Giving Voice to Patient Values Throughout Cancer: A Novel Nurse-Led Intervention.
Advance care planning
cancer
communication
nursing
patient participation
Journal
Journal of pain and symptom management
ISSN: 1873-6513
Titre abrégé: J Pain Symptom Manage
Pays: United States
ID NLM: 8605836
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
27
02
2019
revised:
18
04
2019
accepted:
19
04
2019
pubmed:
30
4
2019
medline:
17
3
2020
entrez:
30
4
2019
Statut:
ppublish
Résumé
Optimal advance care planning allows patients to articulate their values as a touchstone for medical decision making. Ideally, this occurs when patients are clinically stable, and with opportunities for iteration as the clinical situation unfolds. Testing feasibility and acceptability in busy outpatient oncology clinics of a novel program of systematic, oncology nurse-led values discussions with all new cancer patients. Within an institutional initiative integrating primary and specialist palliative care from diagnosis for all cancer patients, oncology nurses were trained to use specific questions and an empathic communication framework to discuss health-related values during outpatient clinic visits. Nurses summarized discussions on a template for patient verification, oncologist review, and electronic medical record documentation. Summaries were reviewed with the patient at least quarterly. Feasibility and acceptability were evaluated in three clinics for patients with hematologic or gastrointestinal malignancies. Oncology nurses conducted 177 total discussions with 67 newly diagnosed cancer patients (17 with hematologic and 50 with gastrointestinal malignancies) over two years. No patient declined participation. Discussions averaged eight minutes, and all patients verified values summaries. Clinic patient volume was maintained. Of 31 patients surveyed, 30 (97%) reported feeling comfortable with the process, considered it helpful, and would recommend it to others. Clinicians strongly endorsed the values discussion process. Nurse-led discussions of patient values soon after diagnosis are feasible and acceptable in busy oncology clinics. Further research will evaluate the impact of this novel approach on additional patient-oriented outcomes after broader dissemination of this initiative throughout our institution.
Identifiants
pubmed: 31034869
pii: S0885-3924(19)30233-7
doi: 10.1016/j.jpainsymman.2019.04.028
pmc: PMC6849206
mid: NIHMS1057677
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
72-79.e2Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Informations de copyright
Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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