Utilization of Peer-Led Education to Enhance Advance Care Planning and Advance Directive Completion

Background: The integration of advance care planning (ACP) and palliative care (PC) into oncology plays a critical role in symptom management and quality of life. Studies reveal a large subset of oncology patients with unmet needs regarding ACP and advance directive (AD) completion. Successful ACP helps to promote congruent medical treatment with patients’ values and preferences and motivates patients to complete ADs. Objective: An evidence-based practice project was conducted to assess the effectiveness of peer-led education to nursing staff to improve ACP and AD completion among inpatient oncology and PC patients Design: A standardized survey created from the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD), was utilized to assess nursing staff knowledge and comfort of ADs and ACP prior to education course. Data outcomes of AD completions, ACP conversations, KAESAD survey results, and code status changes were recorded quarterly. Setting/Subjects: 42 nursing staff at a local medical center, inpatient oncology, and PC patients. Results: A total of 42 nursing staff attended in person education, online education was disseminated to approximately 20 remaining staff. A total of 633 patient records were reviewed from July 2019 to December 2019 to assess for AD completion. An increased proportion of comfort care codes could suggest a potential link between education and ACP conversations initiated by nursing staff. AD completion rates decreased post intervention but were not statistically significant. Pre-course standardized survey revealed varying levels of knowledge and comfort in discussing ADs. Conclusions: ACP and ADs are pivotal components of the PC continuum. Timely ACP discussions and completion of ADs can improve patient and family satisfaction, decrease symptom burden, and improve quality of life. Recommendations call to educate across all interdisciplinary teams to verify sustainability and further improvements in AD completion and ACP conversations. Key words: advance care planning, advance directive, peer-led education, nursing, oncology, palliative care