Coaching in Palliative Surgical Oncology

We measured the quality of the SIC conducted based on number of components explored. The seven components explored were disease understanding/prognosis, fear/worry, goals of care, treatment expectations, informational preferences, trade-offs, caregiver involvement. The team will ask questions from Serious Illness Conversations Guide (Ariadne Labs), which enable Healthcare providers to understand patients' values and goals. This would be used as part of a palliative care delivery quality indicator. Team members will share with the caregivers of the patient's goals and palliative care needs when the patient is being coached by the care coach.

We measured HRQoL in patients with the Functional Assessment of Cancer Therapy - General (FACT-G). FACT-G is a well-validated HRQoL questionnaire that covers 4 domains - physical well-being (7 items), social/family well-being (7 items), emotional well-being (6 items) and functional well-being (7 items). Each item has response choices in a 5-point Likert-type scale, with a maximum value of 4 (being, "Very much") and a minimum value of 0 (being "Not at all"). Higher scores indicate a better quality of life.

We also measured HRQoL in patients with the 5-level EuroQol-5 Dimension instrument (EQ-5D-5L). EQ-5D-5L is a HRQoL questionnaire with five domains (mobility, selfcare, usual activities, pain/discomfort, anxiety/depression) and has five levels for each domain. Scores from all five items will be used to derive a single utility score ranging from 0 to 1, with 0 representing the worst possible health to 1 representing perfect health. It also contains a health state component and a visual analog scale.

We measured decisional conflict in patients using the Traditional Decisional Conflict Scale (DCS). DCS is a validated 16-item instrument that measures personal perceptions of uncertainty in choosing among options, the factors contributing to uncertainty, and the quality of the decision made. Items are rated on a 5-point Likert scale (0 = Strongly agree to 4 = Strongly disagree). Scores are summed, divided by 16, and multiplied by 25 to produce a total score ranging from 0 (no decisional conflict) to 100 (extremely high decisional conflict). Lower scores indicate less decisional conflict and better decision support.

We determined the goals of care and life priorities in patients by using the Life Priorities Survey (LPS). LPS assesses patients' goals and priorities for their medical care across five domains: prolonging life, curing a disease, establishing a diagnosis, preserving function or independence, and relieving symptoms. This tool identifies patients' primary goals of care and will be used to assess concordance between patient-reported priorities and the treatments and interventions received. Changes in life priorities over the cancer and surgical journey will also be examined.

We measured the caregiver's understanding of the patient's goals and SIC components by using modified questions based on the Serious Illness Conversations Guide (Ariadne Labs). The outcome measure will be assessed by alignment and concordance with the SIC responses and seven components provided by the caregiver's respective patient. The seven components assessed are disease understanding/prognosis, fear/worry, goals of care, treatment expectations, informational preferences, trade-offs, caregiver involvement.

We measured decisional conflict in patients using a modified Decisional Conflict Scale (DCS) tailored to the perspective of the caregivers. DCS is a validated 16-item instrument that measures personal perceptions of uncertainty in choosing among options, the factors contributing to uncertainty, and the quality of the decision made. Items are rated on a 5-point Likert scale (0 = Strongly agree to 4 = Strongly disagree). Scores are summed, divided by 16, and multiplied by 25 to produce a total score ranging from 0 (no decisional conflict) to 100 (extremely high decisional conflict). Lower scores indicate less decisional conflict and better decision support.

We measured the caregiver satisfaction by using the Family Satisfaction with the End-of-Life Care-2 (FAMCARE-2). FAMCARE-2 is a validated 17-item instrument measuring family caregiver satisfaction with palliative care. It assesses satisfaction across four domains: management of physical symptoms and comfort, provision of information, family support, and patient psychological care. Each item is rated on a 5-point Likert scale (1 = "Very satisfied" to 5 = "Very dissatisfied"). Scores are summed to produce a total score ranging from 17 to 85, with lower scores indicating greater satisfaction with care. The FAMCARE-2 will be used to evaluate caregivers' perceived quality of communication, support, and overall satisfaction with the surgical and palliative care provided throughout the surgical journey.

We measured the caregiver quality of life with the Singapore Caregiver Quality of Life Scale (SCQOLS-15). SCQOLS-15 is a validated 15-item instrument developed and normed specifically for caregivers of patients in the Singapore context. It assesses caregiver quality of life across multiple domains capturing the physical, emotional, social, and practical impact of caregiving for a patient with serious illness. The SCQOLS-15 will be used to evaluate the broader impact of the patient's advanced cancer and surgical journey on caregiver well-being, and to assess whether the CONCORD coaching program - through improved communication, goal alignment, and caregiver preparedness - translates into meaningful improvements in caregiver quality of life over the study period.

We determined the healthcare utilization of patients by extracting the length of index hospitalization, all-cause emergency department visits, and total hospital days up to 6 months post-surgery.

We determined the cost of intervention(s) by extracting inpatient and outpatient billing records will be considered in total all-cause healthcare costs up to 6 months post-surgery.