Nurse-led palliative care improves advance care planning for patients with advanced cancer
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Key takeaways:
- Rates of end-of-life conversations and completion of advance directives increased after the intervention.
- The findings represent a potential solution to an unmet need within community oncology centers.
Nurse-led primary palliative care led to significantly higher uptake of advance care planning vs. standard care among patients with advanced cancers, according to study results in JCCN — Journal of the National Comprehensive Cancer Network.
Researchers noted increases in rates of end-of-life conversations and completion of advance directives following a 3-month assessment.
“I was surprised to see that this approach to primary palliative care increased uptake of advance care planning so significantly, particularly because the oncology nurses told us that this was one of the hardest things we asked them to do,” Yael Schenker, MD, MAS, FAAHPM, director of the palliative research center and professor in the division of general internal medicine at University of Pittsburgh and UPMC, said in a press release. “Clearly, they rose to the challenge and were able to have a major impact on rates of [advance care planning].”
Background and methodology
Palliative care specialists with expertise in advance care planning remain a limited resource, especially at community cancer centers that are not close to academic facilities, according to researchers. Oncology nurses, meanwhile, often form close bonds and relationships with their patients and could potentially provide primary palliative care, they wrote.
“For people with serious illness like advanced cancer, this kind of communication can allay anxiety, help patients and families to feel more supported in decision making, and help to ensure that people receive the kind of care that aligns with their preferences,” Schenker said in the press release.
Schenker and colleagues performed a secondary analysis of a cluster randomized controlled trial to determine the potential impact of an oncology nurse-led primary palliative care intervention on advance care planning uptake among patients with advanced cancers.
The CONNECT parent trial compared a primary palliative care intervention with standard care among 672 patients with advanced solid tumor malignancies from 17 community clinics in the Hillman Cancer Center network, located in western Pennsylvania. Each patient’s oncologist indicated they “would not be surprised” if the patient died within a year.
Nurses received palliative care training in the areas of addressing symptom needs, engaging patients and caregivers in advanced care planning, offering emotional support, and communicating and coordinating appropriate care. They conducted monthly visits with patients in the intervention group over a 3-month period.
Researchers evaluated occurrence of an end-of-life conversation and completion of an advanced directive at baseline and 3 months later.
Results and implications
At baseline, 182 of the 336 patients in the intervention group (54%) and 196 of the 336 patients in the standard care arm (58%) reported that they had not had an end-of-life conversation. Among those patients, 82 (45.1%) in the intervention group and 29 (14.8%) in the standard care group reported having had an end-of-life conversation at 3 months (adjusted OR = 5.28; 95% CI, 3.1-8.97).
Regarding advance directive, 111 (33%) of patients in the intervention arm (33%) and 105 (31%) of those in the standard care arm had none at baseline. Among them, 48 (43.2%) in the intervention arm and 19 (18.1%) in the standard care arm completed an advance directive during the study period (adjusted OR = 3.68; 95% CI, 1.89-7.16).
The findings represent a potential solution to the unmet need within community oncology centers for facilitation of advanced care planning for all patients with advanced malignancies, as recommended by NCCN clinical practice guidelines.
“Advance care planning is an important component of care for patients with advanced cancers,” Schenker said in the release. “Empowering and training nurses to develop shared care plans with patients and communicate this with oncologists represents a unique and effective way to improve advance care planning in this population. Leadership support and protected time are needed to ensure that nurses are able to accomplish nontreatment-related activities like advance care planning.”
References:
- Cohen MG, et al. J Natl Compr Canc Netw. 2023;doi:10.6004/jnccn.2023.7002.
- New study in JNCCN identifies approach for improving end-of-life conversations for people with cancer (press release). Available at: www.prnewswire.com/news-releases/new-study-in-jnccn-identifies-approach-for-improving-end-of-life-conversations-for-people-with-cancer-301790107.html. Published April 4, 2023. Accessed April 4, 2023.
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