The Surgery for Cancer with Option of Palliative Care Expert (SCOPE) Trial

摘要 对于老年患者，生命末期（EOL）的护理通常是分散的，昂贵的，不必要的 咄咄逼人，不足以提供舒适和尊严。专家姑息治疗咨询是一种策略， 改善EOL护理。姑息治疗提供者的参与也被证明可以改善临床和 在危及生命的疾病治疗过程早期开始时的患者报告结局， 尤其是癌症。然而，早期姑息治疗在老年人中的效用还没有得到很好的研究， 癌症手术有一个驱动未满足的需求，以改善接受手术的患者的结果， 癌症，同时改善终末期护理那些谁最终死于他们的疾病。早期姑息治疗 协商是满足这一需要的一个有希望的战略。 癌症手术与姑息治疗专家选择（SCOPE）试验将开始回答 接受癌症手术的病人是否会从早期姑息治疗中受益的问题。 SCOPE是一项随机对照试验，入组了200例因恶性肿瘤接受切除术的患者， 尤其是可怜的小女孩。在干预组中，患者将接受术前咨询， 姑息治疗提供者沿着，并在术后继续进行住院和门诊姑息治疗随访。 对照组患者将接受常规护理。SCOPE试验的具体目的是确定：1） 干预是否改善了沿着90天时的身体和功能生活质量以及其他 手术后恢复; 2）干预患者是否改善了癌症生存率; 3） 干预提高了EOL护理的质量。 SCOPE试验是Myrick Shinall博士职业发展计划的一部分，旨在成熟为一名 独立研究人员的好处姑息治疗干预手术患者严重年龄- 相关条件。SCOPE试验将为Shinall博士提供一个平台， 老年外科人群姑息治疗的调查。在进行试验的同时，Shinall博士还将 接受临床试验方法学、老龄化研究、生物统计学、以患者为中心的结局方面的培训 研究和研究。他还将受益于他的主要导师E博士的指导。 韦斯利伊利，谁一直保持独立的联邦资金为15年，并指导了几个年轻的 调查人员在这一过程中的独立性。教学训练，伊利博士的指导， 从进行SCOPE试验中获得的经验将使Shinall博士发展成为一个独立的 对患有严重年龄相关疾病的外科患者进行姑息治疗干预的研究者。

Abstract For elderly patients, care at the end of life (EOL) is often fragmented, expensive, needlessly aggressive, and insufficient to provide comfort and dignity. Expert palliative care consultation is one strategy to improve EOL care. Involvement of palliative care providers has also been shown to improve clinical and patient-reported outcomes when initiated early in the course of treatment for life-threatening diseases, especially cancer. However, the utility of early palliative care is not well studied in older adults undergoing surgery for cancer. There is a driving unmet need to improve outcomes of patients undergoing surgery for cancer while improving EOL care for those who ultimately succumb to their disease. Early palliative care consultation is a promising strategy to meet this need. The Surgery for Cancer with Option of Palliative Care Expert (SCOPE) Trial will begin to answer the question of whether patients undergoing surgery for cancer will benefit from early palliative care. SCOPE is a randomized controlled trial enrolling 200 patients undergoing resections for malignancies with particularly poor prognoses. In the intervention arm, patients will receive a pre-operative consultation with a palliative care provider along with continued inpatient and outpatient palliative care follow-up post-operatively. Control arm patients will receive usual care. The Specific Aims of the SCOPE Trial are to determine: 1) whether the intervention improves physical and functional quality of life at 90 days along with other markers of recovery from surgery; 2) whether intervention patients have improved cancer survivorship; and 3) whether the intervention increases the quality of EOL care. The SCOPE Trial forms part of the career development plan of Dr. Myrick Shinall to mature into an independent researcher of the benefit of palliative care interventions for surgical patients with serious age- related conditions. The SCOPE Trial will provide a platform for Dr. Shinall to launch larger, more intensive investigations of palliative care in older surgical populations. While conducting the trial, Dr. Shinall will also undertake training in clinical trial methodology, aging research, biostatistics, patient-centered outcomes research, and grantsmanship. He will additionally benefit from the guidance of his primary mentor, Dr. E. Wesley Ely, who has maintained independent federal funding for 15 years and has mentored several young investigators to independence in the process. The combination of didactic training, Dr. Ely's mentorship, and experience gained from conducting the SCOPE trial will allow Dr. Shinall to develop into an independent investigator of palliative care interventions in surgical patients with serious age-related conditions.