Nurse-Led Telephonic Palliative Care

Abstract

Americans near the end of life experience high rates of nonbeneficial, burdensome, and preventable hospital-based care. If patients' goals of care are unknown or unclear, they have higher rates of hospitalization at the end of life. The demand for palliative care has grown exponentially because of its impact on quality of life, symptom burden, and resource use, requiring the development of new palliative care models. Nurses' holistic outlook and patient-centered focus make them ideal to deliver telephonic palliative care. This article discusses 4 cases delivered by a nurse-led telephonic palliative care program, a part of the Emergency Medicine Palliative Care Access project, which is a randomized controlled trial comparing outpatient palliative care with nurse-led telephonic case management after an emergency department visit. Telephonic nurses discuss patients' goals, fears, hopes, and concerns regarding their illness and its trajectory that inform decisions for future interventions and treatments. In addition, they share this information with the patients' surrogate decision-makers and clinicians to facilitate care coordination and symptom management. For seriously ill patients, nurses' abilities and expertise, as well as the difficulties of providing care through in-person models of palliative care delivery, make a nurse-led telephonic model an optimal option.

Nurse‐led adult palliative care models in low‐ and middle‐income countries: A scoping review

“…With the shortage of physicians in LMICs, particularly in rural areas, the nursing workforce must be educated and supported to lead palliative care development (Rosa et al, 2022;Yamarik et al, 2022) if universal coverage of palliative care is to be achieved.…”

“…There is a need for LMICs to put into action calls to maximize the nursing workforce and leadership potential to increase availability of and accessibility to palliative care (Hagan et al, 2018; Rosa et al, 2021, 2022). With the shortage of physicians in LMICs, particularly in rural areas, the nursing workforce must be educated and supported to lead palliative care development (Rosa et al, 2022; Yamarik et al, 2022) if universal coverage of palliative care is to be achieved.…”

“…The use of a variety of care delivery strategies is shown in this review as a vital component of nurse‐led palliative care models. The use of telephones and home‐based care strategies promotes ease of access to palliative care for underserved populations, by addressing geographical and financial inequalities in access to palliative care (Dhiliwal & Muckaden, 2015; Roberts et al, 2021; Yamarik et al, 2022). In LMICs, especially in rural areas, patients may need to travel long distances, sometimes by foot, to receive treatment (Nkhoma et al, 2015; Sankaran et al, 2015).…”

Complex Care Needs at the End of Life for Seriously Ill Adults With Multiple Chronic Conditions

“…Despite having higher symptom burden, patients with cancer had higher functional status compared with those without cancer, albeit still diminished. Prospective studies are needed to develop interventions that include nurses at the forefront of delivering serious illness and palliative care to medically complex patients 29,30 . Ultimately, identifying ways to revolutionize nursing care and training nurses to meet the complex care needs of all seriously ill adults across health care settings will be necessary for the delivery of high-quality palliative and end-of-life care.…”

“…Prospective studies are needed to develop interventions that include nurses at the forefront of delivering serious illness and palliative care to medically complex patients. 29,30 Ultimately, identifying ways to revolutionize nursing care and training nurses to For the overall score, responses are based on a 0 to 10 scale (0 equating to very poor QOL and 10 equating to excellent QOL). There are no clinical cut points described in the literature; therefore, quartile categories were created for analysis.…”