Integrative Palliative Care/Psycho-Oncology Telehealth Intervention in Patients With Advanced Cancer

Qualitative methods to analyze participant feedback obtained during exit interviews and code notes from by the existing domains: session relevance, delivery mode, ease of participation, suggested changes. A thematic content analysis will be performed to determine themes based on patterns and responses in these categories. Two coders will then meet to discuss the themes and reach agreement on final categories used to refine intervention for Phase 2 participants.

The proportion of eligible and approached patients who consent to participate.

The percentage of patients who complete pre and post-treatment questionnaires.

Percentage of patients who complete 2 or more sessions. Will use one-sample negative binomial probability and tests of binomial proportions to compare rates of feasibility to hypothesized values.

Number of participants who are determined to be ineligible before 1st virtual visit or refusal to participate before 1st visit and during treatment.

For potential study candidates who are ineligible, we will log reasons for ineligibility

For potential study candidates who decide not to participate, we will log reasons for refusal.

Participant ratings on intervention convenience, helpfulness, recommendation to others, worth doing, and feeling connected with University of California, San Francisco (UCSF). Descriptive statistics (frequencies, means, and standard deviations (SDs)) and 95% confidence intervals will summarize patients' ratings

This 8-item questionnaire is used currently in the Symptom Management Service (SMS) and completed at each visit which measures severity at the time of assessment of each symptom and is rated from 0 to 10 on a numerical scale; with 0 meaning that the symptom is absent and 10 that it is the worst possible severity items (pain, activity, nausea, depression, anxiety, drowsiness, appetite, and sensation of well-being) . The sum of the scores for all symptoms is defined as the symptom distress score.

The PHQ-8 is used to measure depression symptoms. The total Patient Health Questionnaire-8 (PHQ-8) score is calculated by combining the responses of the participant on questions addressing how bothered the participant has been by various problems over the past 2 weeks. Each of the 8 items is scored on a scale of 0 ("Not bothered at all") to 4 ("Nearly every day"). A total score of 0-4= No depression, 5-9='Mild Depression", 10-4="Moderate Depression", 15-19="Moderately severe depression", and 20 or higher ="Severe Depression".

The GAD-7 is a seven-item instrument that is used to measure or assess the severity of generalized anxiety disorder. The GAD-7 score is calculated by assigning scores of 0, 1, 2, and 3, to the response categories of "not at all," "several days," "more than half the days," and "nearly every day," respectively, and then adding together the scores for the seven questions. Scores of 5, 10, and 15 represent cut-points for mild, moderate, and severe anxiety, respectively. When used as a screening tool, further evaluation is recommended when the score is 10 or greater

This 4-item questionnaire to measure the extent to which pain hinders engagement with social, cognitive, emotional, physical, and recreational activities based on responses to statements about how the participants feel with a with a response ranging from 1="Never" to 5="Always", and a total raw score ranging from 4 - 20, which are converted to a scaled T-score (range 41.6 to 75.6) with higher scores indicating a greater hinderance to engagement in activities based on how much pain participants are experiencing.

This 6-item questionnaire to measure sleep disturbance based on responses to statements about how the participants feel with a response ranging from 1="Never" to 5="Always", and a total raw score ranging from 6 - 30, which are converted to a scaled T-score (range 31.7 to 73.3) with higher scores indicating a greater feeling of sleep disturbance.

This 6-item questionnaire to measure fatigue based on responses to statements about how the participants feel with a response ranging from 1="Never" to 5="Always", and a total raw score ranging from 6 - 30, which are converted to a scaled T-score (range 33.4 to 76.8) with higher scores indicating a greater feeling of fatigue.

This 4-item questionnaire to measure social isolation based on responses to statements about how the participants feel with a response ranging from 1="Never" to 5="Always", and a total score ranging from 4 - 20 which are converted to a scaled T-score (range 34.8 to 74.2) with higher scores indicating a greater feeling of social isolation.

The Cancer Behavior Inventory-Brief Version (CBI-B), a 12-item measure of self-efficacy for coping with cancer. Participants rate each item on how confident they are that they can do that behavior. Responses range from 1 to 9 with 1="Not at all confident", 5="Moderately Confident" and 9="Totally confident". Numbers in the middle of these cut points indicate somewhat confidence in performing these behaviors to a lesser or greater degree but are not specifically labelled. The total score is calculated by summing the scores for the 12 items for a total score range of 12-98, with higher scores indicating greater coping efficacy.

The FACT-G is a 27-item questionnaire designed to measure four domains of health related quality of life (HRQOL) in cancer patients with 4 domains of interest: Physical, social, emotional, and functional well-being. Each item response score ranges from 0 (not at all) to 5 (very much). The total score is a sum of the subscale scores, with a range from 0 - 108. The higher the score, the better the HRQOL.

This is a single-item question, "How would you rate your overall quality of life?" with responses ranging from a scale of 1 to 10 with greater scores indicating a greater quality of life. This is a validated measure used currently in the SMS.