Oncology nurses at cancer centers across the country are developing ways to improve palliative care referrals for seriously ill patients and families who could benefit from these services.
A common thread woven through these referral strategies is expanding palliative care awareness among clinicians across the continuum. Misperceptions proliferate among clinicians as to the nature and benefits of palliative care, which trickles impacts into access.
This lack of understanding can mean clinicians may not be able to recognize when these services could be appropriate for cancer patients, according to Meredith Hellman, nursing professional development specialist in medical and surgical oncology at Nebraska Medicine.
“Our staff nurses [had previously] reported difficulty identifying patients in need of palliative care and articulating those needs to providers,” Hellman told Oncology Nursing News.
Oncology nurses at Nebraska Medicine in 2021 began utilizing a palliative care screening assessment tool to help differentiate patients in need of general or specialized serious illness care.
The Identification of Patients in Need of Palliative Care, or ID-PALL, is a patient screening tool that does not require detailed medical information. Nurses and physicians can be complete it based on their clinical observations.
The tool enables them to assess the physical, psychosocial or existential distress of patients or their family members, as well as address pain and symptom management needs.
The ID-PALL has helped clinicians at Nebraska Medicine better identify patients who could benefit from palliative care support, according to Hellman.
“The tool can be used by both nurses and doctors based on their clinical observations and by answering questions related to the patient’s symptom burden, such as shortness of breath and uncontrolled pain,” she said. “The information obtained from ID-PALL also provides the palliative care team with meaningful information that can be used to create a tangible road map for each patient. If a patient is screened and doesn’t warrant palliative care, but has a change in their condition, nurses can redo the screening.”
ID-PALL was piloted in a study among seven internal medicine units at hospitals in Switzerland between January and December 2018. Around 35% of patients were identified for general palliative care needs, while 7% were identified for specialized palliative care services, according to a study published in the Journal of Pain and Symptom Management. Nurses assessed 97% of the patients included in the study, with physicians also aiding in 50% of the assessments.
Other oncology centers have since begun using the tool.
Oregon Health & Science University’s Knight Cancer Institute also began integrating the ID-PALL tool in 2021.
Misperceptions were a contributing factor in a 24% appointment cancellation rate for patients referred to Knight Cancer Institute’s palliative care clinic between January and August 2021, according to Sarah Espe Lewis, palliative care nurse navigator at the institute.
Between September 2021 and August 2022, nurses at Knight Cancer Institute used the palliative care assessment tool to reduce the cancellation rate to 17%, Espe Lewis indicated.
““The role of the new nurse navigators was to connect with newly referred patients before their first appointment and educate them on the wide variety of services we can provide them through palliative care,” Espe Lewis stated, according to Oncology Nursing News.
Memorial Sloan Kettering’s Patient Access Service
Meanwhile, New York-based Memorial Sloan Kettering Cancer Center has developed a program to help facilitate care coordination among patients. Dubbed the Patient Access Service, the program led to nearly 69,000 new patient visit requests from August 2021 to August 2022.
Approximately 2,348 patient visits that were not scheduled during that time frame were due to “clinically driven reasons,” though follow-up reviews found that some were potential candidates for palliative care, according to MaryPat Porinchak, palliative care patient access nurse at Memorial Sloan Kettering Cancer Center.
Arming nurses with the knowledge and skills to discuss goals of care with patients and families could move the needle towards improved access and quality outcomes, Porinchak stated.
“It’s changing the narrative from cancer-directed care to educating patients and their families about how palliative care can increase their comfort and quality of life,” Porinchak told Oncology Nursing News. “Patients and caregivers benefit from nurse-led guidance resulting in earlier access to palliative care, and patient access nurses have a high degree of readiness to have effective end-of-life conversations.”