Giving Voice to Patient Values Throughout Cancer: A Novel Nurse-Led Intervention.

Autor: Epstein AS; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA. Electronic address: epsteina@mskcc.org., Desai AV; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA., Bernal C; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Romano D; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Wan PJ; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Okpako M; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Anderson K; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Chow K; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Kramer D; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Calderon C; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Klimek VV; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA., Rawlins-Duell R; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Reidy DL; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA., Goldberg JI; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Cruz E; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Nelson JE; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA.
Jazyk: angličtina
Zdroj: Journal of pain and symptom management [J Pain Symptom Manage] 2019 Jul; Vol. 58 (1), pp. 72-79.e2. Date of Electronic Publication: 2019 Apr 26.
DOI: 10.1016/j.jpainsymman.2019.04.028
Abstrakt: Context: Optimal advance care planning allows patients to articulate their values as a touchstone for medical decision making. Ideally, this occurs when patients are clinically stable, and with opportunities for iteration as the clinical situation unfolds.
Objectives: Testing feasibility and acceptability in busy outpatient oncology clinics of a novel program of systematic, oncology nurse-led values discussions with all new cancer patients.
Methods: Within an institutional initiative integrating primary and specialist palliative care from diagnosis for all cancer patients, oncology nurses were trained to use specific questions and an empathic communication framework to discuss health-related values during outpatient clinic visits. Nurses summarized discussions on a template for patient verification, oncologist review, and electronic medical record documentation. Summaries were reviewed with the patient at least quarterly. Feasibility and acceptability were evaluated in three clinics for patients with hematologic or gastrointestinal malignancies.
Results: Oncology nurses conducted 177 total discussions with 67 newly diagnosed cancer patients (17 with hematologic and 50 with gastrointestinal malignancies) over two years. No patient declined participation. Discussions averaged eight minutes, and all patients verified values summaries. Clinic patient volume was maintained. Of 31 patients surveyed, 30 (97%) reported feeling comfortable with the process, considered it helpful, and would recommend it to others. Clinicians strongly endorsed the values discussion process.
Conclusion: Nurse-led discussions of patient values soon after diagnosis are feasible and acceptable in busy oncology clinics. Further research will evaluate the impact of this novel approach on additional patient-oriented outcomes after broader dissemination of this initiative throughout our institution.
(Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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