Palliative care is an interdisciplinary model of care with the overarching goal of improving quality of life for
patients with serious illness through symptom management, provision of psychosocial support, elicitation of
preferences and aiding decision-making. Prior studies have demonstrated that specialist palliative care is
associated with decreases in treatment intensity and improvements in quality of life, but have also suggested
that existing heterogeneity among palliative care teams may be associated with variability in their
effectiveness. Early integration of specialist palliative care for patients with advanced cancer has been
recommended by the American Society of Clinical Oncology. However, as hospitals race to implement
palliative care programs to meet these guidelines, there is little evidence to guide them as to which ingredients
are necessary for effective care delivery. The proposed research will target this important knowledge gap by 1)
quantifying the association between use of specialist palliative care and end-of-life quality metrics in cancer
care, 2) examining whether differences in specialist palliative care implementation (as measured by key
variables reflecting team attributes and operational characteristics) are associated with improvements in quality
metrics and 3) using qualitative research methods to understand how programs operationalize care delivery
within different hospital settings. This project will create and utilize a novel data source that combines
nationwide patient and hospital-level data, detailed data on palliative care programs and valid information on
receipt of specialist palliative care. Quantitative analyses of this unique dataset will be followed by in-depth site
visits to six select palliative care programs; together, these data will be used to develop an actionable roadmap
that may be used to refine existing palliative care programs and inform implementation of future programs to
ensure effective delivery of palliative care for patients with cancer. This project represents an important
advance in understanding the role of palliative care specialists in cancer care, as prior work has focused on
whether specialist palliative care is associated with improved outcomes, while this work will focus identifying
the conditions under which specialist palliative care may achieve improved outcomes.
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