| Description |
Background: Bone marrow transplant (BMT) patients often experience complex, high-burden symptoms, including pain, fatigue, and emotional distress, which can significantly impact their quality of life. Palliative care, provided by Supportive Oncology Services (SOS), is specialized medical care that focuses on improving symptom management, enhancing patient and family support, and facilitating goals-of-care discussions alongside curative treatments. Despite its well-documented benefits in oncology, BMT patients receive palliative care at significantly lower rates than those with solid tumors, often due to provider misconceptions that it is only for end-of-life care. Enhancing BMT provider awareness of SOS and its role in comprehensive patient management is essential to ensuring timely and appropriate consults, improving patient outcomes, reducing unnecessary suffering, and fostering better communication between patients, families, and their care teams. Local Problem: Before the intervention, registered nurses (RNs) and advanced practice clinicians (APCs) demonstrated limited awareness and confidence in initiating SOS consults and recognizing patients who could benefit from SOS involvement. Additionally, there was minimal engagement from physicians and challenges in implementing an IT-driven trigger tool further complicated comprehensive screening efforts. Methods: Guided by the PDSA cycle and the Johns Hopkins Evidence-Based Practice Model, the project used an iterative process to improve awareness of SOS and increase consults. A pre-and post intervention survey design was utilized to assess changes in RN/APC awareness, confidence, and consult behaviors related to SOS. The study measured outcomes, including the rate of initiating palliative care consults, the confidence in identifying suitable patients for SOS consults, and the overall belief in the benefits of enhanced SOS involvement. Interventions: A structured education session focusing on the role of SOS in managing BMT patients across various stages of disease was developed and delivered to RNs/APCs. Although an IT-driven trigger tool was planned to automate screening and trigger consults, its deployment was delayed due to interdepartmental and IT-related challenges. The education session was designed to empower frontline providers with the knowledge and skills to integrate SOS involvement more effectively into their practice. Results: Post-intervention survey results indicated a 16.4% increase in the RN/APC self-reported initiation of SOS consults, a 19.8% increase in confidence in recognizing patients who might benefit from SOS consults, and a 2.5% increase in the belief that patients would benefit from enhanced SOS involvement. These improvements highlight the positive impact of the educational intervention on RN/APC practices. However, the project faced challenges, including the non-implementation of the IT tool and limited physician engagement, which suggests that further refinement and targeted strategies are necessary to achieve broader implementation. Conclusion: The structured education session enhanced RN/APC awareness and confidence in utilizing SOS services for BMT patient care, leading to measurable improvement in consult behaviors. While the intervention shows promise in improving patient management, addressing IT integration challenges and increasing physician engagement will be critical for sustainable impact and broader applicability. Future initiatives should focus on these areas to optimize provider workflows and extend the benefits of the intervention across diverse clinical settings. |
