Assessment of Embedding Palliative Care Nurse Practitioners in Oncology Clinics

Key Points

  • The palliative care nurse practitioner intervention resulted in improved hospice referral and advance care planning documentation.
  • Much of the nurse practitioner time was devoted to tasks that could have been completed by other personnel.

In a study reported by Walling et al in the Journal of Oncology Practice, the embedding of a palliative care nurse practitioner in an oncology clinic resulted in improved hospice referral, advance care planning documentation, and referral for psychosocial support.

Study Details

The study compared health-care outcomes over 1 year between 2 oncology clinics in the University of California Los Angeles (UCLA) health system with an embedded palliative care nurse practitioner and 35 clinics without the nurse practitioner intervention. During the intervention period (March 2014 to March 2015), 2,370 patients with advanced cancer were treated in the control clinics, and 224 were treated in the 2 clinics with the embedded nurse practitioner.

Improvements in Care

During the intervention period, patients in the intervention group were more likely to have hospice referral before death (53% vs 23%, P = .02), advance care planning documentation (30% vs 17%, P < .01), and referral for psychosocial support (46% vs 16%, P < .01). Overall, among the patients treated by the nurse practitioner, 96% had documented advance care planning, 66% received psychosocial support, and 85% of those dying did so in hospice. There were no significant differences between the groups in the hospital or intensive care unit stays in the 30 days before death.

Efficiency evaluation indicated that approximately half the time spent by the palliative care nurse practitioner was devoted to tasks that could have been completed by such other personnel as nurses, social workers, or administrative staff.

The investigators concluded: “An embedded palliative care [nurse practitioner] model using scalable implementation strategies can improve advance care planning and hospice use among patients with advanced cancer.”

The study was supported by the California Health Care Foundation Payer-Provider Partnerships to Expand Community-Based Palliative Care.

Anne M. Walling, MD, PhD, of UCLA, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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