An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial.

BACKGROUND: Early palliative care provided through a palliative care consultative service is effective in enhancing patient outcomes. However, it is unknown whether the integration of palliative care as part of routine comprehensive cancer care improves patients' self-reported clinical outcomes. OBJECTIVE: The objective of this study was to evaluate the effects of a multidisciplinary coordinated intervention by advanced practice nurses at the clinic level on outcomes with patients newly diagnosed with late-stage cancer. METHODS: A clustered, randomized, controlled trial design was used. Four disease-specific multidisciplinary clinics were randomized to the 10-week intervention (gynecologic and lung clinics) or to enhanced usual care (head and neck and gastrointestinal clinics). Patient primary outcomes (symptoms, health distress, depression, functional status, self-reported health) were collected at baseline and one and three months, and secondary outcomes were collected one and three months postbaseline. General linear mixed model analyses with a covariance structure of within-subject correlation was used to examine the intervention's effect. RESULTS: The sample included 146 patients with newly diagnosed late-stage cancers. We found no differences between the two groups on the primary patient-reported outcomes at one and three months postbaseline; however, physical and emotional symptoms remained stable or significantly improved from baseline for both groups. Overall, secondary outcomes remained stable within the groups. CONCLUSION: In this translational study, we demonstrated that if patients newly diagnosed with late-stage cancer were managed by disease-specific multidisciplinary teams who palliated their symptoms, providing whole-patient care, patient outcomes remained stable or improved.

Using online learning and interactive simulation to teach spiritual and cultural aspects of palliative care to interprofessional students.

BACKGROUND: To meet the complex needs of patients with serious illness, health professional students require education in basics aspects of palliative care, including how to work collaboratively on an interprofessional team. OBJECTIVES: An educational program was created, implemented, and evaluated with students in medicine, nursing, chaplaincy, and social work. Five learning objectives emphasized spiritual, cultural, and interprofessional aspects of palliative care. DESIGN: The program blended two sequential components: an online interactive, case-based learning module, and a live, dynamic simulation workshop. MEASUREMENTS: Content analysis was used to analyze students' free-text responses to four reflections in the online case, as well as open-ended questions on students' postworkshop questionnaires, which were also analyzed quantitatively. RESULTS: Analysis of 217 students' free-text responses indicated that students of all professions recognized important issues beyond their own discipline, the roles of other professionals, and the value of team collaboration. Quantitative analysis of 309 questionnaires indicated that students of all professions perceived that the program met its five learning objectives (mean response values>4 on a 5-point Likert scale), and highly rated the program and its two components for both educational quality and usefulness for future professional work (mean response values approximately>4). CONCLUSIONS: This innovative interprofessional educational program combines online learning with live interactive simulation to teach professionally diverse students spiritual, cultural, and interprofessional aspects of palliative care. Despite the challenge of balanced professional representation, this innovative interprofessional educational program met its learning objectives, and may be transferable for use in other educational settings.