In a single-center study reported in JCO Oncology Practice, D’Ambruoso et al found that their Integrated Palliative Care and Oncology Program, which included the embedding of a palliative care nurse practitioner (PC-NP) in an oncology clinic, resulted in marked improvements in aspects of palliative care for patients with advanced cancer over a 6-year period compared with patients not enrolled in the program.
The study evaluated the effect of a dedicated PC-NP’s efforts to integrate early, concurrent advance care planning and palliative care on quality of advance care planning, psychosocial support, hospice utilization, and hospital and intensive care unit (ICU) lengths of stay at the end of life among patients enrolled in the program in an oncology clinic (Simms/Mann-UCLA Center for Integrative Oncology) between March 2014 and March 2020.
Key Findings
Over the 6 years, the PC-NP had 617 initial encounters, 2,442 follow-up visits, 13 telemedicine visits, and 6,164 e-mail or telephone encounters among patients of all oncologists within the health system. Maximum capacity of the program was reached in years 5 and 6, during which there were an average of 134 initial consults, 540 follow-ups, 7 telemedicine visits, and 1,651 telephone/e-mail/meet-and-greet encounters each year. The PC-NP began working with 2 oncologists in 2014, increasing to 17 oncologists by 2020. Overall, 26 oncologists referred at least one patient to the program.
Embedding a trained palliative care nurse practitioner in oncology clinics to deliver early integrated palliative care can lead to improved quality of care for patients with advanced cancer.— D’Ambruoso et al
Tweet this quote
Compared with patients with advanced cancer not seen in the PC-NP program, in March 2020, those enrolled in the program were more likely to have goals of care note documentation (82% vs 15%, P < .01), Physician Orders for Life-Sustaining completion (16% vs 5%, P < .01), and referral to the psychosocial oncology program (67% vs 37%, P < .01).
Among decedents, those enrolled vs not enrolled in the program had a higher referral rate to hospice (61% vs 34%, P < .01) and had fewer hospital days (12 vs 18, P < .01) and ICU days (1.2 vs 2.3 days, P < .01) in the last 6 months of life.
As noted by the investigators, “The program expanded over time with the support of faculty skills training for advance care planning and palliative care, supporting a shared mental model of palliative care delivery within the oncology clinic.”
The investigators concluded, “Embedding a trained palliative care nurse practitioner in oncology clinics to deliver early integrated palliative care can lead to improved quality of care for patients with advanced cancer.”
Anne M. Walling, MD, PhD, of the Department of Medicine, University of California, Los Angeles, is the corresponding author for the JCO Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
