Innv-33. neuro-oncology visits at home (novah): a pilot program to improve care for patients with brain cancer

Abstract Informational and care needs of brain cancer patients change rapidly and often outstrip the capacity of clinical encounters at key time points, including transitions from inpatient to home and times of high emotional and psychological needs (e.g., new diagnosis, disease progression). The existing care-model leaves little time for illness understanding and advance care planning (ACP) work. We piloted a home visit program (NoVaH) to assess feasibility and acceptability of specialty-level clinical support in the home at times of increased care needs. METHODS: Eligible patients were treated in the neuro-oncology practice of a single academic medical center, resided within 15 miles of the hospital, and were referred by clinic staff. Home visits were conducted by a neuro-oncologist one half-day per week and scheduled longitudinally according to need, in parallel with primary outpatient visits. 9 family caregiver interviews were conducted virtually and analyzed by a qualitative researcher using rapid analysis methods to synthesize findings across predetermined, deductive categories. RESULTS: 18 patients referred from outpatient (61%) or inpatient service (39%) completed ≥ 1 home visit. Most patients had glioblastoma (78%). 59 home visits took place over 12 months (median per patient 2, range 1-8). A first life-sustaining treatment order form was completed by 10/18 patients (56%). Among 10 patients who died, place of death was home (50%), skilled nursing facility (20%), inpatient hospice (20%), or hospital (10%); 90% were enrolled in hospice at time of death. Caregivers voiced specific benefits such as ability to receive care patients would have otherwise forgone, improved communication about illness understanding and ACP, and enhanced sense of control and ability to digest prognostic information compared with office setting. CONCLUSIONS: Neuro-oncology home visits are feasible and acceptable to patients with brain cancer and represent an innovative way to provide patient-centered cancer care at times of transition and complex decision-making.