Advance care planning (ACP) involves communication with the patient, his or her family and/or caregivers, and the healthcare team to plan for the future and promote shared decision making that incorporates patient preferences. Guidelines from the American Society of Clinical Oncology and National Comprehensive Cancer Network recommend that ACP discussions take place within three months of a diagnosis of incurable cancer; however, ACP conversations may not occur because patients, family members, and providers each wait for the other to initiate the discussion.
Although the conversations can be difficult for all parties, a study found that nurse-initiated ACP can help patients complete advanced directives (AD) and reflect on their wishes. Poonam Goswami, MS, APRN, OCN®, FNP, Sabrina Mikan, PhD, RN, ACNS-BC, and Lalan Wilfong, MD, presented the results in “Advanced Practice Nurse-Initiated Advance Care Planning and Successful Completion of Advance Directives in a Community Oncology Practice” as part of the e-poster sessions on November 2 and 3 during the 2018 JADPRO Live conference in Hollywood, FL.
Researchers adopted the My Choices, My Wishes (MCMW) ACP program in a community oncology practice led by an advance practice RN (APRN) who was trained in ACP counseling. A total of 245 ACP counseling sessions occurred between March and October 2017, including a population of patients with gynecologic cancer and medical oncology who were undergoing treatment. ACP counseling was voluntary and took place in one to two visits, depending on patient ACP readiness.
During the first visit, the APRN used the Patient Values and Goals for Healthcare (PVA) questionnaire, which addresses quality of life, healthcare values, and preferences for life-sustaining interventions. The APRN also introduced patients to the medical power of attorney (MPOA) and directive to physicians AD. Patients could then complete their ADs or make another counseling appointment.
ACP conversations led by the APRN resulted in 96.87% completion of MPOA, 96.87% completion of directive to physicians, and 5% completion of out-of-hospital do not resuscitate instructions.
At the first ACP visit, 161 patients were introduced to the MCMW ACP program, of which 44.7% completed both ADs. Among those who opted for a second ACP visit, 84 patients (52.17%) completed their AD documents. Only 3.13% of the few patients who did not return for a second visit completed the PVA questionnaire. Every patient who had a second visit completed the MPOA and directive to physicians.
“The avoidance of end-of-life communication has many inherited negative outcomes for patients and their families,” the researchers noted. “Initiatives from APRNs can help the patients to understand the values and goals of care for their advanced stage cancer.”