Need for more data describing, explaining and predicting a desired behavior in timely palliative care initiation
Although palliative care (PC) leads to improved quality of life in people with cancer, it is often initiated too late or not initiated at all. Current studies focusing on timely initiation of PC are doing so from a health service and health professional perspective and rarely from a health promotion perspective focusing on the pertinent role that behavior of the patient can play. The change of certain behaviors of patients could improve the timely initiation of PC in the disease trajectory. Theory-based behavioral research and interventions are needed to understand patient behaviors and to realize patient behavioral change. Within this proposal, people with a non-curable cancer starting a conversation about palliative care with a treating health professional is the defined behavior to be examined and assumed to be contributing to more timely initiation of PC. The use of a theoretically grounded focus on the role of behaviors to palliative care is highly innovative: it is almost unexplored although behavioral theories have proven their worth in other domains of health promotion research.
This proposal focuses on timely communication about palliative care and more specifically on the behavior ‘starting a conversation about palliative care with a health professional’ from the perspective of people with non-curable cancer.
The specific objectives are threefold:
1) to develop a palliative care behavioral model by defining determinants of ‘starting a conversation about palliative care with a health professional’ in people with non-curable cancer;
2) to examine the relationship between the defined determinants within the develop palliative care behavioral model, the intention to perform the behavior and the behavior itself in people with non-curable cancer;
3) to develop an intervention based on our model and evaluate 1) its acceptability and feasibility and 2) preliminary effects on improving timely initiation of palliative care.
A number of choices and considerations underlie the focus in our research in terms of behavior, population and behavioral theory to be used.
We address the research objectives through different study designs including a qualitative interview study, a cross-sectional survey study and a pilot non-blinded randomized controlled trial.