Many people living with metastatic breast cancer face challenging symptoms and frequent medical visits. At the same time, conversations about personal goals, values, and preferences for care may not always happen as early or as often as patients and families would like. This multi-site study will test the effectiveness of a five-session palliative care program, designed specifically for people with metastatic breast cancer and their caregivers, to strengthen communication with clinicians about what matters most in their care. The study aims to inform how palliative care services can be delivered in a more timely, personalized, and scalable way for people living with advanced cancers who have long disease trajectories, such as metastatic breast cancer.
The diagnosis of metastatic breast cancer can bring many challenges including physical symptoms, treatment side effects, and emotional stress for patients and their families. Palliative care specialists work alongside the oncology team to help patients and families manage symptoms, communicate effectively with their clinicians, and cope with the impact of living with cancer. Research has shown that when palliative care and oncology teams collaborate closely, patients often experience better symptom relief, clearer communication about their goals and preferences, improved quality of life and mood, and a stronger understanding of their illness. Caregivers also report feeling more supported and less distressed. The purpose of this research study is to learn whether a personalized palliative care program for people with metastatic breast cancer and their caregivers, called TARGET-PC, can further improve communication, symptom management, coping skills, and understanding of care. In this study, 400 patients with metastatic breast cancer and their caregivers will be randomly assigned to receive either the TARGET-PC program or enhanced usual care. Enhanced usual care includes an electronic prompt that reminds oncology clinicians to discuss and record each patient's goals and preferences for care. The study will take place at the Massachusetts General Hospital Cancer Center, Penn Abramson Cancer Center, and Duke Cancer Center.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Enrollment
400
Palliative care intervention focused on eliciting patients' goals and values to facilitate discussion and documentation of health care preferences.
Oncology clinicians will receive an electronic message to encourage them to discuss and document their patients' health care preferences.
Massachusetts General Hospital
Boston, Massachusetts, United States
RECRUITINGDuke University
Durham, North Carolina, United States
RECRUITINGUniversity of Pennsylvania
Philadelphia, Pennsylvania, United States
RECRUITINGDocumentation of End-of-Life Care Preferences
To compare proportions of patients with clinician-documented end-of-life care preferences in the electronic health record by last follow-up time point or date of death between study groups.
Time frame: From date of randomization until date of death or last follow up assessed up to 60 months
Hospice Utilization
To compare proportions of patients using hospice services by last follow up time point or death of death between study groups.
Time frame: From date of randomization until date of death or last follow up assessed up to 60 months
Hospice Length of Stay
To compare patients' lengths of stay in hospice between study groups among patients who die during study follow up.
Time frame: From date of randomization until date of death or last follow up assessed up to 60 months
Death in the Hospital
To compare proportions of patients dying in the hospital between study groups among patients who die during study follow up.
Time frame: From date of randomization until date of death or last follow up assessed up to 60 months
Patient-reported Communication about End-of-Life Care Preferences
To compare proportions with patient-reported communication about their end-of-life care preferences between study groups by last follow-up time point or date of death using the Prognosis and Treatment Perceptions Questionnaire (PTPQ). The PTPQ has a single item in which patients indicate whether they have discussed their end-of-life care wishes with their clinicians (scored dichotomously as "yes or no").
Time frame: From date of randomization until date of death or last follow up assessed up to 60 months
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