Date of Graduation

Summer 8-13-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Dr Cathy Coleman

Second Advisor

Tara O'Connor

Abstract

Problem: Patients with stage IV cancer have a high mortality rate. Evidence shows that patients have a better quality of life when they receive specialty palliative care (SPC) services. In the microsystem of focus for this project, referrals to SPC are not automatic, and there are no triggers to help the oncologist decide when to refer during a patient’s terminal illness trajectory. Siloes between oncology and SPC exist, which leads to a lack of communication and coordination of care, ultimately affecting patient access to support services from SPC.

Context: A multi-disciplinary SPC clinic and a referring oncologist within the same facility partnered to improve early SPC among patients with certain high mortality cancers.

Intervention: A weekly oncology/palliative care team huddle was instituted to improve communication and proactively refer, discuss, and plan patient coordination of care. Communication tools were created to enhance patient education and team communication.

Measures: Pilot goal was to increase SPC consultation and ongoing follow-up support for stage IV gastrointestinal cancer patients by 20% from a baseline of 37% from February 2021 to 57% by June 31, 2021, for one participating oncologist patient panel.

Results: At baseline, 37% (20 out of 54) of patients received SPC consultation and ongoing support. After the huddle interventions, scripted introduction, and direct bookable appointments, 68% (52 out of 76) of patients received SPC consultation and ongoing support. Of the nine patients who died during the project, six died at home with hospice support and three died in the hospital on comfort-only orders.

Conclusion: A collaborative and coordinated huddle with oncology resulted in improved consultation and ongoing routine follow up, which benefited the patient and the family by having a peaceful and dignified death concordant with their goals and wishes. The organization benefited by having terminal patients expire with support from hospice or expire without receiving aggressive or ineffective treatment.

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