A Pilot Study of a Primary Palliative Care Communication Intervention (PRECURSOR) to Address Supportive Oncology Needs for Patients With Incurable Cancer and Their Caregivers in the Outpatient Oncology Setting

Abstract

Introduction: As cancer care increasingly shifts to outpatient settings, patients with incurable cancer and their caregivers face growing challenges in addressing supportive oncology needs across five domains: informational, physical, emotional, social, and spiritual. Integration of supportive care in routine oncology practice—or primary palliative care—remains limited. Oncology encounters prioritize clinical agendas, leaving little time for supportive care and setting the stage for adverse outcomes. This study pilot tested a primary palliative care communication intervention, PRECURSOR (NCT05995860), using a nonrandomized (10 usual care control, 10 intervention) approach in a gynecology oncology clinic. Methods: PRECURSOR combines a brief Freelisting activity—used to elicit communication intentions about supportive oncology needs among patients, caregivers, and providers—with an educational handout on the five domains of supportive oncology needs. Primary outcomes were feasibility (≥25% enrollment rate; ≥4 enrollments/month) and acceptability (overall and by component). Exploratory outcomes were communication behaviors (qualitatively coded from audio-recorded encounters) and post-encounter outcomes (via surveys). Results: Of 1356 screened, 78 were eligible, and 20 enrolled (26%) in 38 weeks (2 enrollments/month). Most (70-78%) patients, caregivers, and providers rated PRECURSOR as acceptable overall. Patients and caregivers found both components acceptable, but providers favored the educational handout. Among exploratory outcomes, a greater proportion of the supportive oncology needs discussed during encounters were initiated by patients in the intervention group (46%), compared to control (37%). Average distress and anxiety scores were lower in the intervention group. No other patterns were observed among the exploratory outcomes. Qualitative findings indicated PRECURSOR was valuable, but refinements were suggested to increase impact. Conclusions: PRECURSOR was a feasible and acceptable primary palliative care communication intervention in the outpatient oncology setting. PRECURSOR holds potential to foster more patient-centered communication about supportive oncology needs and improve the psychological well-being of patients and caregivers facing incurable cancer, though refinements are needed.