Implementation and assessment of an advanced practice nurse-led early palliative care initiative for patients with advanced pancreatic cancer.
Notice bibliographique
Résumé
262 Background: Early palliative care (EPC) referral reduces health care costs and improves quality of life and survival in some advanced cancers. Barriers to EPC exist. In April 2022, our provincial cancer centre (CCMB) implemented a clinical nurse specialist (CNS)-led intervention for patients with advanced pancreatic cancer (PANC), circumventing known barriers. New PANC referrals received at the provincial centralized referral office are triaged by an oncologist and concurrently referred to the CNS. CNS consultation focuses on physical and psychological symptoms, medication review, patient and family coping, and goals of care. Education is provided on PANC diagnosis, prognosis, symptoms, potential treatment options, navigating the cancer system, and community palliative care/hospice supports, with close collaboration with the patient’s primary care provider. This study reports on the impact of the CNS role and patient perceptions of this role on patient-centered care. Methods: We compared patients with PANC in the pre-implementation period (Jan 1, 2021, to December 31, 2021) to the post-implementation period (April 1, 2022, to March 31, 2023). Patients were identified using the Manitoba Cancer Registry and the CNS clinical database. Descriptive statistics were used to report quality measures. Results of patient reported perception of patient-centered care during the post-implementation period will also be reported. Results: In the pre-implementation period, 83 patients were referred to CCMB with PANC. In the post implementation period, 135 patients were referred. 125 (93%) accepted a consultation with the CNS, with a median time to meeting of 5 days (range, 0-18). After CNS consultation, 35% declined biopsy, oncology appointment or both. In the pre-implementation period, 29 (55%) patients were referred to palliative care/hospice within 8 weeks of diagnosis, compared to 66 (77%) in the post-implementation period. The mean time to palliative care referral was 18.2 weeks pre-implementation vs 8.0 weeks post-implementation (p=0.0007). Data on number of diagnostic biopsies, medical oncology consultations, and receipt of chemotherapy are in the attached table. Conclusions: This novel approach of CNS assessment and education soon after diagnosis of PANC, at the time of referral to CCMB, is acceptable to patients. It results in increased early referral to community-based palliative care/hospice. Exploring patient goals early may also spare patients from treatments that are time-consuming and associated with adverse effects, allowing those with a life limiting illness to focus on quality of life.[Table: see text]
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».