Effectiveness of the Supportive and Palliative Care Review Kit (SPARK) for Cancer Patients in the Acute Hospital

National Cancer Centre, Singapore

Status: Completed

Conditions: Health Services Research

Treatments: Other: SPARK intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT03330509

NRSMFSP17101

Details and patient eligibility

About

Introduction

There is a rising need for palliative care services in Singapore due to a rapidly ageing population and an increasing incidence of cancer. Current existing resources are inadequate - novel models of care are needed to expand access to palliative care without requiring significantly more specialist palliative care manpower.

Oncologist-driven referrals to a palliative care consultation service is the norm worldwide, including Singapore. This results in variable access to palliative care due to differences in referral practices. Palliative care involvement is also often delayed. In this study, the investigators propose to test Supportive and Palliative care Review Kit (SPARK) - a novel integrated model of care in which the palliative care team co-rounds with the medical oncology team.

Specific Aims and Hypothesis

This study aims to evaluate the impact of SPARK compared to usual care. The study investigators hypothesize that SPARK will result in more advanced cancer patients having access to palliative care, and at the same time operate at lower net cost. The study investigators also hypothesize that the improved efficiency of SPARK will result in shorter hospital length of stay for stage 4 cancer patients.

Methods

A cluster randomized trial with step wedged design will be used to compare SPARK to usual care. Data will be collected on health services utilization and access to palliative care services. Net costs will also be compared between SPARK and usual care. Semi-structured interviews with patients and healthcare professionals will be used to explore differences in experiences of healthcare provision between both models of care.

Importance

Singapore has a rising prevalence of cancer patients who require palliative care input, but only a minority are able to access it at present. If the SPARK model of care proves to be a scalable and cost-effective way of expanding access to palliative care, more cancer patients can benefit from palliative care.

Enrollment: 7,514 patients

Sex: All

Ages: 21 to 110 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All patients admitted under the care of the medical oncology team in Singapore General Hospital will be included.

Exclusion criteria

• Patients below 21 years old.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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7,514 participants in 4 patient groups

Cluster 1

Experimental group

Description:

Control: 1-4 months; SPARK intervention: 5-20 months

Treatment:

Other: SPARK intervention

Cluster 2

Experimental group

Description:

Control: 1-8 months; SPARK intervention: 9-20 months

Treatment:

Other: SPARK intervention

Cluster 3

Experimental group

Description:

Control: 1-12 months; SPARK intervention: 13-20 months

Treatment:

Other: SPARK intervention

Cluster 4

Experimental group

Description:

Control: 1-16 months; SPARK intervention: 17-20 months

Treatment:

Other: SPARK intervention