Nurse-Led Palliative Care Intervention Improves ACP in Patients With Advanced Cancer

A nurse-led primary palliative care intervention was associated with higher rates of advance care planning (ACP) uptake among patients with advanced cancer. These findings were published in the Journal of the National Comprehensive Cancer Network.

Establishing ACP allows patients to maintain control at the end of their lives when they may not be able to understand or engage in complex medical decision making. However, uptake of ACP often occurs late in a patient’s disease course, or not at all.

This study was a secondary analysis of data from Cluster Randomized Trial of a Primary Palliative Care Intervention (CONNECT) with the aim of assessing whether a nurse-led intervention improved ACP uptake. To that end, completion of ACP, defined as an end-of-life conversation (EOLC) with their oncologist or completion of an advanced directive (AD), was evaluated in 378 of 672 enrolled patients with advanced cancer who either received monthly primary palliative care visits with nurses (182 patients) or standard care (196 patients).

The patients were a mean age 69.1 (SD, 10.3) years, 55.6% were women, 95.2% were White, 34.9% had lung cancer, 19.6% gastrointestinal cancer, and 18.8% breast or gynecologic cancers. At baseline, 111 in the intervention arm and 105 in the standard care arm did not have an AD.

The nurse-led intervention increased the likelihood of having an EOLC with their oncologist (adjusted odds ratio [aOR], 5.28; 95% CI, 3.10-8.97; P <.001) and completing a new AD (aOR, 3.68; 95% CI, 1.89-7.16; P <.001) by 3 months compared with standard care.

This study may have been limited, as the primary outcome of the CONNECT trial was to assess quality of life and not ACP.

“[A] nurse-led primary palliative care intervention improves ACP uptake … among patients with advanced cancer. Nurse-led primary palliative care is a promising approach to improve ACP among patients with advanced cancer,” concluded the study authors.

Reference

Cohen MG, Althouse AD, Arnold RM, et al. Primary palliative care improves uptake of advance care planning among patients with advanced cancers. J Natl Compr Canc Netw. 2023;21(4):383-390. doi:10.6004/jnccn.2023.7002