A web-based application to promote palliative care in advanced ovarian cancer: A pre-post design

In the advanced ovarian cancer setting (AOC), palliative care (PC) is appropriate for virtually every patient. The objectives of this study were 1) to compare referral and visit rates to PC services, pre and post implementation of the electronic Self-Assessment and Care (eSAC) application, in both a prospective study sample and for the institutional population of patients with advanced ovarian cancer; and 2) explore patients' experiences integrating PC into their medical care.

Participants remotely submitted symptom and quality of life (QOL) reports about 5 days prior to clinic visits. Moderate-severe symptoms or QOL reports triggered teaching modules, including PC, and clinicians received summary reports with a PC prompt. PC rates were calculated for the prospective sample participants. Pre- and post-study rates for PC were compared using two-sample tests of proportions in the institutional population. A purposive sample of participants who triggered PC referral recommendations were recruited for semi-structured, telephone interviews to explore their experiences with PC integration. Reflexive thematic analysis was conducted to analyze interview data.

In the prospective sample, 145/165 (88 %) patients enrolled; 120 submitted ≥1 report. 78/120 (65 %) participants triggered the PC referral recommendation on ≥1 report; 46 of 78 (59 %) were referred to PC and 49 (63 %) had an initial PC visit by six weeks after the end of the enrollment period. From pre-to-post implementation, institutional PC referral rates increased from 8.6 % to 12.8 % (p = 0.014). Rates of having a PC visit were not significant between pre- and post-implementation. Thirteen participants completed qualitative interviews. Two primary domains emerged: cancer care narratives, and perceptions of PC integration. Key barriers to PC engagement included limited understanding of PC scope, perception of adequate current care, and concerns about care burden and appointment fatigue.

Implementation of eSAC may have impacted the institutional referral rates for PC but did not result in a significant increase in visits. In study participants who triggered a referral, 63 % attended at least one PC visit. Qualitative findings revealed significant barriers to PC engagement including limited understanding of PC services and perceived care burden.