Giving voice to patient values throughout cancer: A novel nurse-led intervention Journal Article


Authors: Epstein, A. S.; Desai, A. V.; Bernal, C.; Romano, D.; Wan, P. J.; Okpako, M.; Anderson, K.; Chow, K.; Kramer, D.; Calderon, C.; Klimek, V. V.; Rawlins-Duell, R.; Reidy, D. L.; Goldberg, J. I.; Cruz, E.; Nelson, J. E.
Article Title: Giving voice to patient values throughout cancer: A novel nurse-led intervention
Abstract: 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. © 2019 American Academy of Hospice and Palliative Medicine
Keywords: nursing; patient participation; communication; advance care planning; cancer
Journal Title: Journal of Pain and Symptom Management
Volume: 58
Issue: 1
ISSN: 0885-3924
Publisher: Elsevier Inc.  
Date Published: 2019-07-01
Start Page: 72
End Page: 79.e2
Language: English
DOI: 10.1016/j.jpainsymman.2019.04.028
PUBMED: 31034869
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 July 2019 -- Source: Scopus
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MSK Authors
  1. Virginia Klimek
    116 Klimek
  2. Diane Lauren Reidy
    165 Reidy
  3. Andrew Saul Epstein
    78 Epstein
  4. Kimberly Chow
    16 Chow
  5. Judith Eve Nelson
    34 Nelson
  6. Peter Justin Wan
    10 Wan
  7. Anjali Varma Desai
    9 Desai
  8. Dana Shulamith Kramer
    6 Kramer
  9. Elizabeth Maria Cruz
    2 Cruz
  10. Danielle Rae Romano
    6 Romano
  11. Camila Bernal
    3 Bernal
  12. Molly Okpako
    4 Okpako