Nurse-led navigation to provide early palliative care in rural areas: a pilot study

Abstract

BackgroundFew services are available to support rural older adults living at home with advancing chronic illness. The objective of this project was to pilot a nurse-led navigation service to provide early palliative support for rural older adults and their families living at home with advancing chronic illness.MethodsTwenty-five older adults and 11 family members living with advancing chronic illness received bi-weekly home visits by a nurse navigator over a 2-year period. Navigation services included symptom management, education, advance care planning, advocacy, mobilization of resources, and psychosocial support. The nurse navigator collected longitudinal data on older adult and family needs, and older adult quality of life and healthcare utilization.ResultsSatisfaction with the service was high. There was no attrition over the 2-year period except through death, and few cancelled visits, indicating a high degree of acceptability of the intervention. The navigator addressed complex, multi-faceted needs through connecting health, social, and informal community resources. Participants who indicated a preferred place of death were able to die in that preferred place (n = 7). Emergency room use by participants was minimal and largely unpreventable by the nurse navigator. Longitudinal health-related quality of life scores for many participants were poor, lending further support to the need for more focused attention to this upstream palliative population.ConclusionsUsing a nurse navigator to facilitate early palliative care for rural older adults living with advanced chronic illness is a promising innovation for meeting the needs of this population. Further research is required to evaluate outcomes on a larger scale.

Rural‐Urban Differences in In‐Hospital Mortality Among Admissions for End‐Stage Liver Disease in the United States

“…(31)(32)(33) Another strategy to contain costs and facilitate patient referral and follow-up would be the employment of patient navigators, who have been proven to reduce unnecessary emergency department visits and readmissions in other settings. (34,35) Our findings support those of previous studies that demonstrated the importance of hospital-level characteristics to outcomes among patients with cirrhosis. (7,8) Mellinger et al found that patients admitted to rural hospitals had a 27% higher odds of in-hospital mortality than patients admitted to urban hospitals after accounting for patient-level factors.…”

“…Subspecialty care through dispersed networks have shown telemedicine and spoke‐and‐hub referral systems to be highly cost‐effective in other disease settings . Another strategy to contain costs and facilitate patient referral and follow‐up would be the employment of patient navigators, who have been proven to reduce unnecessary emergency department visits and readmissions in other settings …”

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

“…For people having one of the cancers associated with the longest survival times who die of non-cancer causes, the median interval from last navigation visit to death is about 4 years (breast cancer, 223 weeks; colorectal cancer, 203 weeks; prostate cancer, 195 weeks); for people having one of the cancers associated with the shorter survival times, the interval is less than 1 year (esophageal cancer, 41 weeks; pancreatic cancer, 29 weeks). Navigation by nurses 40 or volunteers 41,42 might provide an ideal means to increase advance care planning for people dying of non-cancer conditions, especially those with advancing non-cancer diseases whose navigation rates are less than 20% (Table ii).…”

Use and Perceptions of Information and Communication Technologies Among Ecuadorian Nurses: A Cross-sectional Study

“…Given the fact that in remote areas, nurses are usually limited in resources and support, ICTs represent a viable channel to increase access and equity to health care information and services [28]. For instance, a pilot study found that the quality of life for older, rural adults and family members living at homes with advancing chronic illness, improved with early palliative support of a nurse navigator, not only through visits but also through cellphone consultations [29]. Telehealth technologies then, through the use of a wide array of ICTs, can provide a platform for remote patient monitoring, videoconferencing, and computer-mediated communications [30].…”