Coaching in surgical ONCOlogy to improve Readiness and Decisions (CONCORD)
This study proposes a novel approach of addressing decisional conflict and treatment resistance by introducing coaching sessions delivered by a trained care coach to focus on decision-making and future planning aspects of palliative care.
It is a two-arm, open-label, randomized controlled trial (RCT) to assess the effectiveness of CONCORD. 110 patients with advanced cancer consulted for major surgery will be recruited and randomised 1:1 between the usual care arm and the CONCORD intervention arm. Primary outcomes such as health-related quality of life (FACT-G) and decisional conflict (DCS) will be assessed between baseline, 1, 3, 6 months after surgery.
In the usual care arm, patients and their caregivers receive care delivered under the generalist palliative surgical oncology care model. Palliative care trained surgeons supported by specialist palliative care teams deliver primary palliative care without the coaching interventions from the care coaches.
In the CONCORD intervention arm, patients with advanced cancer and their caregivers will be actively engaged by a trained care coach. The care coach will be a palliative care trained professional with prior experience in patient coaching and may come from nursing, social work or psychology backgrounds. Before surgery, limiting advanced cancer the care coach will focus on decision-making and future planning aspects of palliative care in the context of life-limiting advanced cancer. After surgery, the care coach will continue to follow up and perform regular check-ins on patients and their caregivers, and the focus of coaching sessions will be on future planning aspects of palliative care.
Principal Investigator
Dr. Wong Si Min Jolene,
Clinical Assistant Professor, Duke-NUS Medical School
Consultant, Singapore General Hospital & National Cancer Centre Singapore