Advanced practice provider initiated advance care planning discussions to enhance patient-centered end-of-life care

Advance Care Planning (ACP) is the process by which patients, with their healthcare provider and family establish values, goals, and preferences for future care, and include discussions on End of Life (EOL) care options. Advance Directives (AD) provide written documentation of patient’s wishes for future care and comprise of a Medical Power of attorney, living will document, and an Out-of-Hospital Do Not Resuscitate (OOHDNR) order. Institute of Medicine (IOM) in their 2014 report, Dying in America, identified an urgent need for improvement in health care at the end of life. The IOM also called for patient-centered EOL care that honors individual preferences and promotes quality of life. Cancer patients experience the high cost of care, may also receive unwanted treatment towards the EOL, and additional suffering, which may not reflect their values and goals. The problem exists that only 20% of the patients have completed AD documents in the Department of Investigational Cancer Therapeutics (ICT), and admitted patients’ resuscitation status remains a full code, which includes a cardiopulmonary resuscitation, and endotracheal intubation with mechanical ventilation. This Doctoral of Nursing Practice project consists of designing, implementing, and evaluating the effect of ACP discussions initiated by an Advanced Practice Provider with advanced cancer patients and their family members in the ICT department. The project aims to enhance patient-centered EOL care with a goal to increase the AD completion and /or a change in code status of the patients referred to ICT department.