Integration of Palliative Care Education Into Clinical Practice

Palliative care is often confused with hospice care and is frequently not offered until there are no more curative treatments available. Hospice care is initiated when the patient has a terminal illness and is expected to live less than six months. It usually takes place at home when they are no longer pursuing curative treatment and are focused on providing comfort. Palliative care is defined as "a team-based approach that works to improve the quality of life of patients and their families or caregivers." It usually takes place in a medical facility, can be initiated at the time of diagnosis, is used in conjunction with curative treatment, and focuses on increasing the quality of life. Both hospice and palliative care connect patients to community resources and provide symptom management, psychosocial, physical, and emotional support. According to the World Health Organization, only 14% of people around the world that need palliative care are utilizing this service.5 Patients need to be introduced to palliative care early in their diagnosis to maximize the benefits they can receive from it, but only 8-18% of patients receive a palliative care consultation >30 days prior to death. Early initiation of palliative care is associated with decreased hospital bills, less aggressive treatment, decreased rates of depression and anxiety, better symptom control, and increased quality of life. It is essential that pts be appropriately educated on what palliative care is, its benefits, and how they can incorporate it into their plan of care.

Integration of Palliative Care Education Into Clinical Practice Melissa Gonzalez, University of Utah BSN Student Background PICOT Question Implementation  Palliative care is often confused with hospice care and is frequently not offered until there are no more curative treatments available For oncology patients, how does implementing a palliative care teaching checklist compared to not having a checklist impact the number of patients able to teach back the information explaining the meaning of palliative care in a 90-day period?  Incorporate the checklist into admission paperwork to ask each patient at time of admission  Palliative care is defined as “a teambased approach that works to improve the quality of life of patients and their families or caregivers”3  Gauge the patient's knowledge and health literacy level  Provide supplemental education to address knowledge deficits Barriers & Limitations  Palliative care can be used in conjunction with curative treatment and can be initiated at the time of diagnosis  Technical issues with computer network adding the checklist  Early initiation of palliative care showed decreased rates of depression and anxiety and increased quality of life  Lack of time to provide adequate education to each patient  Increased time spent on charting  Compliance of nurses to complete the checklist Difference Between Hospice & Palliative Care Ways to Overcome Barriers Intervention  Create a checklist in the form of questions to address: Quality of life Advanced care planning Symptom management Spiritual needs Psychological needs Definitions of both palliative and hospice care  Provide patient education on these topics as needed        Work closely with information technology  Include staff in decision making process  Assign champions as experts of checklist References 1. Bakitas, M. A., Tosteson, T. D., Li, Z., Lyons, K. D., Hull, J. G., Li, Z., Dionne-Odom, J. N., Frost, J., Dragnev, K. H., Hegel, M. T., Azuero, A., & Ahles, T. A. (2015). Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. Journal of clinical oncology, 33(13), 1438–1445. https://doi.org/10.1200/JCO.2014.58.6362 2. El-Jawahri, A., LeBlanc, T. W., Kavanaugh, A., Webb, J. A., Jackson, V. A., Campbell, T. C., O'Connor, N., Luger, S. M., Gafford, E., Gustin, J., Bhatnagar, B., Walker, A. R., Fathi, A. T., Brunner, A. M., Hobbs, G. S., Nicholson, S., Davis, D., Addis, H., Vaughn, D., Horick, N., … Temel, J. S. (2021). Effectiveness of Integrated Palliative and Oncology Care for Patients With Acute Myeloid Leukemia: A Randomized Clinical Trial. JAMA oncology, 7(2), 238–245. https://doi.org/10.1001/jamaoncol.2020.6343 3. Graul, A., Haggerty, A., Stickley, C., Kumar, P., Morales, K., Bogner, H., Burger, R. A., Morgan, M., & Ko, E. (2020). Effect of patient education on palliative care knowledge and acceptability of outpatient palliative care services among gynecologic oncology patients: A randomized controlled trial. Gynecologic oncology, 156(2), 482–487. https://doi.org/10.1016/j.ygyno.2019.11.023 4. Moroney, M. R., & Lefkowits, C. (2019). Evidence for Integration of Palliative Care into Surgical Oncology Practice and education. Journal of surgical oncology, 120(1), 17–22. https://doi.org/10.1002/jso.25454 5. World Health Organization. (2020, August 5). Palliative care. https://www.who.int/news-room/factsheets/detail/palliative-care 6. Yang, G. M., Teo, I., Neo, S. H., Tan, D., & Cheung, Y. B. (2018). Pilot Randomized Phase II Trial of the Enhancing Quality of Life in Patients (EQUIP) Intervention for Patients With Advanced Lung Cancer. The American journal of hospice & palliative care, 35(8), 1050–1056. https://doi.org/10.1177/1049909118756095 COLLEGE OF NURSING