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Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS – a randomized clinical trial
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Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS – a randomized clinical trial

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Background:
The focus of specialized palliative care is to improve quality of life for patients with incurable cancer and their relatives including an increased opportunity to make their own choice of place of care and death.

Aim:
To investigate whether a systematic fast-track transition from oncological treatment to specialized palliative care at home for patients with incurable cancer reinforced with a psychological dyadic intervention could result in more time spent at home and death at home. Secondary aims were to investigate effects on quality of life, symptomatology and survival.

Design:
A prospective, single-centre, randomized controlled trial (Clinicaltrials.gov: NCT01885637).

Setting/participants:
In all, 340 patients with incurable cancer and no or limited antineoplastic treatment options.

Results:
No statistically significant difference was found regarding number of deaths (4%, p = 0.460) and time spent at home (3%, p = 0.491). The secondary outcomes indicated that the intervention resulted in improved quality of life (−11.6 ± 25.5, p = 0.005, effect size = −0.44, 95% confidence interval = −0.77; −0.11), social functioning (−15.8 ± 31.4, p = 0.001, effect size = −0.50, 95% confidence interval = −0.84; −0.17) and emotional functioning (−9.1 ± 21.2, p = 0.039, effect size = −0.43, 95% confidence interval = −0.76; −0.10) after 6 months. A linear mixed-effect regression model confirmed a possible effect on emotional and social functioning at 6 months. Regarding survival, no differences were found between groups (p = 0.605). No adverse effects were seen as consequence of the intervention.

Conclusions:
The main findings indicated that the intervention had no effect on time spent at home or place of death. However, the intervention resulted in a weak improvement of quality of life, social functioning and emotional functioning after 6 months.
Forfattere Mie Nordly
Kirstine Skov Benthien
Eva S Vadstrup
Geana P Kurita
Annika B Von Heymann-horan
Hans Von Der Maase
Christoffer Johansen
Helle Timm
Jakob Kjellberg, SFI
Per Sjøgren
Udgivelsesdato 12.11.2018
Publiceret i Palliative Medicine
Sprog Engelsk

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