Abstract / Summary
Objectives: To evaluate the association of integrating family physicians into the specialist palliative care team (SPCT) with four outcomes among patients with metastatic cancer: Palliative care (PC) access, emergency department (ED) visits and the use of aggressive treatments such as cardiopulmonary resuscitation (CPR) and endotracheal intubation (ETT). Materials and Methods: This research employed a single-group interrupted time series (ITS) design conducted at Lampang Hospital. The study period, spanning 71 monthly observations from February 2019 to December 2024, provided extensive pre- and post-intervention data. The intervention – the addition of family physicians to the SPCT – was implemented in January 2021. Retrospective data were extracted from the hospital’s electronic medical records for patients aged over 18 with metastatic cancer. Four primary outcomes were measured monthly: the proportion of patients receiving PC services, the rate of ED visits, CPR events and ETT procedures per 100 metastatic cancer patients per month. Statistical analysis was performed using segmented linear regression with ordinary least squares estimation. Results: A total of 5,507 metastatic cancer patients accounted for 41,176 hospital visits. ITS analysis revealed a significant positive change in the trend of PC access following the intervention. While the pre-intervention trend was slightly declining, the post-intervention trend increased by 0.006/month (95% confidence interval: 0.003–0.008). Conversely, no significant changes in level or trend were observed for ED visits, CPR events or ETT procedures. Conclusion: The strategic integration of family physicians into the SPCT enhanced access to PC for patients with metastatic cancer. However, it did not lead to significant reductions in ED visits or the use of CPR and ETT. Future research that includes outcomes such as quality of life, symptom burden and caregiver experience will provide a more comprehensive understanding of the impact of PC.