Giving Voice to Patient Values Throughout Cancer: A Novel Nurse-Led Intervention

Abstract Context Optimal advance care planning allows patients to articulate their values as a touchstone for medical decision-making. Ideally, this occurs when patients are clinically stable, and with opportunities for iteration as the clinical situation unfolds. Objectives Testing feasibility and acceptability in busy outpatient oncology clinics of a novel program of systematic, oncology nurse-led values discussions with all new cancer patients. Methods Within an institutional initiative integrating primary and specialist palliative care from diagnosis for all cancer patients, oncology nurses were trained to use specific questions and an empathic communication framework to discuss health-related values during outpatient clinic visits. Nurses summarized discussions on a template for patient verification, oncologist review, and electronic medical record documentation. Summaries were reviewed with the patient at least quarterly. Feasibility and acceptability were evaluated in three clinics for patients with hematologic or gastrointestinal (GI) malignancies. Results Oncology nurses conducted 177 total discussions with 67 newly-diagnosed cancer patients (17 with hematologic and 50 with GI malignancies, respectively) over 2 years. No patient declined participation. Discussions averaged 8 minutes and all patients verified Values Summaries. Clinic patient volume was maintained. Of 31 patients surveyed, 30 (97%) reported feeling comfortable with the process, considered it helpful, and would recommend it to others. Clinicians strongly endorsed the values discussion process. Conclusion Nurse-led discussions of patient values soon after diagnosis are feasible and acceptable in busy oncology clinics. Further research will evaluate the impact of this novel approach on additional patient-oriented outcomes following broader dissemination of this initiative throughout our institution.