Date of Award

2022-05-28

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN Chair; Caroline Etland, PhD, RN, ACHPN Committee Member; Laurie Ecoff, PhD, RN, NEA-BC Committee Member

Keywords

Palliative Care, Advanced Stage Cancer, Colon cancer, Lung Cancer, Rectal Cancer

Abstract

Background: Despite lung, colon, and rectal cancer being the leading and third leading cause of cancer-related death among both men and women respectively, few studies have examined Palliative Care Consultation (PCC) on healthcare utilization (HCU) in individuals with advanced stage diagnosis in this disease cohort. Extant research shows advanced stage cancer patients receive aggressive treatments, within the last 30 days of life. Palliative care is linked to less aggressive cancer treatment, and palliative interventions applied early, at diagnosis of advanced cancer, is more favorable for improving symptom and disease management. Patients and family members with early PCC are better informed about treatment directives and end-of-life decisions. The American Nurses Association (ANA, 2017) recommends discussions of PC begin at diagnosis of a chronic illness; American Society for Clinical Oncology (ASCO, 2012) guidelines recommend PCR within 8 weeks of advanced cancer diagnosis.

Purpose: The purpose of this study was to examine the relationship among select socio-demographics, participant clinical characteristics, PCC time, healthcare utilization, and PCC to death for patients with PCC compared to no PCC, in a cancer patient cohort at an advanced stage in their disease process.

Methods: Descriptive correlational design using retrospective EHR data collected within the calendar year 2019-2020. Descriptive and inferential approaches were utilized to analyze the data.

Results: Bronchus/lung cancer, accounted for 74.7% (n = 71) of the sample; colon, rectosigmoid junction accounted for 25.3% (n = 24). Eighty percent (n = 76) of the participants had been diagnosed with stage IV and 20% (n = 19) stage III cancer. The average number of days from first PCC to death was 10 days, inferring that PC was being utilized as hospice. Participants with stage IV diagnosis had less days from diagnosis to death. For patients with PCC, time from diagnosis to death was 445 days (n = 85), compared to 320 days for those with no PCC (n = 10). Also, participants who were White had more days from diagnosis to death, compared to those who were Hispanic or “other race;” and White participants were also more likely to get PCC. Overall, average number of ED, hospital, and clinic visits during the study period (3.72 visits) was reduced after PCC (0.16 visits); average acute care LOS (6.97 days) was reduced after PCC (0.76 days); and average ICU LOS for the study period (4.55 days) was reduced after PCC (0.51 days). However, none of the participants got PCC at the recommended time; at diagnosis or within 8 weeks of diagnosis.

Implications for Nursing Research: All clinicians who care for patients with chronic illnesses need to become more confident in having PC discussions with patients and advocating for physicians to do the same. State regulatory agencies need to ensure this by requiring mandatory EOL classes for licensure renewal, mandating the inclusion of more PC and EOL courses in nursing and medical curriculum. To ensure timely referrals and consults, health systems should implement a referral criterion for patients with advanced cancer diagnosis that automates a trigger system; this will ensure PCR and PCC is initiated outside of physician discretion; and remove the possibility of inequity in the referral process. Centers for Medicare, and Medicaid Service can build value-based reimbursement into existing programs to ensure dual-eligibility, not only by diagnosis of specific diseases. Preventable hospital admissions are often a consequence of poorly managed transitions in the illness trajectory, and delayed PCC leads to burdensome transitions for patients and their families.

Document Type

Dissertation: Open Access

Department

Nursing

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