Specially trained oncology infusion room nurses may be capable of improving advance care planning for patients with advanced cancer at the end of life, according to a new study published by Cohen et al in JNCCN—Journal of the National Comprehensive Cancer Network.
Background
“Advance care planning is a process designed to help [patients] have a voice in their medical care. For [those] with serious illnesses 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 [patients] receive the kind of care that aligns with their preferences,” explained senior study author Yael Schenker, MD, MAS, FAAHPM, Professor of Medicine in the Division of General Internal Medicine at the University of Pittsburgh and Director of the Palliative Research Center at the University of Pittsburgh Medical Center Hillman Cancer Center.
Study Methods and Results
In the new study, the researchers assigned oncology nurses to undergo immersive, 3-day training sessions on primary palliative care—with lessons that focused on addressing symptom needs, engaging patients and caregivers in advance care planning, providing emotional support to patients and caregivers, and communicating and coordinating appropriate care.
The researchers then enrolled 672 patients who all had advanced solid tumor malignancies and an indication from their physicians that death was expected within 1 year. The patients completed a survey on advance care planning at the time of enrollment, and again 3 months later. The results showed that 378 patients did not initially report having had an end-of-life conversation and 216 lacked an advance directive at the time of enrollment.
The researchers discovered that compared with patients who received standard care, those who participated in the targeted and specialized intervention created more advance directives and took part in more conversations about end-of-life issues. Among those who had not previously had an end-of-life conversation, 45.1% and 43.2% of the patients who engaged with the nurses who had undergone the training sessions subsequently engaged in conversations about end-of-life care and created advance directives, respectively, within 3 months. Comparatively, just 14.8% and 18.1% of patients who underwent standard care engaged in end-of-life conversations and created advance directives, respectively.
Conclusions
“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. Clearly, they rose to the challenge and were able to have a major impact on rates of [advance care planning],” highlighted Dr. Schenker. “[This process] is an important component of care for patients with advanced cancers. 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 patient population. Leadership support and protected time are needed to ensure that nurses are able to accomplish non–treatment-related activities like advance care planning.”
“Advance care planning is critical to providing high-quality care to patients with cancer and is highlighted in the NCCN Guidelines for Palliative Care,” noted Anne M. Walling, MD, PhD, FAAHPM, Associate Professor of Medicine in the Division of General Internal Medicine and Health Services Research as well as Director of Palliative Care at the David Geffen School of Medicine at the University of California, Los Angeles, and Chair of the NCCN Clinical Practice Guidelines in Oncology Panel for Palliative Care, who was not involved in this study. “These study results provide evidence to support oncology nurses playing a key role in this important care process,” she concluded.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
