Abstract Purpose For individuals with cancer, palliative care improves quality of life, mood, and survival. Rural residents experience limited access to palliative care. In eastern North Carolina, a rural area, little is known about access to inpatient cancer‐related palliative care. This study describes access to inpatient palliative care and developed a predictive model of who was most likely to be admitted to an inpatient facility without a palliative care provider. Methods A descriptive, exploratory design was used to examine demographics, clinical variables, and inpatient admissions from 2017 and 2018, in a major regional teaching hospital system that included 8 hospitals (7 rural hospitals). Descriptive statistics and a binary logistic regression were used to analyze data. Findings The mean age was 62.2 years (N = 2,161, range: 18‐88, SD = 15.52): 49.4% were female, 54% lived in a rural county, and 44.4% were black. The outlying rural hospitals, with no palliative care providers on staff, had 388 admissions (18%). Only gender ( P = .0128), county ( P < .0001), and age ( P < .05) contributed to the logistic model. The predicted probability of being admitted to an inpatient facility with a palliative care provider is higher for younger males living in urban counties. That probability decreases with age regardless of the gender or type of county. Conclusions These findings highlight the limited availability of inpatient palliative care for those with cancer. Women, older adults, and rural residents are more likely to be admitted to 1 of the 7 rural hospitals with no palliative care provider on staff.
ABSTRACT Purpose: A palliative care infrastructure is lacking for Latinos with life-threatening illness, especially in rural regions of the United States. The purpose of this study was to develop and evaluate a community-based palliative care lay health advisor (LHA) intervention for rural-dwelling Latino adults with cancer. Methods: An exploratory mixed-methods participatory action research design was carried out by an interprofessional research team that included community and academic members. Fifteen Latino community leaders completed a 10-hour palliative care training program and then served as palliative care LHAs. Although 45 Latinos with cancer initially agreed to participate, four withdrew or died and six were not reachable by the LHAs, for a final total of 35 patient participants. The trained palliative care LHAs delivered information on home symptom management and advance care planning to assigned participants. Palliative care nurses led the training and were available to the LHAs for consultation throughout the study. The LHAs made an average of three telephone calls to each participant. The Edmonton Symptom Assessment System–Revised (ESAS-r) and the four-item Advance Care Planning Engagement Survey (ACPES-4) were administered pre- and postintervention to determine the intervention's effectiveness. Encounter forms were transcribed, coded, and analyzed using case comparison. Results: The major finding was that significant improvements were shown for all four items of the ACPES-4 among both the LHAs (posttraining) and the participants (postintervention). Information on advance care planning was shared with 74.3% of the 35 participants. Participants showed clinical improvement in physical symptom scores and clinical deterioration in emotional symptom scores following the intervention, although these changes did not reach statistical significance. The advisors noted that participants were anxious about how to explain cancer to children, the uncertainty of their prognosis, and medical expenses. This sample was younger than those of other cancer studies; 51.4% were under age 50 and 73.1% had at least one child in the home. Conclusions: A community-based palliative care LHA–nurse partnership was shown to be a feasible way to engage in conversations and deliver information about advance care planning to rural-dwelling Latino adults with cancer. The positive results led to the regional cancer center's decision to select “cultural care” as its 2022 goal for maintaining its accreditation with the Commission on Cancer.
To educate generalists for work with older adults, geriatric specialists will increasingly be used as educators and consultants. Recent work found many Geropsychologists felt well trained as clinicians and researchers, but they did not feel as prepared to educate; further few choose primarily educational careers. To address these issues, Geropsychologists from the VA and University partnered to develop a national webinar entitled “Advancing your Confidence as an Educator in geriatrics and gerontology” 9/2017 to 5/2018. Monthly session attendance ranged between 40–70 individuals. On average, 69% of attendees were psychologists, 13% were nurses, and 13% were social workers; 74% of attendees reported specialty training in aging, 14% reported some training in aging, and 12% reported no training in aging. 45% were faculty/staff in hospital settings, 28% were faculty/staff in academic settings, and 23% were students/trainees. In our presentation we will describe the development and implementation of the webinar in further detail.
Leadership succession planning is an extremely important exercise for individuals and organizations to prepare for ambulatory health care in the future. There are several opportunity points and approaches to consider for identifying emerging leaders and developing leaders. Ambulatory care nurses should consider their own potential for leadership and take steps to develop their leadership competencies.
In this symposium we share experiences developing, using, and evaluating innovative methods for engaging learners in geriatrics education across disciplines. In our first talk, Powers and colleagues present multiple technologic innovations to manage diverse learners, including a phone app, a web based learning tool, and a video-based system for teaching and evaluation. Kresevic and colleagues present data on 80+ learners on the use of simulation as part of a multi-modal delirium education intervention. Garner describes the use of the team as an educational tool including individual and team based assessment and activities in learning focusing on palliative care. Nathan and Schwartz provide two examples of engaging Harvard Medical School trainees in geriatrics through the arts and humanities, with results from 170 learners. Amir describes the implementation of a geriatrics curriculum at a Indian Health Services site using multi-modal techniques. In view of the geriatric workforce shortage, there will not be enough geriatric trained professionals to meet the healthcare needs of older adults. Therefore geriatric professionals will have increasing roles as educators to students, staff, patients, and families. This symposium provides an up to date overview and outcome evaluation of the wide ranging platforms and possibilities for engaging learners in geriatric education.
Early integration of palliative care after a diagnosis of cancer improves outcomes, yet such care for Latino populations is lacking in rural regions of the United States. We used a participatory action research design with Latino community leaders from emerging immigrant communities in North Carolina to explore sociocultural perspectives on cancer and death. Thematic analysis was conceptualized as Four Kinds of Hard represented by four themes: Receiving an Eviction Notice, Getting in the Good Book, Talking is (Sometimes) Taboo, and Seeing Their Pain Makes us Suffer. These themes captured fears of deportation, coping with cancer through faithfulness, ambivalence about advance care planning, and a desire to spare families from suffering. Findings suggest strategies to improve conversations about end-of-life wishes when facing advanced illness and death. This study demonstrates the importance of training Latino community leaders to improve palliative care and bridge service gaps for Latino families living in emerging rural communities.
Lung cancer, most often diagnosed at an advanced stage, is the leading cause of cancer-related death in the United States (American Cancer Society [ACS], 2018). The five-year relative survival rate for an individual diagnosed with lung cancer is between 4.5% and 8% (Dillman & McClure, 2014), and the median survival time for those with advanced disease is eight months (Dillman & McClure, 2014; Schiller et al., 2002).
Ambulatory care faces challenges in sustaining a nursing workforce in the future as newly licensed nurses are heavily recruited to inpatient settings and retirements will impact ambulatory care sooner than other areas. Building a diverse team by recruiting nurses of different ages (generations) and skills may result in a more successful and robust organization. Knowledge about generational characteristics and preferences will aid nurse leaders and recruiters in attracting high-quality, talented nurses. Nurses of Generations X and Y can increase their likelihood of success in ambulatory care by better understanding intergenerational issues.
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