Patients are more likely to create an advance care plan if they receive nurse-led palliative care services versus those who had standard care alone.
Among patients who received palliative services, a recent three-month assessment found significant increases in the number who participated in end-of-life conversations and completed advance care plans, according to research published in the Journal of the National Comprehensive Cancer Network.
“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,” Dr. Yael Schenker, director of the palliative research center and professor in the division of general internal medicine at University of Pittsburg, said in a press release. “Clearly, they rose to the challenge and were able to have a major impact on rates of [advance care planning].”
In the study, researchers compared a primary palliative care intervention with standard care among 672 patients with advanced solid tumor malignancies from 17 community clinics in the Pennsylvania-based Hillman Cancer Center network. Each patient was expected to die within 12 months.
Participating nurses underwent palliative care training focused on symptom management, conducting goals-of-care conversations, providing emotional support and care coordination.
“For people with serious illness 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 people receive the kind of care that aligns with their preferences,” Schenker said.
About 45% of the palliative care patients said they had a goals-of-care conversation, compared to nearly 15% of the control group, the study found.
Likewise, more than 43% of those who had received palliative care reported completing an advance directive. Only 18% had done so among the control group.
“Advance care planning is an important component of care for patients with advanced cancers,” Schenker said. “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 population. Leadership support and protected time are needed to ensure that nurses are able to accomplish non-treatment-related activities like advance care planning.”