What happens during early outpatient palliative care consultations for persons with newly diagnosed advanced cancer? A qualitative analysis of provider documentation

Bağçıvan, Gülcan; Dionne‐Odom, J. Nicholas; Plunkett, Margaret; Stephens, Lisa; Bishop, Peggy; Taylor, Richard A.; Li, Zhongze; Tucker, Rodney; Bakitas, Marie

doi:10.1177/0269216317733381

Cited by 17 publications

(11 citation statements)

References 39 publications

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“…However, the benefits of palliative care increase multifold when moved further upstream in the care trajectory. 6,7 Our purpose in this article is to promote palliative care engagement in critical care; share palliative care resources to support critical care nurses in alleviating health-related suffering during the COVID-19 pandemic; and make recommendations to strengthen nursing capacity to deliver highquality, person-centered critical care. Ultimately, we argue that palliative care is critical care.…”

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confidence: 99%

Increasing Critical Care Nurse Engagement of Palliative Care During the COVID-19 Pandemic

Rosa

Ferrell

Wiencek

2020

Critical Care Nurse

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Background The coronavirus disease 2019 pandemic has led to escalating infection rates and associated deaths worldwide. Amid this public health emergency, the urgent need for palliative care integration throughout critical care settings has never been more crucial. Objective To promote palliative care engagement in critical care; share palliative care resources to support critical care nurses in alleviating suffering during the coronavirus disease 2019 pandemic; and make recommendations to strengthen nursing capacity to deliver high-quality, person-centered critical care. Methods Palliative and critical care literature and practice guidelines were reviewed, synthesized, and translated into recommendations for critical care nursing practice. Results Nurses are ideally positioned to drive full integration of palliative care into the critical care delivery for all patients, including those with coronavirus disease 2019, given their relationship-based approach to care, as well as their leadership and advocacy roles. Recommendations include the promotion of healthy work environments and prioritizing nurse self-care in alignment with critical care nursing standards. Conclusions Nurses should focus on a strategic integration of palliative care, critical care, and ethically based care during times of normalcy and of crisis. Primary palliative care should be provided for each patient and family, and specialist services sought, as appropriate. Nurse educators are encouraged to use these recommendations and resources in their curricula and training. Palliative care is critical care. Critical care nurses are the frontline responders capable of translating this holistic, person-centered approach into pragmatic services and relationships throughout the critical care continuum.

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confidence: 99%

Increasing Critical Care Nurse Engagement of Palliative Care During the COVID-19 Pandemic

Rosa

Ferrell

Wiencek

2020

Critical Care Nurse

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“…This QI project demonstrated an increased percentage of defined surrogate decision makers and ACP documents through (a) standardized assessment process and EHR documentation templates, (b) educational resources combined with CNS mentoring, (c) dedicated palliative CNS patient consultation time, and (d) structured discussion format through the use of the Five Wishes document and POLST ( Bagcivan et al, 2018 ; Lund et al, 2015 ). Inclusion of the SURE tool promoted the patient’s realization of the need for participation in ACP and assessed specialty palliative consultation effectiveness by demonstrating a statistically significant decrease of uncertainty after CNS consultation.…”

Section: Discussionmentioning

confidence: 99%

Palliative Integration Into Ambulatory Oncology: An Advance Care Planning Quality Improvement Project

Lucas¹,

Dimmer²

2021

JADPRO

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Advance care planning (ACP) is essential to ensuring that patient-centered end-of-life goals are respected if a health crisis occurs. Advanced practitioner barriers to ACP include insufficient time and limited confidence in discussions. The purpose of this quality improvement project was to increase advanced cancer patients’ electronic health record (EHR) documented surrogate decision maker and ACP documentation by 25% over 8 weeks. A secondary aim was to decrease patients’ decisional conflict scores (DCS) related to life-sustaining treatment preferences after a clinical nurse specialist (CNS)-led ACP session. Using the define, measure, analyze, improve, and control (DMAIC) process of quality improvement methodology, an interprofessional team led by a palliative CNS fostered practice change by (a) incorporating a patient self-administered Supportive Care and Communication Questionnaire (SCCQ) to standardize the ACP assessment, (b) creating an EHR nursing and provider documentation template, (c) offering advanced cancer patients a palliative CNS consultation for ACP review and advance directive completion, and (d) evaluating patients’ DCS through the four-item SURE tool. Of 126 participants provided with the SCCQ, 90 completed the document, resulting in a 71% return rate. Among the completed SCCQs, 37% (n = 33) requested a CNS consultation, with 76% (n = 25) returning for the ACP session. The CNS intervention yielded an average reduction of 1.4 points in SURE tool findings, a statistically significant decrease determined by a paired sample t-test. The project’s interprofessional collaboration promoted a system-wide standardized ACP process throughout ambulatory, acute, and post-hospital settings.

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“…Prior studies have shown that palliative care can facilitate the receipt of goal-concordant care. [20][21][22] At the end of life, patients who have goals-of-care discussions are more likely to receive comfort-focused care and less likely to experience an in-hospital death. 23 These outcomes are associated with improved satisfaction with care among bereaved caregivers.…”

Section: Discussionmentioning

confidence: 99%

Natural Language Processing to Assess Palliative Care and End-of-Life Process Measures in Patients With Breast Cancer With Leptomeningeal Disease

Brizzi

Zupanc

Udelsman

et al. 2019

Am J Hosp Palliat Care

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Background: Palliative care consultation during serious life-limiting illness can reduce symptom burden and improve quality of care. However, quantifying the impact of palliative care is hindered by the limitations of manual chart review and administrative coding. Objectives: Using novel natural language process (NLP) techniques, we examined associations between palliative care consultations and performance on nationally endorsed metrics for high-quality end-of-life (EOL) care in patients with leptomeningeal disease (LMD) secondary to metastatic breast cancer. Methods: Patients with breast cancer with LMD were identified using administrative billing codes and NLP review of magnetic resonance imaging reports at 2 tertiary care centers between 2010 and 2016. Next, NLP was used to review clinical notes to (1) determine the presence of palliative care consultations and (2) determine the performance of process measures associated with high-quality EOL care, including discussions of goals of care, code status limitations, and hospice. Associations between palliative care consultation and documentation of EOL process measures were assessed using logistic regression. Results: We identified 183 cases of LMD. Median age was 56 (interquartile range [IQR]: 46-64) years and median survival was 150 days (IQR: 67-350). Within 6 months of diagnosis, 88.5% of patients had documentation of ≥1 process measure, including discussions of goals of care (63.4%), code status limitations (62.8%), or hospice (72.1%). Palliative care consultation was a predictor of subsequent documentation of goals of care (odds ratio [OR], 3.15; 95% confidence interval [CI], 1.58-6.27) and hospice discussions (OR, 4.61; 95% CI, 2.12-10.03). Conclusion: Palliative care involvement is associated with increased performance of EOL process measures in patients with breast cancer with LMD.

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What happens during early outpatient palliative care consultations for persons with newly diagnosed advanced cancer? A qualitative analysis of provider documentation

Cited by 17 publications

References 39 publications

Increasing Critical Care Nurse Engagement of Palliative Care During the COVID-19 Pandemic

Increasing Critical Care Nurse Engagement of Palliative Care During the COVID-19 Pandemic

Palliative Integration Into Ambulatory Oncology: An Advance Care Planning Quality Improvement Project

Natural Language Processing to Assess Palliative Care and End-of-Life Process Measures in Patients With Breast Cancer With Leptomeningeal Disease

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