Piloting 'mPal,' a Multilevel Implementation Strategy to Integrate Non-Hospice Palliative Care Into Advanced Stage Lung Cancer Treatment

Laurie McLouth Abstract The goal of this KL2 is to provide Dr. McLouth with critical knowledge and research skills to develop a comprehensive, independent NCI-funded research program investigating multilevel interventions and implementation strategies to improve equitable cancer care and patient outcomes in advanced stage lung cancer (asLC). asLC is the second most common cancer and leading cause of cancer mortality in the U.S. asLC is also a disease with significant disparities regarding its disproportionate incidence and mortality in rural areas, high rates of unmet patient supportive care needs (e.g., physical and psychological concerns), and underutilization of evidence-based supportive care services that could address those needs. Palliative care is an evidence-based supportive care service that improves quality of life and care outcomes in asLC. National practice guidelines and standards now stipulate that palliative care should be delivered concurrently with cancer treatment for all asLC patients; however, less than 15% of asLC patients receive palliative care. Barriers to palliative care implementation occur at the patient, provider, and system-levels. In this proposal, Dr. McLouth will conduct a pilot randomized controlled trial of a multilevel implementation strategy, called ‘mPal,’ designed to target key determinants of palliative care utilization at patient, provider, and system-levels. The central hypothesis is that mPal will be feasible and acceptable to patients and providers. Specific Aim 1 will evaluate mPal’s feasibility and acceptability with respect to enrollment, retention, quantitative feasibility and acceptability ratings, and depth interviews. Specific Aim 2 will obtain preliminary data on effectiveness (e.g., patient, provider palliative care knowledge and motivation, palliative care referral rates) and equity (e.g., enrollment rates among rural vs. urban patients) outcomes related to a future trial. Ultimately, this research will have a large scientific impact by enhancing conceptual understanding of theory-based, multilevel approaches to provide timely, equitable palliative care delivery. It will have a significant clinical and translational impact through the development of a scalable, practical, and easily translatable intervention to increase palliative care utilization among patients facing cancer and other serious illnesses. The training objective is to provide crucial knowledge of implementation science and pragmatic trials through mentored scientific training integrated and aligned with her KL2 research. Completion of the research and scientific training will position Dr. McLouth to lead a research program investigating multilevel intervention and implementation strategies to achieve equitable patient and cancer care delivery outcomes in advanced stage cancer.