JL504. Complex Illness Support Alongside Standard Oncology Care for Patients With Incurable Cancer
Kimberly A. Bland, DNP, APRN-NP, FNP, AOCN®, Nebraska Methodist Hospital, Omaha, Nebraska, and Alice Kindschuh, DNP, APRN-CNS, AGCNS-BC, CNE, Nebraska Methodist Health System and Nebraska Methodist College, Omaha, Nebraska
© 2018 Harborside™
JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017
The posters for the abstracts below can be found at:
Objective: This was a descriptive study to evaluate the effect of Complex Illness Support (Palliative Care) alongside standard oncology care for patients with incurable cancer on symptom control, patient satisfaction with care, and chemotherapy utilization within 30 days of death using inferential statistics.
Method: A convenience sample of consecutive patients who presented through a lung cancer clinic in a Midwestern urban community hospital was utilized. One survey evaluated patient satisfaction with Complex Illness Support. Patients’ self-report of overall symptom burden (mild, moderate, severe) was documented at the first consultation visit and at the 3-month follow-up visit. For those patients who died within the study period, the electronic medical record was reviewed to determine chemotherapy utilization within 30 days of the patient’s death.
Results: A total of 13 physicians referred 22 patients with terminal illness to Complex Illness Support for a total of 22 patient visits over a 5-month timeframe. Of the 18 patients seen, 10 died (56%). Patients were highly symptomatic and a variety of interventions were used for support. Symptoms on the two patients seen consistently remained stable from initial consultation to the 3-month follow-up visit. Chemotherapy use within 30 days of death (two of the four patients received chemotherapy) was within national benchmark measures, and patients strongly endorsed satisfaction with the Complex Illness Support team.
Conclusion: Patients with cancer frequently experience significant symptom burden and psychosocial distress. Patients and providers are accepting of and asking for outpatient Complex Illness Support to address these issues. In this 5-month project, 56% of patients referred to this service died, affirming the rationale. For holistic care, Complex Illness Support needs to be available to patients where they most often access oncology care: in the cancer center. Integration of Complex Illness Support as part of standard oncologic care enhances patient care and satisfaction.
Implications: Complex Illness Support with an APRN provider alongside standard oncology care appears to be acceptable, beneficial, and feasible. Cancer patients can be co-managed between Complex Illness Support and oncology, with referral to other services as needed. Complex Illness Support must be offered where the patient receives care in order to be successful; oncology nurse practitioners are a critical element of this team.
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