None of the estimated differences achieved statistical significance; however, for those who remained on study for 12 months, the PPCS group performed better than their standard of care counterparts. Patients identified consistent communication, emotional support, and pain and symptom management as positive contributions delivered by the PPCS.
  
  
  CONCLUSIONS
  It is unclear whether lower pain perceptions despite greater symptom distress were clinically meaningful; however, when coupled with the patients' perceptions of their increased resources and alternatives for pain control, one begins to see the value of an integrated PPCS.
authors.affiliation: National Institutes of Health Clinical Center, Building 10, Room 2B14, 10 Center Drive, Bethesda, MD 20892, USA. gwallen@cc.nih.gov
authors.forename: Gwenyth R
authors.initials: GR
authors.lastname: Wallen
authors.forename: Karen
authors.initials: K
authors.lastname: Baker
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stolar
authors.forename: Claiborne
authors.initials: C
authors.lastname: Miller-Davis
authors.forename: Nancy
authors.initials: N
authors.lastname: Ames
authors.forename: Jan
authors.initials: J
authors.lastname: Yates
authors.forename: Jacques
authors.initials: J
authors.lastname: Bolle
authors.forename: Donna
authors.initials: D
authors.lastname: Pereira
authors.forename: Diane
authors.initials: D
authors.lastname: St Germain
authors.forename: Daniel
authors.initials: D
authors.lastname: Handel
authors.forename: Ann
authors.initials: A
authors.lastname: Berger
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D003142:Communication; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010147:Pain Measurement; D010166:Palliative Care; D010352:Patient Dropouts; D017060:Patient Satisfaction; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011594:Psychometrics; D036301:Qualitative Research; D011788:Quality of Life; D012944:Social Support; D011795:Surveys and Questionnaires; D016019:Survival Analysis
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