Implementation and assessment of an advanced practice nurse-led early palliative care initiative for patients with advanced pancreatic cancer.

Abstract

262 Background: Early palliative care (EPC) referral reduces health care costs and improves quality of life and survival in some advanced cancers. Barriers to EPC exist. In April 2022, our provincial cancer centre (CCMB) implemented a clinical nurse specialist (CNS)-led intervention for patients with advanced pancreatic cancer (PANC), circumventing known barriers. New PANC referrals received at the provincial centralized referral office are triaged by an oncologist and concurrently referred to the CNS. CNS consultation focuses on physical and psychological symptoms, medication review, patient and family coping, and goals of care. Education is provided on PANC diagnosis, prognosis, symptoms, potential treatment options, navigating the cancer system, and community palliative care/hospice supports, with close collaboration with the patient’s primary care provider. This study reports on the impact of the CNS role and patient perceptions of this role on patient-centered care. Methods: We compared patients with PANC in the pre-implementation period (Jan 1, 2021, to December 31, 2021) to the post-implementation period (April 1, 2022, to March 31, 2023). Patients were identified using the Manitoba Cancer Registry and the CNS clinical database. Descriptive statistics were used to report quality measures. Results of patient reported perception of patient-centered care during the post-implementation period will also be reported. Results: In the pre-implementation period, 83 patients were referred to CCMB with PANC. In the post implementation period, 135 patients were referred. 125 (93%) accepted a consultation with the CNS, with a median time to meeting of 5 days (range, 0-18). After CNS consultation, 35% declined biopsy, oncology appointment or both. In the pre-implementation period, 29 (55%) patients were referred to palliative care/hospice within 8 weeks of diagnosis, compared to 66 (77%) in the post-implementation period. The mean time to palliative care referral was 18.2 weeks pre-implementation vs 8.0 weeks post-implementation (p=0.0007). Data on number of diagnostic biopsies, medical oncology consultations, and receipt of chemotherapy are in the attached table. Conclusions: This novel approach of CNS assessment and education soon after diagnosis of PANC, at the time of referral to CCMB, is acceptable to patients. It results in increased early referral to community-based palliative care/hospice. Exploring patient goals early may also spare patients from treatments that are time-consuming and associated with adverse effects, allowing those with a life limiting illness to focus on quality of life.[Table: see text]