Graduation Semester and Year
Summer 2024
Language
English
Document Type
Dissertation
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Kristine Cope
Abstract
Context: Early serious illness conversations related to end-of-life and goals of care with seriously ill patients have been associated with improving patients' outcomes and quality of care (Bernacki et al., 2015). However, initiating these serious illness discussions has been challenging in the home-based primary care setting.
Objectives: To train and support home-based primary care clinicians in integrating best practices in serious illness discussions and decision-making engagement among patients sixty-five and older with serious illnesses, optimize the alignment between patient goals and the medical care they receive, improving their quality of life and the rate of palliative care and hospice referrals.
Methods: A pragmatic before-and-after quality improvement descriptive pilot study design analyzed data survey to gauge clinicians' confidence levels and capability to initiate serious illness discussions. A qualitative survey was used to collect clinicians' responses to highlight the importance of on goal-based communication skills education and training. Palliative care and hospice referral rates data were collected six months before implementing the prognosticator algorithm bundle and compared to the data for the 8-week change intervention period and after. The methodology for the quality improvement project was explained to all clinicians, and weekly sessions with clinicians were held to safeguard proper training and education on serious illness discussions via PowerPoints, handouts, brochures, flyers, and videos. Monthly data collection was conducted from QuestionPro and the Regional Director of Operations for palliative care and hospice. A t-test and analysis of variance were used to assess the effectiveness of the Prognosticator Algorithm Bundle. The data were analyzed using QI Macros 2024 software.
Results: Seven Clinicians' level of confidence in the initiation of serious illness discussions were collected in an independent samples t-test comparing pre-test and post-test mean and variance of the goal-based communication skills training intervention, which showed a significant increase in confidence and independence in the initiation of serious illness discussions with t = 2.447, df = 6, 95% Cl, P < 0.0001. One hundred twenty-three patients with an average age of 77.7±14.2 years participated in this study. The intervention showed a significant change in the rate of referrals to both palliative and hospice using analysis of variance (ANOVA)- (F= 76.96; P= 0.00001) as well as hospice referral rate (F= 9.127; P= 0.02336). This difference is considered to be extremely statistically significant.
Conclusion: According to the findings of this study, there is a relative increase in serious illness discussions when clinicians are trained and educated on goal-based communication skills — indicating a direct relationship between the two variables. Home-based primary care clinicians' readiness for advance care planning increases the rate of palliative care and hospice referrals. Therefore, implementing the use of prognosticator algorithm bundle intervention to improve the readiness of the home-based community clinicians on advance care planning through early initiation of serious illness discussions results in an increased rate of palliative care and hospice referrals and improved quality of life by providing patient-centered and family-focused care through palliative care and hospice services.
Keywords
Serious illness, Advance care planning, Palliative care, Hospice, End of life, Goals of care
Disciplines
Adult and Continuing Education | Alternative and Complementary Medicine | Community College Leadership | Exercise Physiology | Homeopathy | Interprofessional Education | Medical Humanities | Nursing | Other Life Sciences | Other Pharmacology, Toxicology and Environmental Health | Other Physiology | Pharmacy and Pharmaceutical Sciences | Physical Sciences and Mathematics | Psychiatry and Psychology | Public Health | Quality Improvement | Social and Behavioral Sciences | Speech Pathology and Audiology
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Isebor, Joy, "Implementation of Prognosticator Algorithm for Initiation of Serious Illness Discussions and Improving the Rate of Palliative and Hospice Referrals" (2024). Doctor of Nursing Practice (DNP) Scholarly Projects. 65.
https://mavmatrix.uta.edu/nursing_dnpprojects/65
Included in
Adult and Continuing Education Commons, Community College Leadership Commons, Exercise Physiology Commons, Homeopathy Commons, Interprofessional Education Commons, Medical Humanities Commons, Nursing Commons, Other Life Sciences Commons, Other Pharmacology, Toxicology and Environmental Health Commons, Other Physiology Commons, Pharmacy and Pharmaceutical Sciences Commons, Physical Sciences and Mathematics Commons, Psychiatry and Psychology Commons, Public Health Commons, Quality Improvement Commons, Social and Behavioral Sciences Commons, Speech Pathology and Audiology Commons