The impact of lung cancer:towards high-quality and patient-centered supportive care

Lung cancer remains a devastating diagnosis to receive. The goal of this thesis was to better understand the impact of lung cancer and study how to integrate palliative and supportive care. We identified the concept of shared-decision making as an important facet as it leads to improved health outcomes through reductions in distress and healthcare utilization. Further, we show that an early palliative care intervention is effective in reducing aggressive treatments near the end of life and that patients with lung cancer at risk for poor outcomes may be timely identified through the use of a short and patient-centered screening tool. Our results also indicate that oncologists respond well to the use of an evidence-based communication guide and that this enables patient-centered conversations with their patients. Yet, oncologists require further training with regards to prognostication and in responding to emotional cues. Accurate and timely documentation of these conversations is another salient issue. When studying survivorship, we conclude that the ideal time to start thinking about these issues in lung cancer care has not yet been identified. However, a number of opportunities for shared and actionable steps in both palliative and survivorship care exist. These mainly pertain to clarifying the confusion on terminology and the lack of consensus on an optimal model of care provision. We subsequently described the design and validation of a tool to capture the most important problems of cancer survivors. We conclude that there are significant opportunities to further improve the level of personal and patient-centered care for all patients living with and beyond lung cancer