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Congress Abstracts 2006
285
FOSTERING ADVANCE CARE PLANNING IN A HOSPITAL-BASED RADIATION ONCOLOGY PRACTICE. Anita Boucher-Concilio, RN, OCN® , Marie Bakitas, DNSc(c), AOCN® , ARNP, FAAN, and Sarah Usher, RN, MSN, OCN® , Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Patients with potentially life-threatening illness often lack Advance Directives (ADs) that are readily available to their care team. Critical discussions about end-of-life care may not take place until the patient is close to death-- a point of extreme stress. Radiation oncology nurses (RON) are in a key role to assist patients in the development and documentation of ADs.
A quality improvement project which developed an algorithm to increase awareness and availability of oncology patient's documented preferences for care.
Several instances of health crises in radiation patients prompted a desire to raise our departmental staff's awareness of patient's preferences for care-primarily AD. The "ONS Radiation Therapy Documentation Tool and Assessment" (our department's assessment standard) does not assess for the presence of ADs. The nursing staff modified the ONS form to assess for the presence and availability of AD in our computerized clinical information system (CIS). Patients are questioned about AD at the time of the initial nursing assessment -typically a non-emergent setting. If no AD exists, the RON provides a pamphlet describing the rational for ADs, provides the appropriate AD form, and queries the patient regarding their desire for referral to a social worker for further discussion and assistance in completing the forms. Additionally, the Palliative Care Nurse Practitioners have provided education and one-on-one mentoring to assist our RON and staff in AD discussions and documentation procedures.
Retrospective and prospective data from our multimedia record are being collected and analyzed to trend the documentation and actual number of AD in the CIS from September 2005 to March 2006. The first quarter's evaluation has demonstrated an improvement since project implementation.
We anticipate dissemination of these results will influence the expansion of this algorithm within our medical center. We would recommend that the ONS Radiation Oncology Nursing SIG modify the tool incorporate assessment of AD. Ongoing education to increase nurses' comfort with these discussions has been important to the success of this project. RON are important members of the oncology care team and should incorporate these critical discussions with patients and their families into their standard of care.