Meeting Abstract

JL501. Advanced Practice Provider Delivery of Advance Care Planning Counseling in Community Oncology

Sabrina Mikan, PhD, RN, ACNS-BC, Supportive Care Programs, Texas Oncology, Austin, Texas

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Abstracts From 
JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017

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Background: Advanced practice providers (APPs) are vital in the team management of oncology. A key role of the APP is assisting patients and families with therapy review and coordination sessions where treatment questions and topics are discussed. Many topics are reviewed, rapport is developed, and the APP is able to introduce Advance Care Planning (ACP) concepts while assessing for any existing advance directives (ADs). ADs are important for the entire oncology care team to know about as care is delivered. When patients do not have ADs, through a systematic process beginning at their first visit together, the APP can introduce ACP basics and potentially refer interested patients for follow-up conversations.

Methods: APPs systematically introduce ACP at the therapy education session. Later, as early as cycle 3 of treatment, the APP re-introduces ACP and attempts a referral. Vital to ACP success is removing the stigma from when ACP is traditionally completed: during times of crisis. By including ACP in each patient’s plan of care, the opportunity is normalized and patients find it helpful to complete their ADs with the APP. Use of a Patient Values Assessment (PVA) is also effective to meet the patient’s goals of care.

Results: Over an 18-month timeframe beginning January 2016, ACP Counseling and Patient Values were measured across 60 practices offering the ACP program. At baseline month, ACP counseling was 64 and increased to 410 in June 2017; a 6-fold increase. Patient Values questionnaires at baseline were 25, increasing to 206 in June 2017; an 8-fold increase. Steady growth took place monthly along with increasing buy-in from each APP and practice leadership.

Conclusions and Recommendations: APPs each develop their personalized method for re-introducing ACP to their active treatment patients. With an identification process beginning at therapy teaching, the APP is able to periodically re-introduce ACP and attempt referrals for counseling. Utilizing specific, measureable, attainable, realistic, and timely (S.M.A.R.T.) goals created by each APP and the practice, there will be objective evaluation for increased improvement. Patient empowerment and education is at the heart of ACP. Monthly review of progress and continual quality improvement of the program process will help increase program access to every patient.

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