[ad_1]
January 08, 2026
4 min read
Key takeaways:
- Surveyed clinicians agreed on the importance of supportive cancer care for patients.
- Respondents also highlighted barriers including lack of funding and prioritization from institutions.
Clinicians agreed that advance care planning and symptom management improve outcomes and are a critical piece of cancer treatment, but they also acknowledged institutional barriers inhibit implementation of supportive care programs.
A survey of staff members taking part in a supportive cancer care investigation highlighted funding and prioritization of other services as obstacles that must be overcome to help more patients receive goal-concordant end-of-life care.
“The overall goal of the trial is to demonstrate how to best deliver supportive cancer care and work with health care clinicians and clinical leaders to ensure that structure is in place to sustain such approaches long-term” Manali I. Patel, MD, MPH, MS, FASCO, associate professor of oncology at Stanford Medicine, told Healio.
Supportive care can be ‘difficult’
Prior studies have shown advance care planning and symptom management have been associated with goal-concordant care, reduced rates of end-of-life treatment, improved survival and qualify of life, lower costs and decreased caregiver bereavement.
However, many patients do not receive this supportive cancer care.
“We consistently see poor quality of care at the end of life across all groups, but specifically by race and ethnicity and other factors. Many patients with cancer experience unwanted high-intensity care in that last month of life,” Patel said. “Yet, we lack consistent, evidence-based approaches of how best to deliver advanced care planning and supportive cancer care.”
Patel posited several possible reasons for this, including perceptions that palliative care could only be provided through specialists, but focused primarily on difficult conversations and costs.
“A really good goals-of-care conversation takes much longer than me signing off on a chemotherapy treatment plan.” she said. “While there are time constraints, there is also stigma regarding advance care planning. While studies show consistently that patients want to engage in these discussions, they can be very difficult for clinicians. These conversations can be emotionally difficult.
“In addition, we live in a fee-for-service world. Hospitalizations and emergency department visits, unless you’re in a value-based practice, are what drive the system. Our nation’s misalignment of financial incentives may be driving some of this higher-intensity care at the end of life.”
Patel and colleagues are conducting a comparative analysis trial of supportive cancer care approaches: team-based in-person care vs. a technology-based delivery.
Before the trial started, researchers surveyed staff from 26 participating clinics to assess potential barriers that could impact the implementation and effectiveness of the interventions.
Overall, 31 principal investigators, research staff and team-based health educators completed an interview, and 24 of them finished a follow-up survey.
Barriers could ‘thwart’ interventions
All participants agreed that supportive cancer care improved patient trust and satisfaction and aided goal-oriented care.
Staff in the team-based intervention had a significantly higher level of confidence than those in the telehealth arm that their trial method would have more advantages than disadvantages (81.25% vs. 37.5%; P = .032) and that it would improve patient outcomes (87.5% vs. 25%; P = .002).
“Overwhelmingly, the respondents perceived that the team-based approach would be more effective, even in the sites that were implementing the technology-based approach,” Patel said.
A staff member in the team-based arm said, “I think [team-based supportive cancer care] will be very helpful, because patients are not always reaching out when they need help … and, unfortunately, sometimes things get out of hand, and they end up in the hospital or worse. The continued follow-up … hopefully will catch those patients that could fall through the cracks.”
Staff in the team-based intervention also had a significantly higher level of confidence that senior leadership “provides effective management for improvement of patient care” (87.5% vs. 50%; P = .046) and patients historically accepted their trial approach (62.5% vs. 12.5%; P = .035).
Staff from both arms noted infrastructural and cultural barriers that could impact the efficacy of both interventions, including funding, lack of prioritization, differing needs based on population, and a stigma surrounding palliative care.
“Even though there’s near-unanimous agreement that these services need to be provided, there are these larger funding and organizational issues that could thwart the most effective intervention being implemented,” Patel said.
A principal investigator said, “You can do it in ivory towers, but doing it in real-world settings, that’s [not] recognize[d] enough. [Many health care executives and industry leaders are] not excited about implementing something that will save the health care system money, improve patient care. My hope is that you use this to tell the nation that we need to fund care delivery and implementation science.”
The primary trial has already enrolled more than 2,800 patients. Researchers will follow them for 1 year. Health-related quality of life serves as the primary endpoint. The study is projected to end in 2027 and researchers hope to have early data in 2028, Patel said.
“The ultimate goal is to get either one of these into practice,” she added.
However, survey findings indicate institutional support will be instrumental to future implementation.
“The clinical and executive leadership that are making decisions will influence the success of whatever approach it is that’s implemented,” Patel explained. “Those cultural characteristics that may choose one intervention vs. another, how much of a priority is supportive cancer care at your clinic, whether your organizational leaders support and prioritize those interventions and that particular service line, that’s going to make or break whether an intervention is adopted, sustainable at that practice and effective.”
For more information:
Manali I. Patel, MD, MPH, MS, FASCO, can be reached at manalip@stanford.edu.
Ask a clinical question and tap into Healio AI’s knowledge base.
- PubMed, enrolling/recruiting trials, guidelines
- Clinical Guidance, Healio CME, FDA news
- Healio’s exclusive daily news coverage of clinical data
[ad_2]
Source link
