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Item Early integration of palliative care in patients with terminal cancer prognosis(Montana State University - Bozeman, College of Nursing, 2024) Martin, Jamie Jo; Chairperson, Graduate Committee: Margaret Hammersla; This is a manuscript style paper that includes co-authored chapters.Cancer ranks as the second leading cause of death in the United States, with a significant portion of patients facing terminal diagnoses and symptom burdens. Despite advancement in cancer treatments, early integration of palliative care remains a challenge, often resulting in delayed referrals and unmet patient needs. This quality improvement initiative focuses on screening all new oncology patients using a distress thermometer tool to identify those suitable for early palliative care involvement. A standardized process is implemented to offer referrals to palliative care services for patients with terminal diagnoses and positive screening results Over a six-week data collection period, 88 new oncology consult appointments were made, with 25% identified as appropriate for palliative care referral. The distress screening tool was completed by an average of 93.3% of patients. Of those appropriate for palliative care, 72.9% were offered a referral, and 43.9% were referred to palliative care. Notably, 100% of referred patients received an initial consult with palliative care within the project timeframe, exceeding the set goals. Early integration of palliative care for terminal cancer patients is crucial for improving quality of life and reducing symptom burden. Standardized screening tools and referral process can facilitate early involvement, although barriers such as patient refusal and provider hesitancy still exist. Effective multidisciplinary communication and patient education are key components in ensuring successful early palliative care integration. Continued efforts in screening, referral, and education are recommended to address these barriers and enhance the quality of care for patients facing terminal cancer diagnoses.Item A pilot implementation of palliative care screening in the primary care setting(Montana State University - Bozeman, College of Nursing, 2022) Johnson, Jordan Mary; Chairperson, Graduate Committee: Susan LuparellPalliative care is described by the World Health Organization (2020) as an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness. With palliative care, patients experience improved quality of life, decreased health care costs, and caregivers experience a greater support system. Despite these benefits, patients in the primary care setting are not being screened for palliative care needs, and therefore the aim of this doctor of nursing practice quality improvement project was formal palliative care screening in the primary care setting. This project was implemented at a primary care clinic with an aging population where before implementation there was no palliative care screening occurring, which made it an optimal clinic to implement screening. A six week implementation period took place between January 6, 2022, and February 24, 2022. Patients aged 70 and older who presented to the clinic for an appointment were screened for palliative care needs using the SPICT screening tool. Findings included: 68% of the patients that fit screening criteria were screened for palliative care needs; of those that were screened, 12% screened positive for palliative care needs; and healthcare staff reported a more than ideal satisfaction with the screening process and screening tool. Project results met two out of three SMART goals, as the goal that 100% of patients who fit screening criteria would be screened was not met, while the goal that the percent of positive would be reported and the goal that staff would have a more than ideal satisfaction with the screening process and tool were met. Though findings paralleled the literature that described the SPICT screening tool as an effective screening tool for palliative care needs and staff reported increased awareness and knowledge on palliative care needs for those patients who would benefit from it. Additionally, there is not enough data to decide implications for the community as a whole related to palliative care needs.Item Screening for palliative care needs in primary care(Montana State University - Bozeman, College of Nursing, 2022) Elverum, McCall Leigh; Chairperson, Graduate Committee: Susan LuparellStatement of the problem. Palliative care is a fast growing, yet underutilized specialty that focuses on patient-perceived needs and goals of care. As the US population becomes older and sicker, the need for palliative care services will only grow. There are a variety of known benefits to early palliative care intervention. Unfortunately, barriers to palliative care referral widely described in the literature are reflected at the local organization. Methods. This project took place at a healthcare organization in Montana. Two primary care teams incorporated a palliative care screening tool into daily huddles for all adult patients with elevated risk scores, according to an internal risk-stratification tool. Using a data collection tool, the care teams recorded screening data including the patient's age, risk score, payer, screening result, whether the patient was referred to palliative care, and the credentials of the screener. A post-intervention verbal debriefing was used to understand the perspectives of the participating care team members and the impact of the screening process at the conclusion of the project. Results. During the six-week data collection period there were 188 high-risk patient encounters. Screening was completed on high-risk patients 43% (n=21) of the time in the first data collection cycle, 63.5% (n=47) of the time in the second data collection cycle, and 82% (n=38) of the time in the final data collection cycle. There were 22 patients with positive screening results, indicating unmet palliative care need. Ultimately, 9 patients were referred to palliative care. Discussion. Though the pilot implementation of the palliative care screening tool did not meet the pre-determined goals, several valuable insights were gained from the project. Barriers to incorporating the screening process included integrating a paper-based process into a primarily digital practice, staffing and other impacts of COVID-19, changes to established workflows and unforeseen procedural issues. The screening tool was found to be acceptable by the project development team and screening for palliative care need was deemed valuable by the care teams. Adjustments for future iterations of this screening protocol were recommended.Item Exploring and clarifying the role of the nurse on the specialty palliative care team(Montana State University - Bozeman, College of Nursing, 2022) Crape, Brooklyn Taylor; Chairperson, Graduate Committee: Denise RiveraPalliative care interdisciplinary teams seek to relieve the pain, stress, and suffering associated with terminal illness. The medical specialty is relatively new, and rapidly developing to attempt to meet the needs of an estimated 6 million Americans coping with a serious illness. Problem: Unfortunately, there is a severe shortage of palliative care professionals, and burnout and dissatisfaction with organizational practices threatens to exacerbate this shortage. Thoughtful use of each interdisciplinary team member's skills is necessary to meet the needs of patients while preserving team satisfaction. Nursing is considered a core role on palliative care interdisciplinary teams, and available evidence suggests nurses positively impact care team satisfaction and the quality of care. However, the palliative care nurse role is under-researched and often misunderstood. The variability of the role across the continuum of care contributes to role misunderstanding. Depending on the setting palliative care nurses may serve as symptom managers, care coordinators, providers of emotional care, team leaders, and/or contributors to quality improvement. This variation requires teams to clarify the role expectations of their palliative care nurses at the microsystem level. Purpose: This quality improvement project aims to create microsystem-specific, evidence-based guidelines for the practice of palliative care nurses on a palliative care interdisciplinary team in western Montana with the goal of increasing care team satisfaction and retention. Methods: A Plan-Do-Study-Act method will be used to guide the project. A committee lead by a clinical nurse leader will facilitate active, interdisciplinary participation in the improvement process. Prior to intervention the interdisciplinary team will complete a Strengths-Weaknesses-Opportunities and-Threats analysis. The nurses will also record their daily activities for one week and complete a role clarity survey. The outcomes of staff satisfaction and improved retention will be assessed with a yearly survey, self-reports at monthly meetings, and repeated role clarity surveys. Recommendations: Since the healthcare environment is ever-changing the quality improvement process should be continuous, and the microsystem specific palliative care nurse guidelines that are created should be considered living documents.Item Improving survivorship care at a community cancer center: a program evaluation(Montana State University - Bozeman, College of Nursing, 2020) Bowen, Melissa Raelene; Chairperson, Graduate Committee: Jennifer SofieSurvivorship care is an opportunity to prepare cancer survivors for living a life impacted by cancer. The physical, psychological, and spiritual effects of cancer goes beyond the days or hours patients have spent receiving treatment. Over a decade ago, the Institute of Medicine created the survivorship care plan (SCP) as a solution for improving care for cancer survivors. The Commission on Cancer (CoC) since adopted the SCP as an accreditation standard which requires SCP delivery to at least 50% of eligible survivors. However, the implementation of SCPs has been challenging as the evidence supporting its use is mixed. There is minimal evidence to support SCPs positively impact patient outcomes, yet, patients report higher satisfaction with survivorship knowledge, find the SCP helpful, and recommend its use. As a result, organizations are confronted with meeting a CoC standard that is difficult to implement and has discordant evidence to support its use. The purpose of this project was to provide a program evaluation for a CoC accredited community cancer center that is committed to improving survivorship care for adult oncology patients. Three objectives were assessed; percentage of SCP delivery completions, evaluation of the SCP and visit with a pre and post survey, and assessment of survivors ongoing needs with a Cancer Impairment Screening Tool. A small case study was also conducted. Between February 1st and July 31st fifty-seven SCP visits were completed, however, only 36 survivorship visits met eligibility criteria making the completion rate 35.6%. The pre and post survey revealed patients had an increase in; knowledge of the SCP visit purpose, available resources, familiarity with treatment side effects, and importance of the visit. There were no reports of unmet needs on the post survey. Survivors most common treatment concerns were numbness in extremities, muscle weakness, fatigue, physical limitations, and sleep difficulties. In conclusion patients find value in the SCP and visit and its use should not be abandoned. It is well understood that survivorship care can be complex. Advancing survivorship care from the sole provision of the SCP to a more individualized process may better address the specific needs of individual cancer survivors.Item Medical cannabis: healthcare professionals' attitudes, perceptions, and behaviors(Montana State University - Bozeman, College of Nursing, 2020) Earle, Kelly A.; Chairperson, Graduate Committee: Sandra Benavides-VaelloBackground: The medical marijuana industry and the sociopolitical atmosphere in which it exists have evolved tremendously over the past decade. However, little is known about the healthcare professionals' attitudes, perceptions, and behavior toward patient use of medical marijuana. In order to understand the legitimacy of medical cannabis in the future of palliative care, it is important to understand the beliefs and perceptions of healthcare professionals. Objectives: The purpose of this scholarly project was to (1) assess the attitudes, perceptions, and behavior of healthcare professionals surrounding medical cannabis through an online survey, (2) provide a live learning opportunity about medical cannabis to staff at an 89-bed rural hospital, and (3) determine if the educational opportunity allowed for staff to feel more comfortable discussing medical marijuana with patients. Methods: A Survey pretest was sent out via email to the staff at Bozeman Health Deaconess Hospital. The largest number of participants were RNs or LPNs (67%, n=103) followed by MDs or DOs (15%, n=23) and NPs (10%, n=16). A live educational opportunity was provided for staff members. Those staff were asked to participate in a post-survey after the educational opportunity. Results: Most of the participants cared for patients who use medical marijuana (n=108, 70%). Furthermore, 13 (64%) MDs/DOs and 13 (67%) NPs/PAs either agree or strongly agree that medical cannabis is a legitimate therapy. Fifty people participated in the live educational opportunity, of which 20 participated in the post-survey. Post-survey demonstrated: 12 (60%) said they felt more comfortable discussing cannabis with patients, five (25%) said they were not more comfortable, and three (15%) said they did not know if they felt more comfortable after the educational opportunity. Discussion: With the growing number of users across the United States, it will be essential that those who work in patient-care areas are able to bring clarity to patients who may be curious about the use of medical cannabis for palliative measures. However, more research is needed, specifically surrounding the longitudinal effects of chronic use of cannabis.