Shared Decision-Making With Otolaryngologists and Palliative Care Specialists in Oral Cavity Cancer.

Importance: Advanced oral cavity cancer greatly affects vital functions, physical symptoms, psychological well-being, and social interactions. Early integration of palliative care is essential to address these burdens, yet access often remains limited, with many patients referred only near the end of life. Objective: To evaluate whether the shared decision-making with otolaryngologists and palliative care specialists (SOP) model is associated with increased palliative care utilization among patients with advanced oral cavity cancer before death. Design, Setting, and Participants: This prospective cohort study compared outcomes before and after SOP model implementation at an otolaryngology outpatient clinic at a national referral center. Patients with newly diagnosed stage IV oral cavity cancer undergoing concurrent chemoradiotherapy were included. The SOP model was introduced between 2020 and 2021, while patients treated from 2018 to 2019 received usual cancer care. Follow-up duration was 3 years, through December 2024. Exposure: The SOP model was structured into 3 sequential steps: choice talk, option talk, and decision talk. During choice talk, otolaryngologists introduced treatment and care options. Option talk and decision talk, facilitated by case managers and palliative care specialists, provided detailed discussion on risks, benefits, and alignment with patient values. Main Outcomes and Measures: The primary outcome was the composite frequency of multidisciplinary palliative care service utilization delivered alongside anticancer treatment before death. Services included consultations with palliative care specialists, social workers, clinical psychologists or chaplains, and physiatrists. Univariate and multivariate linear regression analyses were performed for continuous outcomes, including the composite frequency of multidisciplinary palliative care consultations and the frequency of medical resource utilization. Results: Among the 430 eligible patients, 110 were analyzed (mean [SD] age, 57.9 [10.7] years; 102 male patients [93%]); 52 were in the SOP group and 58 were in the non-SOP group. The SOP group had significantly higher frequency of multidisciplinary palliative care consultations compared with the non-SOP group (multivariate linear regression, β = 0.49; 95% CI, 0.11-0.87; P = .01). Conclusions and Relevance: In this cohort study of patients with advanced oral cavity cancer, implementation of the SOP model was associated with greater utilization of multidisciplinary palliative care services. Broader adoption of this model may facilitate timely palliative care engagement and improve the quality of end-of-life care in this population.