Development and Initial Validation of a Palliative Care Readiness Tool for Older Adults with Cancer.

PROJECT SUMMARY
Older adults with cancer suffer from multi-morbidity and age-related physiological changes that can result in
high symptom burden, diminished quality of life, and increased complexity of care. While early palliative care
(PC) is associated with positive health outcomes such as symptom relief and improved quality of life, older
adults with cancer utilize PC services to a lesser extent than their younger counterparts. They request not to be
referred to PC or miss PC appointments when referred and delay PC until symptoms are uncontrollable or end
of life is near. This low uptake of PC could stem from negative views of PC, lack of knowledge or awareness of
PC, or the notion that they don’t ‘need’ PC or are not ‘ready’ for PC. Measuring readiness for early PC may
increase the uptake of PC by increasing knowledge and awareness of PC and debunking negative perceptions
of PC among older adults with cancer. Unfortunately, there are no tools available to measure readiness for
early PC among adults or older adults with cancer. Thus, there is a critical need to develop and validate a tool
that measures readiness for early PC in this group. To fulfill this gap, we propose developing the Palliative
Care Readiness tool (PALCARE) that measures early PC readiness in older adults with cancer and establish
its content validity and preliminary convergent validity and test-retest reliability. The project has three specific
aims: a) develop the PALCARE tool to measure PC readiness in older adults with cancer; b) establish the
content validity of the PALCARE tool; c) establish the preliminary convergent validity and test-retest reliability
of the PALCARE tool. Results of this study will allow the primary oncology team to measure readiness for early
PC in older adults with cancer and provide targeted PC that is congruent with their readiness level. The
PALCARE tool will also help clinicians educate and support older adults with cancer who are not yet ready for
PC. Ultimately the use of PALCARE can improve early PC utilization among older adults with cancer and
improve their quality of life. Upon successfully completing this project, we will seek extramural funding from
National Institute of Health for R15 renewal or R21 to further establish the psychometric validity and reliability
of the PALCARE tool. Subsequently, we would seek R01 funding to conduct an intervention study that would
examine the effectiveness of the PALCARE tool and develop targeted interventions to improve health
outcomes in older adults with cancer. This project also provides opportunity for hands-on research training for
several graduate and undergraduate students from the fields of nursing and health sciences. With expertise in
instrument development, palliative care, and geriatric oncology, our interdisciplinary research team is well
suited to conduct the proposed study. This project will enhance the research environment at the growing
University of North Carolina at Charlotte with a large and diverse body of undergraduate students.