Doctor of Nursing Practice (DNP) Projects

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Doctor of Nursing Practice

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Family Nurse Practioner

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Palliative care, referral tool, education


Rachel Walker

DNP Project Outside Member Name

Melanie Smith


Background: Referral tools and clustered symptom sets embedded in the electronic health record (EHR) that automatically prompt providers to screen their patients for palliative care consulation have been shown to generate earlier involvement of these vitally-important services. These constellations of patient complaints and characteristics are grouped together to permit pattern recognition within the EHR. The detection of these subgroups by the EHR subsequently triggers an alert for providers to consider consulting the recommendations of the palliative care service. However, many facilities lack these standardized screening triggers, and therefore the consultation of palliative care is based on the referring provider’s understanding of this valuable resource. Providers’ suboptimal knowledge of the palliative care scope of practice, combined with the absence of such standardized, institutional screening procedures, create barriers to the early initiation of palliative care involvement.

Purpose: The following toolkit identifies current tools and approaches designed to guide providers in identifying which patients should be referred to palliative care. The current gaps in research are evaluated, highlighting the areas in which interventions for the recognition of patient populations who might benefit from palliative care services are lacking.

Method: An education-based intervention is used to increase the overall uptake of palliative care services. By expanding referring providers’ knowledge of and comfort with palliative care, project participants will be equipped to appropriately involve this resource without the benefit of an EHR embedded referral trigger system. A pre- and post-intervention survey design is used to assess participants’ comfort with and knowledge of palliative care concepts and goals of care communication. Following the pre-survey and subsequent intervention implementation, posteducation mentoring and support was provided for 8 weeks prior to the post-survey administration.

Results: Pre- and post-survey comparisons depict an increase in both comfort and knowledge regarding palliative care concepts, recognition of patients appropriate for palliative care referral, and approaches to communication during goals of care conversations.

Conclusions: Findings suggest that mid-level provider education on the palliative care scope of practice and communication techniques yields increased comfort with goals of care discussions and knowledge of palliative care concepts.

Implications for Practice: Often the link between the patient, bedside nurse, and other members of a patient’s care team, mid level providers are optimally positioned to advocate for their patients. Increasing understanding of key palliative care components as well as comfort in communication of serious health concerns will aid in increasing the early involvement of palliative care where appropriate.

Key words: Palliative care, referral tool, education, support, early intervention, end of life.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.