Pilot Study of the SPaRK (Supportive and Palliative Care Review Kit) Model of Care for Advanced Cancer Patients Who Have an Unplanned Admission to Singapore General Hospital

Specific Aims ==========

This is a pilot study of the Supportive and Palliative care Review Kit (SPaRK) model of care, which is integrated palliative care and oncology care for advanced cancer patients, and will be focused on improving outcomes in lung cancer patients in the acute hospital inpatient setting. The current usual care will be provided in the first 3-month period from 1 October to 31 December 2015, and the novel SPaRK model of care will be piloted in the latter 3-month period from 1 January to 31 March 2016. The overall aim of this pilot study is to facilitate the planning of an upcoming phase III trial.

Specific aim 1: To estimate the recruitment rate and data completion rate of the FACT-G instrument We will estimate the recruitment rate and data completion rate for FACT-G, which will demonstrate the feasibility and help in the planning of the future Phase III trial. The measurement properties of FACT-G will be detailed later in the 'Methods' section of this proposal. The FACT-G questionnaire will be administered at up to four time points - day 1, 4 and 7 of hospital admission and day of discharge.

Specific aim 2: To obtain tentative estimate the effect size of SPaRK on change in FACT-G from day 1 to day 7 of hospital admission The control group will be hospital admissions that are managed under the current model of care. The intervention group will be hospital admissions that are managed under the new SPaRK model of care. We hypothesize that the SPaRK model of care will result in a greater improvement in FACT-G score from day 1 to day 7 of hospital admission.

Specific aim 3: To explore the responsiveness to change of FACT-G from day 1 to day 4 of hospital admission Within the three-day period from day 1 to day 4 of hospital admission, we expect the acute problems that prompted the admission to be addressed. The patient's 'phase of illness' will be recorded by the primary medical oncology physician on day 1 and day 4 as part of the study protocol. For patients who change from an 'unstable phase' on day 1 to 'stable phase' on day 4, we will estimate the responsiveness to change of FACT-G score in terms of association with this change. Even though FACT-G uses a recall period of seven days, we hypothesize that FACT-G score will nonetheless increase among patients who change from an 'unstable phase' to 'stable phase' over the shorter time period of three days from day 1 to day 4 of hospital admission while there is no change in FACT-G score among patients who remained in the 'unstable phase. This would be useful for measuring outcomes in patients who are discharged before day 7 of hospital admission.