UC Irvine

Purpose: Palliative care (PC) is a medical service that provides physical and emotional care to individuals living with a chronic disease such as cancer. Although PC can significantly improve quality of life, there are numerous barriers that negatively affect patient engagement with the service. One of the primary barriers that has been identified is lack of patient knowledge about PC. The purpose of this quality improvement (QI) project was to increase cancer patient engagement with PC services by implementing an educational intervention at the time of referral. Methods: The Johns Hopkins Evidenced-Based Practice (EBP) Model guided the development and implementation of the project. The intervention was an educational brochure about PC developed by the National Cancer Institute. A pre-post practice change design was utilized, with outcomes being collected from the electronic medical record pre- and post-intervention. Outcomes included the number of PC referrals made and the percentage of those referrals scheduled as appointments. Data regarding barriers and facilitators to project implementation by the 8 participating clinicians were collected via weekly and post-intervention surveys using electronic data capture. Results: Pre-data were collected over a 5-week period, during which time 13 patients received PC referrals and 9 (69%) scheduled their initial appointment. Throughout the course of the 6-week implementation period, 17 patients received PC referrals and 6 (35%) scheduled their initial appointment. Of the 8 clinician participants, 4 completed the post-intervention survey. Two respondents reported utilization of the intervention less than 25% of the time and the other two did not refer a patient to PC during the implementation period. Three clinicians who completed the post-intervention survey expressed a future desire to use the intervention in their practice. Common barriers to intervention utilization identified in the survey included limited time in appointments and heavy workloads. Conclusion: Findings reveal multiple barriers faced by the project site to PC provision and access. The PC clinic also experienced significant increases in patient volume during the implementation period, which impacted the ability of new referrals to be seen in a timely manner. Further exploration is needed to determine how clinicians, patients, and site leadership can best overcome these challenges.