Integration of an APP-Led Supportive and Palliative Oncology Care Program: A Quality Improvement Project

Abstract

Patients with advanced cancer have been found to demonstrate severe symptoms and low quality of life at diagnosis; therefore, it is imperative that they have early access to palliative care services along the continuum of care. Oncology advanced practice providers are uniquely poised to serve as champions for primary palliative care integration within their practice. The purpose of this quality improvement project was to develop and implement an APP-led supportive and palliative oncology care (SPOC) program within routine cancer care. The project design utilized the Plan-Do-Study-Act (PDSA) methodology as the guiding framework for development, implementation, and analysis of the SPOC program. Across 49 participants, there were a total of 239 SPOC encounters during the studied period. Participants had a mean of 4.9 visits (SD = 3.5) with the APP. There was a high prevalence of patient-reported symptom burden, the most frequent of which included pain at 44 (90%), fatigue at 36 (74%), appetite loss at 29 (59%), and weakness at 27 (55%) instances. Ninety-four percent of participants (n = 46) had a structured and documented goals of care conversation with the APP during their participation within the program. A total of seven patients completed their advance directives while receiving SPOC care, which was a 25% completion rate. There was a significant demand for interdisciplinary resources (n = 136). Integration of SPOC principles into routine oncology practice is an opportunity to improve the patient and family experience while demonstrating the value of APPs at the clinical and organizational level.

Figure 1

SWOT analysis. IDT = interdisciplinary team; ARNP = advanced registered nurse practitioner.

Figure 2

Supportive and palliative oncology care encounters (n = 239).

Figure 3

Interdisciplinary referrals (n = 136). PT = physical therapy; OT = occupational therapy; ST = speech therapy; ortho = orthopedics; DWD = Death with Dignity.