Study of Stepped Palliative Care in Patients With Advanced Lung Cancer DF/HCC SOCIAL-BEHAVIORAL RESERACH PROTOCOL

Patients with serious cancers, like advanced lung cancer, often experience physical symptoms,
such as pain or shortness of breath. Both patients and their families often feel worried
and/or sad about this 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 serious
illnesses, improves patients' quality of life and mood, and can help their loved ones' feel
less depressed or sad. This team is called "palliative care," and consists of physicians and
advanced practice nurses who work closely and collaboratively with the oncology team to care
for the patient and their loved ones.

While the investigators know having palliative care clinicians care for patients along with
their oncology team is helpful for the participant and their loved ones, the investigators do
not know the optimal timing of the visits with palliative care.

The purpose of this study is to see if the investigators can closely monitor participants'
health condition and quality of life and use these metrics as indications of when the
participant should see the palliative care team.

This study will monitor participants' health condition and schedule the participant to see
the palliative care team if the participants' cancer grows or after the participant have been
admitted to the hospital. The investigators will also monitor participants' quality of life
every six weeks and schedule the participant to see the palliative care monthly if the
participant quality of life decreases during the study.

This study will also monitor participants' mood, coping, and understanding of the participant
illness and prognosis. The investigators will ask the participant to fill out questionnaires
asking about these topics every 12 weeks. The participant will be able to complete these
questionnaires in clinic, via email, using a mailed paper copy, or over the phone with a
member of the research team.

Inclusion Criteria:

- Diagnosed with advanced non-small cell lung cancer, small cell lung cancer, or
mesothelioma, 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
2 (symptomatic and in bed <50% of the day)

- The ability to read and respond to questions in English or with minimal help from a
family member or medical interpreter.

- Primary cancer care at the MGH Cancer Center

- Age > 18 years

Exclusion Criteria:

- They are already receiving PC or hospice services

- They have cognitive or psychiatric conditions as determined by the treating oncologist
that prohibits study consent or participation