Supportive Oncology Care at Home Post-Discharge

Inclusion Criteria: Patient Eligibility * Age 18 or older * Diagnosed with advanced cancer (defined as receiving treatment with palliative intent per chemotherapy order entry treatment intent designation and/or trial consent forms OR based on documentation in the oncology clinic notes for those not receiving chemotherapy) * Admitted with an unplanned or non-elective hospitalization at Massachusetts General Hospital (MGH) * Not requiring ICU-level care during their hospitalization * Receiving care at the MGH Cancer Center * Ability to read and respond to question in English * Residing within 50 miles of MGH. Caregiver Eligibility * Relative or friend of eligible patient * Verbally fluent in English * Age 18 or older Clinician Eligibility \-- Outpatient oncology physicians and advanced practice clinicians who care for patients that receive the Supportive Oncology Care at Home intervention Exclusion Criteria: Patient Exclusion * Are admitted to the intensive care unit * Have a high oxygen requirement (FIO2 \> 0.40) * Experience active angina or cardiac arrythmias * Have a planned inpatient surgical or interventional procedure * Have uncontrolled psychiatric illness or impaired cognition interfering with their ability to understand study procedures and provide written informed consent * Are deemed ineligible for home-based care based on the inpatient oncology clinician assessment * Are planning to be discharged to hospice or to any location other than their home Caregiv…