Development and protocol for a nurse-led telephonic palliative care program

Abstract

Background The COVID-19 pandemic has resulted in a profound transformation of health care delivery toward telemedicine models. Purpose We present the structure of a nurse-led telephonic palliative program and operational metrics to influence further development of tele-palliative programs. Methods The nurses engage with seriously ill patients for 6 months with the goal of discussing advance care planning (ACP) and addressing self-identified issues related to their illness. Findings Of the first 100 program graduates, 78% were actively engaged and 51% named a health care agent and/or engaged in ACP. Of the 18 patients who died during the study, 13 (72%) were enrolled in hospice services. Discussion Our preliminary results indicate that seriously ill patients are willing to engage with nurses and to participate with discussions on ACP. Conclusion Given the gaps in health care exposed by the COVID-19 pandemic, this innovative program serves as an important model for bringing palliative care directly to patients.

Implementation of advance care planning amid the COVID‐19 crisis: A narrative review and synthesis

“…In total, 20 articles were included, of which eight were primary studies incorporating 5542 participants. The design of the primary studies was retrospective observational ( n = 4), 17–20 comparative cross‐sectional ( n = 1), 21 design process ( n = 2), 22,23 quality improvement intervention ( n = 1), 24 case report/study ( n = 2) 25,26 and virtual workshop ( n = 1) 27 . The rest of the articles were perspective papers ( n = 5), 3,28–31 letters to the editor ( n = 2), 32,33 newspaper analysis ( n = 1) 34 and guideline review ( n = 1) 35 .…”

Nurse-Led Telephonic Palliative Care

“…This case series has several limitations. As a report on only 4 cases, it is difficult to generalize conclusions for the population of seriously ill patients; however, only a few studies are available in nurse-led programs in palliative care, and on the basis of an analysis of the first 100 patients in Emergency Medicine Palliative Care Access, these cases are representative 26 . Even with centrally located nurses that were not embedded in each health system, we demonstrated that it is still possible to coordinate care and engage with providers.…”

“…This program is part of the Emergency Medicine Palliative Care Access, [24][25][26][27] a large comparative effectiveness trial funded by the Patient-Centered Outcomes Research Institute comparing facilitated, outpatient specialty palliative care with nurse-led telephonic case management after an ED visit. The study enrolls patients at 18 sites in 9 states.…”

Cuidados paliativos, cuidados de fin de vida y COVID-19: revisión de alcance

“…Las restricciones instauradas para el control de la pandemia promovieron un modelo de atención basado en la telesalud [40][41][42]48,[51][52][53][54][55][56] . Las herramientas tecnológicas fomentaron la comunicación con pacientes, familiares y entre profesionales de la salud, mientras se minimizaba el riesgo de exposición al virus 39,41,47,48,57,58 .…”

“…Las herramientas tecnológicas fomentaron la comunicación con pacientes, familiares y entre profesionales de la salud, mientras se minimizaba el riesgo de exposición al virus 39,41,47,48,57,58 . También facilitó el monitoreo y tratamiento de síntomas 25,52,55 , la prestación de servicios de manera más consistente y directa 52,53 , el establecimiento de objetivos de cuidado 46,52,55 , la toma de decisiones 48,55 y el apoyo espiritual 41 .…”