The Orkdal Model. Collaboration Between Specialist and Community Care Within Palliative Cancer Care

The Orkdal Model. Development, Implementation and Evaluation of Collaboration Between Specialist and Community Care Within Palliative Cancer Care

The overall aim of this project is to deliver better health care services through improved coordination of cancer care within specialist care (at the local hospital Orkdal Hospital) and community care (13 municipalities in the Orkdal region, Norway), and between these two levels in the health care system. "The Orkdal model" is developed and will be implemented and evaluated within cancer care. Cancer patients living in one of the 12 municipalities participating in the formal collaboration "Samhandlingsenheten i Orkdalsregionen" (SIO), or the municipality of Oppdal, having metastatic and/or loco-regional disease will be included in the study. Carers and health care providers will be included as well. Results from this project will be transferable to other parts of Norway and/or to other countries as well as to patients with other diagnoses causing complex conditions, such as chronic heart-, lung- and neurological disease.

Study Overview

• Status: Completed
• Conditions: Neoplasms
• Intervention / Treatment: Other: integrated palliative care program

Detailed Description

This study will be a prospective controlled observational pre-post study. The intervention consists of three parts: a standardised care pathway, an educational programme and information to general public, patients and their carers. Data from patients, carers and health care providers (physicians, nurses and nurse assistants) will be collected before the model is implemented (pre-intervention part) and after final implementation (post-intervention part). In addition, a comparison with a similar patient population, carers and health care providers will be conducted. A local hospital in the county of Romsdal and community care in the same region will be used as control.

Added January 2020: The study was in 2018 extended to also evaluate the effect of implementing "advance care planning" in the county of Møre and Romsdal. Møre and Romsdal started implementation of "advance care planning" in January 2018. The evaluation of "advance care planning in Møre and Romsdal" has the same endpoints as the evaluation of the Orkdal model trial.

Added December 17th, 2021: Inclusion of participants (patients, carers and healthcare professionals) is from Sept 2018 to March 2021. Follow-up ends in Sept. 2022.

• Study Type: Observational
• Enrollment (Actual): 969

Contacts and Locations

Study Locations

• Norway
  • Agdenes, Norway
    • Agdenes community care
  • Aukra, Norway
    • Aukra community care
  • Eide, Norway
    • Eide community care
  • Fræna, Norway
    • Fræna community care
  • Frøya, Norway
    • Frøya community care
  • Halsa, Norway
    • Halsa community care
  • Hemne, Norway
    • Hemne community care
  • Hitra, Norway
    • Hitra community care
  • Meldal, Norway
    • Meldal community care
  • Midsund, Norway
    • Midsund community care
  • Molde, Norway
    • Molde Hospital
  • Molde, Norway
    • Molde community care
  • Nesset, Norway
    • Nesset community care
  • Oppdal, Norway
    • Oppdal community care
  • Orkdal, Norway
    • Oppdal community care
  • Orkdal, Norway
    • Orkdal Hospital
  • Rauma, Norway
    • Rauma community care
  • Rennebu, Norway
    • Rennebu community care
  • Rindal, Norway
    • Rindal community care
  • Skaun, Norway
    • Skaun community care
  • Snillfjord, Norway
    • Snillfjord community care
  • Sunndal, Norway
    • Sunndal community care
  • Surnadal, Norway
    • Surnadal community care
  • Trondheim, Norway
    • St Olavs Hospital
  • Vestnes, Norway
    • Vestnes community care

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Cancer patients in need of palliative care, inhabitants of one of 22 municipalities in Central Norway, carers (1 per patient) and health care providers (community care and 2 regional hospitals)

Description

Inclusion Criteria (Patients):

• Advanced loco-regional disease and/or metastatic cancer disease
• For the intervention group in the Orkdal region: Inhabitant of one of the following thirteen districts: Surnadal, Halsa, Rindal, Hemne, Orkdal, Frøya, Hitra, Snillfjord, Agdenes, Meldal, Rennebu, Skaun, and Oppdal
• For the intervention group in the Romsdal region: Inhabitiant of one of the following nine districts: Aukra, Molde, Eide, Vestnes, Sunndal, Fræna, Midsund, Nesset, Rauma
• Acceptance of participation, based on information about the study and that participation is voluntary. Documented by a signed consent form.
• Able to comply with the study procedures
• Able to read and write Norwegian

Inclusion criteria (Carers) (a carer a person identified as such by the patient)

• the patient is eligible for the study
• the patient has given his or her consent to allow the study nurse to approach the carer to participate in the study
• the patient has identified the carer to be approached
• acceptance of participation, based on information about the study and that participation is voluntary. Documented by a signed consent form.

Inclusion Criteria (Health care providers)

• has accepted to participate in the study
• Acceptance of participation, based on information about the study and that participation is voluntary. Documented by an electronically signed consent form.

Exclusion Criteria (Patients):

• Receiving anti-cancer treatment with curative intent

Exclusion Criteria (Carers)

• not able to complete the assessments

Study Plan

How is the study designed?

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Orkdal region patients; cancer patients participating in a integrated palliative care program for diagnostics, treatment, care and follow-up in and between hospital care and 13 municipalities	Other: integrated palliative care program; a standardised care pathway, an educational programme and information to general public, patients and their carers
Romsdal county patients; control palliative care cancer patients in standard care, i.e. a local hospital in the county of Møre and Romsdal, Molde Hospital, and nine districts
Orkdal region carers; carers of cancer patients participating in a integrated palliative care program for diagnostics, treatment, care and follow-up in and between hospital care and 13 municipalities	Other: integrated palliative care program; a standardised care pathway, an educational programme and information to general public, patients and their carers
Romsdal county carers; carers of cancer patients receiving standard care, i.e. in a local hospital in the county of Møre and Romsdal, Molde Hospital, and community care in nine districts
Orkdal region health care providers; Health care providers for cancer patients participating in a integrated palliative care program for diagnostics, treatment, care and follow-up in and between hospital care and 13 municipalities	Other: integrated palliative care program; a standardised care pathway, an educational programme and information to general public, patients and their carers
Romsdal county health care providers; Health care providers for cancer patients receiving standard care, i.e. in a local hospital in the county of Møre and Romsdal, Molde Hospital, and community care in nine districts

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
proportion of patient's time spent at home the last 3 months of life	time in days	3 years
carers' health related quality of life (HRQOL) 6 months after patient's death	as measured by the total score of the RAND-Short Form-36	3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of home deaths		3 years
Use of tumor directed treatment the last 3 months of life	radiotherapy and chemotherapy	3 years
change over time in health care providers' knowledge and skills		3 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient reported health-related quality of life	measured by the total score of the European Organisation for the Research and Treatment of Cancer Core Quality of Life Questionnaire EORTC QLQ C15	3 years
place of death	if place of death is in accordance with patients' wish as reported at inclusion	3 years
distribution of health care services usage	between specialist and community care	3 yeart
total cost per patient		3 years
share of specialist and community care costs		3 years

Collaborators and Investigators

• Sponsor: St. Olavs Hospital
• Collaborators: Norwegian University of Science and Technology; Helse Møre og Romsdal HF; The Coordination Unit in the Orkdal region (SIO)
• Investigators: Study Director: Jo-Åsmund Lund, MD PhD, St. Olavs Hospital

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2014
• Primary Completion (Actual): March 31, 2022
• Study Completion (Actual): September 30, 2022

Study Registration Dates

• First Submitted: June 19, 2014
• First Submitted That Met QC Criteria: June 19, 2014
• First Posted (Estimate): June 23, 2014

Study Record Updates

• Last Update Posted (Actual): April 13, 2023
• Last Update Submitted That Met QC Criteria: April 12, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: Referral and consultation; Terminal care; Community health services; Models, organizational; Palliative medicine
• Other Study ID Numbers: 2014/212

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No