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Measuring quality of care delivery is essential to palliative care program growth and sustainability. We formed the Carolinas Consortium for Palliative Care and collected a quality data registry to monitor our practice and inform quality improvement efforts.We analyzed all palliative care consultations in patients with cancer in our quality registry from March 2008 through October 2011 using 18 palliative care quality measures. Descriptive metric adherence was calculated after analyzing the relevant population for measurement.We used a paper-based, prospective method to monitor adherence for quality measures in a community-based palliative care consortium.We demonstrate that measures evaluating process assessment (range 63%-100%), as opposed to interventions (range 3%-17%), are better documented.Analyzing data on quality is feasible and valuable in community-based palliative care. Overall, processes to collect data on quality using nontechnology methods may underestimate true adherence to quality measures.

Context Patients with incurable cancer engage in several coping styles to manage the impact of cancer and its treatment. The Brief COPE is a widely used measure intended to capture multiple and distinct types of coping. The Brief COPE has not been validated among patients with incurable cancer. Objectives We sought to validate seven subscales of the Brief COPE in a large sample of patients newly diagnosed with incurable lung and noncolorectal gastrointestinal cancers ( N = 350). Methods Participants completed the Brief COPE and measures assessing quality of life (QOL) (Functional Assessment of Cancer Therapy—General) and psychological distress (Hospital Anxiety and Depression Scale) within eight weeks of diagnosis of incurable cancer. We evaluated the psychometric properties of the Brief COPE using a confirmatory factor analysis and tests of correlation with the QOL and distress scales. Results The Brief COPE factors were consistent with the original subscales, although the Behavioral Disengagement Scale had low internal consistency. Factors showed anticipated relationships with QOL and distress measures, except emotional support coping, which was correlated with increased depression and anxiety. We also conducted an exploratory high-order factor analysis to determine if subscales' score variances grouped together. The high-order factor analysis resulted in two factors, with active, emotional support, positive reframing, and acceptance loading onto one factor and denial and self-blame loading onto the second. Conclusion The selected subscales of the Brief COPE are appropriate measures of coping among individuals newly diagnosed with incurable lung and gastrointestinal cancers.

The cancer anorexia-cachexia syndrome (CACS) is common in patients with advanced solid tumors and is associated with adverse outcomes including poor quality of life (QOL), impaired functioning, and shortened survival.To apply the recently posed weight-based international consensus CACS definition to a population of patients with advanced non-small cell lung cancer (NSCLC) and explore its impact on patient-reported outcomes.Ninety-nine patients participated in up to four study visits over a six-month period. Longitudinal assessments included measures of physical function, QOL, and other clinical variables such as weight and survival.Patients meeting the consensus CACS criteria at Visit 1 had a significantly shorter median survival (239.5 vs. 446 days; hazard ratio, 2.06, P 0.05). Physical function was worse in the CACS group (mean Karnofsky Performance Status score 68 vs. 77, Eastern Cooperative Oncology Group Performance Status score 1.8 vs. 1.3, P 0.05 for both), as was QOL (Functional Assessment of Cancer Therapy-General [FACT-G] Lung Cancer subscale of 17.2 vs. 19.9, Anorexia/Cachexia subscale of 31.4 vs. 37.9, P 0.05 for both). Differences in the FACT-G and the Functional Assessment of Chronic Illness Therapy-Fatigue subscale approached but did not reach statistical significance. Longitudinally, all measures of physical function and QOL worsened regardless of CACS status, but the rate of decline was more rapid in the CACS group.The weight-based component of the recently proposed international consensus CACS definition is useful in identifying patients with advanced NSCLC who are likely to have significantly inferior survival and who will develop more precipitous declines in physical function and QOL. This definition may be useful for clinical screening purposes and identify patients with high palliative care needs.

palliative care program that cares for over 1,000 homebound patients annually. Our previous study showed that homebound patients have high symptom burden upon program entry including pain (47%) presumably due to the conditions and/or treatments that contribute to their homebound state. Yet little is known as to how individual symptoms are treated at home and how they respond to intervention, especially over longer time periods. Research Objectives. The purpose of this study was to see how symptoms change over time following HBPC enrollment. Method. HBPC patients who reported any symptoms on the Edmonton Symptom Assessment Scale (ESAS) at program entry between 2008 and 2010 were eligible for telephone ESAS follow-up at 3 week and 12 week intervals. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow up care, interdisciplinary care management including social work, and urgent in home care as necessary. Paired t-tests assessed change between baseline and subsequent time points. Result. 130 patients were followed. For each individual symptom, among those with baseline moderate or severe symptoms, mean symptom score decreased at 3 week follow up (p< .05). Patient pain, anxiety, depression, lack of well-being, loss of appetite, drowsiness, nausea, and tiredness remained significantly decreased at 12 week follow-up. Conclusion. In a non-hospice chronically ill population of urban homebound, patient symptoms can be successfully managed in the home. Implications for Research, Policy, or Practice. Future work should continue to explore symptom assessment and management over time for the chronically ill homebound who are cared for in HBPC programs.