Caregiver Satisfaction with Early Integrated Palliative Care in Oncology: Secondary Outcomes from the PALLiON Cluster-Rct

IntroductionPalliative care is often introduced late in the disease trajectory. Earlier access to palliative care has been reported to benefit patient outcomes, but few studies have explored its impact on caregivers. PALLiON (PALLiative care Integrated in ONcology) was a cluster-randomized controlled trial designed to integrate systematic palliative care earlier in oncology settings. The aim of this follow-up study was to assess whether the intervention influenced caregivers’ satisfaction with care in the intervention group compared to the standard care group, and to explore whether patients’ quality of life (QoL) at inclusion influenced caregivers’ satisfaction with care over time.MethodsThe trial was conducted across 12 Norwegian hospitals. The intervention included a physician education program, a patient-centered care pathway, and systematic symptom assessment. Adult patients with advanced cancer and their caregivers were recruited. Caregivers’ satisfaction with care was assessed longitudinally using the FAMCARE-20 scale, while patients’ QoL was measured with the EORTC QLQ-C15-PAL questionnaire. Linear mixed-effects regression models were used to examine the intervention’s effects, and partial least squares regression to examine associations between the intervention and responses to each FAMCARE-20 item.ResultsA total of 432 caregivers of 660 patients participated between 2017 and 2021. The average caregiver age was 61.8 years (SD = 13.2), and 71% were spouses or partners. The intervention had no significant effect on caregivers’ overall satisfaction with care (B = -0.070, 95% CI [-0.23, 0.082], β = 0.02, p = 0.35), and the groups did not significantly differ in slope of satisfaction with care over the first 6 months (B = 0.040, 95% CI = [0.003, 0.08], β = 0.07, p = 0.07). Lower patient QoL at baseline was significantly associated with greater increases in caregiver satisfaction over time in both groups (B = 0.001, 95% CI [0.0001, 0.003], β = 0.06, p = 0.03).ConclusionsCaregivers’ satisfaction with care did not differ between the intervention and control groups. Satisfaction seemed to be more affected by patients’ baseline QoL rather than early palliative care. Thus, a systematic, person-centered approach rooted in needs may be more beneficial than a purely time-based palliative care model.ClinicalTrials.gov: NCT03088202.