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Development and Evaluation of a Nurse Practitioner Directed Early Palliative Care Initiative and Its Impact on Goal-Concordant Care at a Cancer Center.

Record Type:	Language materials, manuscript : Monograph/item
Title/Author:	Development and Evaluation of a Nurse Practitioner Directed Early Palliative Care Initiative and Its Impact on Goal-Concordant Care at a Cancer Center./
Author:	Weinmann, Ashley Virginia.
Description:	1 online resource (117 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 85-10, Section: B.
Contained By:	Dissertations Abstracts International85-10B.
Subject:	Nursing. -
Online resource:	click for full text (PQDT)
ISBN:	9798382224077

Development and Evaluation of a Nurse Practitioner Directed Early Palliative Care Initiative and Its Impact on Goal-Concordant Care at a Cancer Center.
Weinmann, Ashley Virginia.

Development and Evaluation of a Nurse Practitioner Directed Early Palliative Care Initiative and Its Impact on Goal-Concordant Care at a Cancer Center. - 1 online resource (117 pages)

Source: Dissertations Abstracts International, Volume: 85-10, Section: B.

Thesis (D.N.P.)--Wilmington University (Delaware), 2024.

Includes bibliographical references

Background: Seriously ill patients often experience discordant care. Delivering high-quality healthcare requires effective communication to support goal-concordant care.Problem: Pancreatic cancer has a 5-year survival rate of 12% with a high symptom burden. Pancreatic cancer patients often have unmet needs that lead to increased psychological, spiritual, social, and physical needs. Early integration of palliative care can provide high-quality communication and goal-concordant care. A retrospective analysis of MDACC's pancreatic patients found that 34% were referred to palliative care.Methods: An evidence-based quality improvement initiative examined whether early integration of palliative care addressed goal-concordant care for pancreatic cancer patients in 2023. Intervention: using pre- and post-visit palliative care surveys and EMR audits for twelve weeks in 2023.Intervention: Over twelve weeks, pancreatic patients (ideally at the time of diagnosis) were referred to palliative care within the ambulatory and inpatient setting at MDACC Cooper. Patients were asked to complete a pre and post-palliative care visit survey. The patients' EMR was analyzed to identify goal-concordant care documentation. Results:19 pancreatic cancer patients were referred to palliative care during the twelve weeks. 2 patients declined a palliative care visit but did complete a pre-visit palliative care survey. Seventeen patient visits were completed with a mean number of days from diagnosis to consult of 121 days (ambulatory setting (n= 14) 120 days, inpatient setting (n= 3) 188 days). Males had a more significant delay of days from diagnosis to a palliative care visit, with a mean of 212 days, compared to females, with a mean of 183 days. 26% (n=5) of patients died, and of those deceased, 60% (n=3) died within 30 days of the initial palliative care consult, with a mean number of days from diagnosis to death of 127 days. Pre-visit survey results: 52.6% of patients never heard of palliative care, 31% never heard of a living will, 52% did not have a living will, and 68.4% did not have a medical power of attorney. 84% of patients felt strongly regarding being involved in medical decisions, and 84.2% did not feel that MDACC did not discuss their personal goals, preferences, and quality of life since cancer diagnosis or recognized their religious, spiritual, and cultural beliefs. Post-visit surveys (n= 9) demonstrated good to excellent remarks (100%) regarding participation in shared decision-making, acknowledged their spiritual and cultural practices, and addressed family concerns/needs. 88.9% (n = 9) of patients reported they felt listened to and the use of language was easy to understand.Conclusion: Goal-concordant care is complex and difficult to quantify due to human nature. Individual goals and preferences require a therapeutic patient-provider relationship that is challenging in today's healthcare pressures. Palliative care is comprehensive care for those with serious illnesses, especially pancreatic cancer. Integrating palliative care as early as possible creates a robust patient-provider relationship to support high-quality communication, shared decision-making, and support for loved ones.

Electronic reproduction.
Ann Arbor, Mich. :
ProQuest,
2024

Mode of access: World Wide Web

ISBN: 9798382224077Subjects--Topical Terms:

563081
Nursing.
Subjects--Index Terms:

Advanced cancerIndex Terms--Genre/Form:

554714
Electronic books.

Development and Evaluation of a Nurse Practitioner Directed Early Palliative Care Initiative and Its Impact on Goal-Concordant Care at a Cancer Center.
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520 $a Background: Seriously ill patients often experience discordant care. Delivering high-quality healthcare requires effective communication to support goal-concordant care.Problem: Pancreatic cancer has a 5-year survival rate of 12% with a high symptom burden. Pancreatic cancer patients often have unmet needs that lead to increased psychological, spiritual, social, and physical needs. Early integration of palliative care can provide high-quality communication and goal-concordant care. A retrospective analysis of MDACC's pancreatic patients found that 34% were referred to palliative care.Methods: An evidence-based quality improvement initiative examined whether early integration of palliative care addressed goal-concordant care for pancreatic cancer patients in 2023. Intervention: using pre- and post-visit palliative care surveys and EMR audits for twelve weeks in 2023.Intervention: Over twelve weeks, pancreatic patients (ideally at the time of diagnosis) were referred to palliative care within the ambulatory and inpatient setting at MDACC Cooper. Patients were asked to complete a pre and post-palliative care visit survey. The patients' EMR was analyzed to identify goal-concordant care documentation. Results:19 pancreatic cancer patients were referred to palliative care during the twelve weeks. 2 patients declined a palliative care visit but did complete a pre-visit palliative care survey. Seventeen patient visits were completed with a mean number of days from diagnosis to consult of 121 days (ambulatory setting (n= 14) 120 days, inpatient setting (n= 3) 188 days). Males had a more significant delay of days from diagnosis to a palliative care visit, with a mean of 212 days, compared to females, with a mean of 183 days. 26% (n=5) of patients died, and of those deceased, 60% (n=3) died within 30 days of the initial palliative care consult, with a mean number of days from diagnosis to death of 127 days. Pre-visit survey results: 52.6% of patients never heard of palliative care, 31% never heard of a living will, 52% did not have a living will, and 68.4% did not have a medical power of attorney. 84% of patients felt strongly regarding being involved in medical decisions, and 84.2% did not feel that MDACC did not discuss their personal goals, preferences, and quality of life since cancer diagnosis or recognized their religious, spiritual, and cultural beliefs. Post-visit surveys (n= 9) demonstrated good to excellent remarks (100%) regarding participation in shared decision-making, acknowledged their spiritual and cultural practices, and addressed family concerns/needs. 88.9% (n = 9) of patients reported they felt listened to and the use of language was easy to understand.Conclusion: Goal-concordant care is complex and difficult to quantify due to human nature. Individual goals and preferences require a therapeutic patient-provider relationship that is challenging in today's healthcare pressures. Palliative care is comprehensive care for those with serious illnesses, especially pancreatic cancer. Integrating palliative care as early as possible creates a robust patient-provider relationship to support high-quality communication, shared decision-making, and support for loved ones.
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