Early Integrated Telehealth Versus In-Person Palliative Care for Patients With Lung Cancer

Patients with serious cancers, like advanced lung cancer, often experience physical symptoms,
such as pain or shortness of breath. In addition, both patients and their loved ones (family
and friends) often feel worried or sad about the cancer diagnosis.

Research has shown that early involvement of a team of clinicians that specialize in
lessening (or "palliating") many of these distressing physical and emotional symptoms and in
helping patients and their families cope with a serious illness improves patients' and their
loved ones' experience with their cancer. This team is called "palliative care," and consists
of physicians and advanced practice nurses (or "nurse practitioners") who work closely and
collaboratively with the oncology team to care for the participant and the participant's
loved ones. Research shows that when the palliative care team works closely with the oncology
team to care for patients with advanced cancer, they have better symptom control, quality of
life, and mood, and their loved ones feel less distressed. the investigators call this model
of care, "early integrated palliative care."

While the investigators know that having palliative care clinicians work closely with the
oncology team is helpful for patients and their loved ones, many patients do not have access
to these specialists because hospitals and cancer clinics lack enough staff and because some
patients and family members live in distant regions that make attending clinic visits
difficult and expensive. One way to overcome these barriers is to have patients meet with
palliative care clinicians using secure video-conferencing technology.

The purpose of this study is to determine if meeting with a palliative care clinician through
video-conferencing is just as beneficial for patients and their families as meeting with a
palliative care clinician in person. Specifically, this study will compare these two
different strategies for meeting with the palliative care clinician. The first strategy is to
schedule the participant to meet with the palliative care clinician regularly each month in
person at the clinic. The investigators call this strategy "In-person palliative care."

The second strategy is to schedule the participant to meet with the palliative care clinician
regularly each month using secure video-conferencing, such as through a smart phone or tablet
computer. If the participant do not have this form of technology, the investigators will
provide it for the participant. The investigators call this strategy "telehealth palliative
care." The primary goals of this study are to learn if telehealth palliative care is just as
effective as in-person palliative care for improving quality of life, mood symptoms, and
satisfaction with care for patients with advanced lung cancer and their families.

Inclusion Criteria:

- Patient Eligibility Criteria

- Diagnosed with advanced non-small cell lung cancer being treated with
non-curative intent, and informed of advanced disease within the prior eight
weeks

- Eastern Cooperative Oncology Group (ECOG) Performance Status from 0
(asymptomatic) to 3 (symptomatic and in bed >50% of the day)

- The ability to read and respond to questions in English or Spanish

- Receiving primary cancer care at one of the participating sites

- Age > or = 18 years

- Lives in a state where their institutions' palliative care clinicians are
licensed to practice

- Caregiver Eligibility Criteria

- Relative or friend who is identified by the patient participant and lives with
the patient or has contact with them at least twice per week.

- The ability to read and respond to questions in English or Spanish

- Age > or = 18 years

Exclusion Criteria:

- Patient Exclusion Criteria

- Already receiving PC or hospice services

- Cognitive or psychiatric conditions as determined by the treating oncologist to
prohibit study consent or participation

- Caregiver Exclusion Criteria --Cognitive or psychiatric conditions as determined by
the treating oncologist to prohibit study consent or participation