Implementation of Palliative Care Tools in Adult Oncology

Background: Palliative care is a multidisciplinary specialty that provides patients and families with physical, psychosocial, and spiritual care facing serious illnesses. However, most patients who are seriously ill do not receive a palliative care intervention early in their disease trajectory. Many providers are unaware of how to approach patients to enroll in palliative care, especially those who do not share their clinician's culture. Local Problem: Palliative care has been utilized poorly among oncology patients. Clinicians stated that barriers to referring patients to palliative care include a lack of knowledge of palliative care and how to engage patients in their services. Methods: This quality improvement project was conducted on an oncology unit in a large cancer center to implement a nursing-driven, Palliative Care Assessment and Referral Tool (PCART). Clinicians' initial perceptions of palliative care and awareness of disparities in palliative care referrals were assessed via an electronic questionnaire. An educational session included a nurse assessment tool workflow flyer, which included the PCART. The workflow tool was developed based on the questionnaire results, current literature on palliative care and disparities in palliative care referrals. Documentation of the changes in palliative care referrals before and after project implementation was assessed through a review of the EHR. In addition, a nurse assessment tool workflow flyer for PCART implementation was distributed to all bedside nurses. Reponses from the pre-and-postintervention questionnaires and data from the EHR were used to assess nurses' responses and improve the use of the PCART. The project's feasibility, usability, and satisfaction were assessed as part of the post-implementation questionnaire. Interventions: Electronic questionnaires were distributed to clinicians to assess awareness of the definition of palliative care, clinicians' description of palliative care, and their role in advocating for palliative care referrals. The education session including nurse assessment tool workflow flyer (PCART). was distributed to all bedside nurses. The intervention took place over 12 weeks and culminated in an EHR chart to assess for frequency of palliative care referral post-intervention of PCART. An electronic post-questionnaire to assess for any changes in palliative care practices and to elicit project satisfaction, feasibility, and usability. Results: A total of 32 clinicians participated in the project pre-questionnaires and 10 clinicians in the post-questionnaire, 90%, noted the importance of palliative care utilization and thought the quality of care would be improved after the PCART implementation. However, only 40% of the clinicians felt patients had been referred appropriately and were good candidates for palliative care referrals. During the 60-day trial, 57% of patients were referred through the PCART, with 100% being non-Hispanic patients. Conclusion: Palliative care referrals among oncology patients increased during project implementation. Results suggest developing an educational program for clinicians on palliative care benefits and differentiating hospice and palliative care to increase patient referrals. Further investigation needs to be conducted to assess barriers to the early integration of palliative care.