A Palliative Nurse Practitioner Intervention to Improve Advance Care Planning and Supportive Care in Patients with Advanced Cancer

Topic: Quality Advance Care Planning

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The simultaneous care model for palliative care provides high quality care for patients with serious illness.  Unfortunately, the U.S. healthcare system falls short of this goal, even in patients with advanced cancer.  As the first phase of a system-wide advance care planning program, we used implementation science methods to test if a nurse practitioner (NP) with structured palliative care training using evidenced-based principles of communication and a model that cultivates prognostic awareness with palliative care physician oversight can improve the quality of care provided to patients with advanced cancer in an academic health system.  The intervention was evaluated using electronic health record data to compare rates of advance care planning and hospice referral for patients with advanced cancer seen by two target oncologists compared to all other advance cancer patients in clinics without NP intervention.  There were no differences in these measures at baseline, but after one year of the program, data suggests that this model of palliative care delivery increased rates of advance care planning among advanced cancer patients (30% v. 17%, p < 0.05) and hospice enrollment among decedents (53% v. 23%).  Improved payment models are needed to help sustain and grow programs of outpatient palliative care delivery.


  • Anne Walling, MD, PhD
  • Assistant Professor in Residence
  • University of California, Los Angeles
  • 911 Broxton Ave
  • Los Angeles, CA 90095


  • Andrew Hackbarth
  • Anne Coscarelli
  • Anne Coscarelli
  • Ann Zisser
  • Bruce Ferrell
  • Christopher Pietras
  • Frances Watts
  • Jennifer Malin
  • Neil S. Wenger
  • Robin Clarke
  • Sarah D’Ambruoso
  • Sarah Hurvitz
  • Thomas Pier
  • Thomas Strouse

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