CONTEXT: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
CONTEXT: 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. OBJECTIVES: Testing feasibility and acceptability in busy outpatient oncology clinics of a novel program of systematic, oncology nurse-led values discussions with all new cancerpatients. METHODS: Within an institutional initiative integrating primary and specialist palliative care from diagnosis for all cancerpatients, 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. RESULTS: Oncology nurses conducted 177 total discussions with 67 newly diagnosed cancerpatients (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. CONCLUSION: 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.
Authors: Alexander K Smith; Julie N Thai; Marie A Bakitas; Diane E Meier; Lynn H Spragens; Jennifer S Temel; David E Weissman; Michael W Rabow Journal: J Palliat Med Date: 2013-05-10 Impact factor: 2.947
Authors: Rachelle Bernacki; Mathilde Hutchings; Judith Vick; Grant Smith; Joanna Paladino; Stuart Lipsitz; Atul A Gawande; Susan D Block Journal: BMJ Open Date: 2015-10-06 Impact factor: 2.692
Authors: Kate M Lillie; Lisa G Dirks; J Randall Curtis; Carey Candrian; Jean S Kutner; Jennifer L Shaw Journal: J Transcult Nurs Date: 2019-07-01 Impact factor: 1.959
Authors: Andrew S Epstein; Michael Riley; Judith E Nelson; Camila Bernal; Steven Martin; Han Xiao Journal: Cancer Date: 2022-07-22 Impact factor: 6.921
Authors: Heather M Derry; Andrew S Epstein; Wendy G Lichtenthal; Holly G Prigerson Journal: Expert Rev Anticancer Ther Date: 2019-08-10 Impact factor: 4.512
Authors: Andrew S Epstein; Sophia E Kakarala; Valerie F Reyna; Ashish Saxena; Paul K Maciejewski; Manish A Shah; Holly G Prigerson Journal: J Pain Symptom Manage Date: 2020-11-27 Impact factor: 5.576
Authors: Anjali Varma Desai; Chelsea L Michael; Gilad J Kuperman; Gregory Jordan; Haley Mittelstaedt; Andrew S Epstein; MaryAnn Connor; Rika Paula B Villar; Camila Bernal; Dana Kramer; Mary Elizabeth Davis; Yuxiao Chen; Catherine Malisse; Gigi Markose; Judith E Nelson Journal: J Med Internet Res Date: 2021-02-17 Impact factor: 5.428
Authors: Kathleen A Lynch; Camila Bernal; Danielle R Romano; Paul Shin; Judith E Nelson; Molly Okpako; Kelley Anderson; Elizabeth Cruz; Anjali V Desai; Virginia M Klimek; Andrew S Epstein Journal: BMC Palliat Care Date: 2022-03-06 Impact factor: 3.234