Background: Although palliative care consultation is recommended early in the course of oncology treatment, little evidence exists to guide the nature of this intervention. We describe a clinical practice of early palliative care consultation that improved quality of life, mood, and survival in a randomized clinical trial. Methods: As part of a randomized trial of early palliative care versus standard care in patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC), we analyzed documentation of the components of the initial palliative care consultation, self-reported quality of life as measured by the Functional Assessment of Cancer Therapy-Lung Trial Outcome Index (FACT-L TOI), and mood as measured by the Patient Health Questionnaire-9 (PHQ-9). Results: Seven palliative care clinicians provided consultation to 67 patients. The median total time spent with patients for the initial visit was 55 minutes (range, 20–120). Consultations focused on symptom management (median, 20 minutes; range, 0–75), patient and family coping (median, 15 minutes; range, 0–78), and illness understanding and education (median, 10 minutes; range, 0–35). Lower quality of life as measured by the FACT-L TOI predicted greater consultation time (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91–0.99). Additionally, lower quality of life scores on the FACT-L TOI (OR = 0.93, 95% CI = 0.88–0.97) and higher depression scores on the PHQ-9 (OR = 1.15, 95% CI = 1.02–1.31) predicted greater time spent on symptom management. Conclusions: Initial palliative care consultation near the time of diagnosis in patients with metastatic NSCLC in this intervention is nearly an hour in length and largely addresses symptom management, patient and family coping, and illness understanding and education. Lower quality of life predicted longer consultations, with more time dedicated specifically to symptom management.

This Viewpoint focuses on an emerging intervention, serious illness communication, and describes its components, presents evidence supporting the approach, and

Several studies have shown that the symptoms of grief are different from symptoms of depression among bereaved family members. This study is an attempt to replicate this finding among advanced cancer patients and examine clinical correlates of patient grief and depression. Analyses were conducted on data from interviews with 123 advanced cancer patients. Grief was measured using symptoms from the patient version of the Inventory of Complicated Grief—Revised (ICG–R) and symptoms of depression were assessed using the Structured Clinical Interview for DSM-IV (SCID). A factor analysis revealed that symptoms of patient grief formed a coherent factor that was distinct from a depression factor. Patient grief “caseness” (defined as being in the top 10% of the distribution of grief scores), but not major depressive disorder, was uniquely associated with the wish to die (odds ratio [OR] 10.13 [0.1.08–95.06]). Both depression and grief were significantly associated with mental health service use (OR 16.07 [1.68, 153.77] vs. 4.82; CI = [1.09, 21.41]) and negative religious coping (OR 1.36 [1.06, 1.73] vs. 1.25 [1.05, 1.49]); neither was associated with terminal illness acknowledgement.

Many patients with serious illness struggle to talk about the possibility of dying; yet basic prognostic awareness is crucial for informed decision making. In this article, we aim to help outpatient clinicians working with seriously ill patients ambivalent, uncomfortable, or fearful of further discussion about the future. We describe a dual framework that focuses on living well while acknowledging the possibility of dying and equips clinicians to help patients hold both possibilities. This dual framework facilitates the developmental process of living as fully as possible while also preparing for the possibility of dying.

Indian J Palliat Care, is an peer-reviewed biomedical periodical of Indian Association of Palliative Care.