questions

2

Improving Patient Readiness for Outpatient Palliative Care

Introduction

Palliative care refers to alleviating and relieving the symptoms and pain of an incurable medical condition the patient is experiencing (Schlick & Bentrem, 2019). This begins with the onboarding process. The onboarding process for palliative care is critical in ensuring that patients and their families receive the highest quality of care and support. It involves the initial assessment, coordination and planning, communication and education, emotional and psychological support, and continuity of care. This process sets the stage for a collaborative and supportive relationship between patients, their families, and the providers.

Background and Significance

The percentage of time that palliative care providers spend explaining what palliative care is to patients can vary depending on several factors. This includes the patient's prior knowledge or experience with palliative care, the healthcare setting, and the specific circumstances of each patient encounter. However, palliative care providers are generally expected to spend significant time discussing and educating patients and their families about palliative care. Generic and standardized educational information fails to provide optimal understanding, engagement, and, eventually, health outcomes for the patient seeking palliative care. This is due to significant gaps created by diversification (such as age, race, disease, and gender) among the patients. It also enhances the gap between the healthcare providers and the patients. This gap substantially influences the patient's healthcare outcomes.

Despite the expansion of palliative care programs and needs over the past few decades, there may still be knowledge gaps and misconceptions among patients and providers. Huo et al. (2019) surveyed the general populace to find out how they felt about palliative care overall. Seventy-one percent of the 3,194 participants said they were unaware of palliative care. Additionally, many of the 10% of participants who self-reported having adequate knowledge of palliative care had misconceptions or could not correctly respond to simple questions about it (Huo et al., 2019). In a study, an increase of 8.8% to 31.5% was observed due to the implementation of intervention involving patient education regarding palliative care (Taibanguay et al., 2019). It can help reduce the mortality rate in palliative care and improve the quality of care ( IAHPC List of Essential Practices in Palliative Care - International Association for Hospice & Palliative Care, 2022).

Problem Statement

Patients currently face obstacles, misconceptions, and knowledge gaps regarding palliative care services (Huo et al., 2019). The problem is that providers may spend too much time consulting and educating the patients regarding palliative care at the initial visit. The potential benefit of a more customized patient education primer document from Phase One could help the physicians, Nurse Practitioners and nurses spend less time during the initial visit and have time to discuss why they were referred. This eventually could reduce the gap between the information provided in palliative care and the needs of individual patients. The goal is to evaluate Elizabeth Burkharts primer packet that she implemented in the first phase and its impact on new patients and the onboarding process at Briarwood Palliative Care Clinic.

The solution to this issue also aligns with the DNP essentials. From the list of DNP essentials, DNP Essential One is Scientific underpinnings for practice which integrates different sciences with nursing science, such as psychosocial, organizational, and analytical (American Association of Colleges of Nursing, 2006). DNP Essentials Three is a clinical scholarship and analytical methods for evidence-based practices, which states that nursing practice should be advanced by incorporating new evidence-based practices concluded from research and analytical methods (American Association of Colleges of Nursing, 2006). These two DNP essentials are relevant as they emphasize integrating scientific evidence into advanced nursing practice by analyzing the data collected for research purposes. In the proposed project, evidence-based practices and provider feedback will assist in revising patient education materials and ensure they are grounded in scientific knowledge. Nurses play a pivotal role in customizing educational material and empowering patients to make informed decisions. This would help bridge the gap, reduce health disparities, and enhance patient understanding, engagement, and adherence to the treatment plan.

Literature Review

Importance of Tailored Patient Education

Personalized patient education engages, encourages, and empowers patients and involves them in their treatment plans. It has been proven to enhance patient outcomes and satisfaction (Bhattad et al., 2022). The most effective components included increasing health literacy, keeping the cultural background in mind, and the patient's preference (Andrulis & Brach, 2007).

Current Challenges in Patient Education

Patients were shown a 3-minute video made by a physician and a written palliative care information page from Vanderbilt Health which was adapted to have the same information as the video (Kozlov et al., 2017). The goal was to ascertain if a brief education intervention can enhance laypeople's knowledge of palliative care. This research showed that a straightforward information page or a quick educational video could improve understanding of palliative care and confidence in that knowledge (Kozlov et al., 2017). Brief educational interventions can fill in patients' knowledge gaps about palliative care by giving them accurate and thorough information and could reduce patient “no show/ cancellation.” A study conducted showed clinical outcomes are impacted, healthcare costs rise, and access to care and provider productivity are reduced when there is a high no-show rate at outpatient clinics (Lagman et al., 2020). This could be patients not understanding what palliative care is. The research studied a busy palliative care outpatient clinic started a quality improvement project that involved staff members calling patients to confirm appointments in an effort to lower the no-show rate. The study's objectives were to ascertain how this intervention affected the no-show rate and evaluate the financial implications of a lower no-show. It concluded that of the 1224 completed visits from September 1st to December 31st, 2015, 271 were no-shows with an average rate of 11.8%. After the intervention, there were 4368 completed visits and 562 no-shows (Lagman et al., 2020). The no-show rate for 2016 averaged 6.9% (p < 0.001), down 4.9% from the last four months of 2015 (Lagman et al., 2020). Estimated opportunity costs were about 396 no-show visits avoided, equivalent to an annual savings of about $79,200. In an outpatient palliative medicine clinic, the no-show rate was decreased by calling patients 24 hours before their appointment (Lagman et al., 2020). Significant opportunity costs were incurred by avoiding unfulfilled visits. At Briarwood Palliative Care Clinic, a cancellation/no-show report was ran for January 2022 through June 2022. There are a total of 56 patients, showing 27 cancellations and 29 no/shows prior to the primer document being distributed. Another report was ran post primer document, and it showed cancellation/no-show sheet from January 2023 through June 2023 for total of 84 patients. It showed 26 “No Shows” since January 1st, 2023 and 57 “cancellations,” and one left prior to being seen. The report showed the majority of no-show/cancellation patients were a total of seventeen, were “deceased,” and the second was a total of twenty-three patients that, “Nothing was documented as to why the “no show” in the chart. These seventeen deceased patients show from the data that referring providers misunderstand the difference between palliative and hospice care. These patients should have been referred to hospice care. In conclusion, judging by the reports ran at Briarwood Clinic from 2022 to the present, and there has been no improvement post-primer document.

Checklists are used in many different settings to standardize and reduce preventable errors in practice (De et al., 2016). Checklists are used in various settings to establish consistent techniques and cut down on preventable errors that can be avoided. The study sought to determine whether a palliative care checklist (PCC) would improve the clinical documentation regarding patient information (De et al., 2016). The documentation before and after the checklist for results on advance care planning (28%  v 41%;  P = .0008), and overall (78%  v 95%;  P ≤ .0001) improved (De et al., 2016). The study found that using a PCC enhanced the accuracy of patient visit documentation in an outpatient clinical setting.

Using a PCC improved the accuracy of the documentation of a patient visit in an outpatient clinical setting, according to a study investigating potential variations in the subject matter of end-of-life decisions and perspectives on advance directives (AD) in palliative care (Voltz et al., 1998). A survey was conducted of 159 patients in palliative care facilities and 93 healthcare providers in palliative care (Voltz et al., 1998). The development of a checklist aid physicians, particularly non-palliative care specialists, communicate with their patients and their families in difficult clinical situations. The research showed A checklist tool might help improve doctor-patient communication. Perhaps this will change how terminally ill patients view their end-of-life choices and the quality of their remaining life (Voltz et al., 1998).

Provider Perspectives and Feedback

An investigation was made into the nurses' viewpoints on the issues that could be raised to enhance patient education. It concluded that nurses strengthening total commitment to the patient's needs, reconstructing the structure of the education plan, developing motivational factors, and facilitating change are some of the effective strategies to enhance the effectiveness of patient education (Fereidouni et al., 2019).

Emphasis on the importance of engaging the patients in the clinical context and maximizing the transfer of learning to the patient can improve the outcomes of the education plan (Jeyakumar et al., 2021). Feedback from the patient can also be used to improve the education plans for the coming patients.

In regard to the primer document, feedback was received from three of the providers at Briarwood Clinic as to the effectiveness of the document. Dr. L. Marsh stated, “patients still think I am hospice or homecare provider and I believe patients breeze over the document in the portal. At the initial appointment, I know I will spend the appointment explaining what palliative care is to the patients (personal communication, July 12, 2023). Dr. A. Bigelow explained that “I have not seen any difference! But that could be based on the types of patients that I am seeing (personal communication, July 17, 2023).” Dr. J. Chargot explained that “I have to say, I don’t have a lot of new patients (they often go to our new faculty member, Dr Marsh, and the NPs as they are building their panel) but the ones I have seem much more familiar with the clinic, expectations and contact (personal communication, July 19, 2023).” There is not much of an impact for two of the providers with the initial primer document from cycle one, and one provider had shown some impact with her patients that came in at the initial appointment.

Synthesis of Overall Findings

The literature review emphasizes the need for tailored patient education material according to the patient's needs and preferences. It also explains how the inclusion of cultural aspects can enhance its effectiveness. Including the perspective of the healthcare providers can provide a better insight into the points to be improved. It also helped understand how patient education can lead to better health outcomes and improve patient compliance with the treatment plan. The overall findings support the rationale and aims of the project.

Implementation Model

The Ottawa Model of Research Use (OMRU) is selected to build a structured framework for implementing evidence-based intervention (Logan & Graham, 1998). This six-step process was developed in the context of innovations in continuity of care. The approach uses the knowledge translation model known as the Ottawa Model of Research Use to direct the process of putting research into action (see Figure 1) (Logan & Graham, 1998). Applying this model to the proposed project on improving patient education through provider survey feedback involves some key components discussed individually. The OMRU directed this project and was chosen for this project because it is adaptable and suitable for the interdisciplinary components of the project (see Figure 2).

The first is assessing the current practice and setting clear goals. It will involve a comprehensive assessment of the current patient education in practice within palliative care. Gaps and challenges will be identified. This information will be used to define the objectives of the project that would be aligned with principles of patient-centered care and improvement in patient outcomes.

The second component is the development and implementation of the intervention. It would involve designing a provider survey questionnaire that collects essential feedback on phase one, "Welcome Letter, "and its effectiveness. This questionnaire will be administered to the healthcare providers in palliative care who are involved in patient care. As well as will ask patients and their families how they felt if the initial primer document helped or what could have made it better. This is why the appropriate data collection methods, and the surety of confidentiality and anonymity will be used.

The third component is analyzing and using the data to modify educational material. Another aspect is evaluating the results, which involves figuring out whether the data was effectively communicated to and accepted by patients and providers and whether it positively affected their satisfaction with the onboarding process. In addition, the implementation process will be assessed. It is important to consider the practice environment at this time and look for areas where improvements can be made moving forward. Suitable statistical methods, tools, and qualitative analysis techniques will be used to identify common themes, patterns, and response gaps. Based on the findings regarding barriers and facilitators of patient education, the education material will be modified and sent to the patients.

The fourth component would be to evaluate the intervention's effectiveness in enhancing the education material. The knowledge will be disseminated in the final step, and further improvements will be made.

Project Purpose and Objectives

The project aims to evaluate the effectiveness of the initial primer document and improve patient readiness before the initial appointment. It enhances patient education in palliative care by incorporating feedback from healthcare providers through a checklist. The project aims to enhance the relevance and impact of educational materials sent to patients. The population will be healthcare providers involved in patient education in palliative care. The intervention is to use provider checklist/survey questionnaire feedback to improve patient readiness.

This project includes a one-page checklist given to the provider to evaluate patient preparedness at the initial appointment. In addition, a survey will be given to the providers inquiring as to any improvements that can be made from phase one’s initial primer document given to patients. This project includes 1.) a checklist will be given to the providers to evaluate and measure patient readiness at the initial appointment 2.) a post-checklist survey given to the providers on how to improve patient readiness. This project will allow for improvements in readiness at the initial appointment and allow providers to focus on patient assessment and management.

Page breaks are useful after a main section to separate the text.

References

American Association of Colleges of Nursing. (2006). The Essentials of Doctoral Education for Advanced Nursing Practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Andrulis, D. P., & Brach, C. (2007). Integrating literacy, culture, and language to improve health care quality for diverse populations. American Journal of Health Behavior, 31 Suppl 1(Suppl 1), S122-33. https://doi.org/10.5555/ajhb.2007.31.supp.S122

Athar, M. W., Record, J. D., Martire, C., Hellmann, D. B., & Ziegelstein, R. C. (2018). The Effect of a Personalized Approach to Patient Education on Heart Failure Self-Management.  Journal of Personalized Medicine,  8(4), 39. https://doi.org/10.3390/jpm8040039

Bhattad, P. B., & Pacifico, L. (2022). Empowering Patients: Promoting Patient Education and Health Literacy.  Cureus,  14(7), e27336. https://doi.org/10.7759/cureus.27336

Birgisdóttir, D., Duarte, A., Dahlman, A., Sallerfors, B., Rasmussen, B. H., & Fürst, C. J. (2021). A novel care guide for personalized palliative care - a national initiative for improved quality of care.  BMC palliative care,  20(1), 176. https://doi.org/10.1186/s12904-021-00874-4

Connor C. M. (2019). Using Technology and Assessment to Personalize Instruction: Preventing Reading Problems.  Prevention Science: The Official Journal of the Society for Prevention Research,  20(1), 89–99. https://doi.org/10.1007/s11121-017-0842-9

Cruz-Oliver, D. M., Pacheco Rueda, A., Viera-Ortiz, L., Washington, K. T., & Oliver, D. P. (2020). The evidence supporting educational videos for patients and caregivers receiving hospice and palliative care: A systematic review. Patient Education and Counseling, 103(9), 1677–1691. https://doi.org/10.1016/j.pec.2020.03.014

De, M., Reddy, A., Vidal, M., Tanco, K., Azhar, A., Silvestre, J., Liu, D. D., Wu, J., & Bruera, E. (2016). Impact of a Palliative Care Checklist on Clinical Documentation. American Society of Clinical Oncology. https://doi.org/10.1200/jop.2015.007203

Fereidouni, Z., Sabet Sarvestani, R., Hariri, G., Kuhpaye, S. A., Amirkhani, M., & Kalyani, M. N. (2019). Moving Into Action: The Master Key to Patient Education.  The Journal of nursing research: JNR,  27(1), 1–8. https://doi.org/10.1097/jnr.0000000000000280

Graul, A., Haggerty, A., Stickley, C., Kumar, P., Morales, K., Bogner, H., Burger, R. A., Morgan, M., & Ko, E. (2020). Effect of patient education on palliative care knowledge and acceptability of outpatient palliative care services among gynecologic oncology patients: A randomized controlled trial.  Gynecologic oncology,  156(2), 482–487. https://doi.org/10.1016/j.ygyno.2019.11.023

Jeyakumar, T., McClure, S., Lowe, M., Hodges, B., Fur, K., Javier-Brozo, M., Tassone, M., Anderson, M., Tripp, T., & Wiljer, D. (2021). An Education Framework for Effective Implementation of a Health Information System: Scoping Review.  Journal of medical Internet research,  23(2), e24691. https://doi.org/10.2196/24691

Kozlov, E., Reid, M. C., & Carpenter, B. D. (2017). Improving patient knowledge of palliative care: A randomized controlled intervention study. Patient Education and Counseling, 100(5), 1007–1011. https://doi.org/10.1016/j.pec.2016.12.022

Lagman, R. L., Samala, R. V., LeGrand, S., Parala-Metz, A., Patel, C., Neale, K., Carrino, C., Rybicki, L., Gamier, P., Mauk, M. E., & Nowak, M. (2020). “If You Call Them, They Will Come”: A Telephone Call Reminder to Decrease the No-Show Rate in an Outpatient Palliative Medicine Clinic. American Journal of Hospice and Palliative Medicine®, 38(5), 448–451. https://doi.org/10.1177/1049909120952322

Logan, J., Graham, I.D. (1998). Toward a comprehensive interdisciplinary model of health care research use.  Science Communication, 20(2), 227-246. https://doi.org/10.1177/1075547098020002004

Martin, L. R., Williams, S. L., Haskard, K. B., & Dimatteo, M. R. (2005). The challenge of patient adherence. Therapeutics and Clinical Risk Management, 1(3), 189–199. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/Ricci, L., Villegente, J., Loyal, D., Ayav, C., Kivits, J., & Rat, A. C. (2022). Tailored patient therapeutic, educational interventions: A patient-centered communication model.  Health Expectations: an international journal of public participation in health care and health policy,  25(1), 276–289. https://doi.org/10.1111/hex.13377

Schlick, C. J. R., & Bentrem, D. J. (2019). Timing of palliative care: When to call for a palliative care consult. Journal of Surgical Oncology, 120(1), 30–34. https://doi.org/10.1002/jso.25499

Timmers, T., Janssen, L., Kool, R. B., & Kremer, J. A. (2020). Educating Patients by Providing Timely Information Using Smartphone and Tablet Apps: Systematic Review.  Journal of medical Internet research,  22(4), e17342. https://doi.org/10.2196/17342

Taibanguay, N., Chaiamnuay, S., Asavatanabodee, P., & Narongroeknawin, P. (2019). Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial.  Patient preference and adherence,  13, 119–129. https://doi.org/10.2147/PPA.S192008

Voltz, R., Akabayashi, A., Reese, C., Ohi, G., & Sass, H.-M. (1998). End-of-Life Decisions and Advance Directives in Palliative Care: A Cross-Cultural Survey of Patients and Healthcare Professionals. Journal of Pain and Symptom Management, 16(3), 153–162. https://doi.org/10.1016/S0885-3924(98)00067-0

Figure 1. The Ottawa Model of Research Use (adapted from Logan and Graham, 1998)

Figure 2. Ottawa Model of Research Use--Adapted for Proposed Project

De, M., Reddy, A., Vidal, M., Tanco, K., Azhar, A., Silvestre, J., Liu, D. D., Wu, J., & Bruera, E. (2016). Impact of a Palliative Care Checklist on Clinical Documentation. American Society of Clinical Oncology. https://doi.org/10.1200/jop.2015.007203

2

Improving Patient Readiness for Outpatient Palliative Care

Introduction

Palliative care refers to alleviating and relieving the symptoms and pain of an incurable medical condition the patient is experiencing (Schlick & Bentrem, 2019). This begins with the onboarding process. The onboarding process for palliative care is critical in ensuring that patients and their families receive the highest quality of care and support. It involves the initial assessment, coordination and planning, communication and education, emotional and psychological support, and continuity of care. This process sets the stage for a collaborative and supportive relationship between patients, their families, and the providers.

Background and Significance

The percentage of time that palliative care providers spend explaining what palliative care is to patients can vary depending on several factors. This includes the patient's prior knowledge or experience with palliative care, the healthcare setting, and the specific circumstances of each patient encounter. However, palliative care providers are generally expected to spend significant time discussing and educating patients and their families about palliative care. Generic and standardized educational information fails to provide optimal understanding, engagement, and, eventually, health outcomes for the patient seeking palliative care. This is due to significant gaps created by diversification (such as age, race, disease, and gender) among the patients. It also enhances the gap between the healthcare providers and the patients. This gap substantially influences the patient's healthcare outcomes.

Despite the expansion of palliative care programs and needs over the past few decades, there may still be knowledge gaps and misconceptions among patients and providers. Huo et al. (2019) surveyed the general populace to find out how they felt about palliative care overall. Seventy-one percent of the 3,194 participants said they were unaware of palliative care. Additionally, many of the 10% of participants who self-reported having adequate knowledge of palliative care had misconceptions or could not correctly respond to simple questions about it (Huo et al., 2019). In a study, an increase of 8.8% to 31.5% was observed due to the implementation of intervention involving patient education regarding palliative care (Taibanguay et al., 2019). It can help reduce the mortality rate in palliative care and improve the quality of care ( IAHPC List of Essential Practices in Palliative Care - International Association for Hospice & Palliative Care, 2022).

Problem Statement

Patients currently face obstacles, misconceptions, and knowledge gaps regarding palliative care services (Huo et al., 2019). The problem is that providers may spend too much time consulting and educating the patients regarding palliative care at the initial visit. The potential benefit of a more customized patient education primer document from Phase One could help the physicians, Nurse Practitioners and nurses spend less time during the initial visit and have time to discuss why they were referred. This eventually could reduce the gap between the information provided in palliative care and the needs of individual patients. The goal is to evaluate Elizabeth Burkharts primer packet that she implemented in the first phase and its impact on new patients and the onboarding process at Briarwood Palliative Care Clinic.

The solution to this issue also aligns with the DNP essentials. From the list of DNP essentials, DNP Essential One is Scientific underpinnings for practice which integrates different sciences with nursing science, such as psychosocial, organizational, and analytical (American Association of Colleges of Nursing, 2006). DNP Essentials Three is a clinical scholarship and analytical methods for evidence-based practices, which states that nursing practice should be advanced by incorporating new evidence-based practices concluded from research and analytical methods (American Association of Colleges of Nursing, 2006). These two DNP essentials are relevant as they emphasize integrating scientific evidence into advanced nursing practice by analyzing the data collected for research purposes. In the proposed project, evidence-based practices and provider feedback will assist in revising patient education materials and ensure they are grounded in scientific knowledge. Nurses play a pivotal role in customizing educational material and empowering patients to make informed decisions. This would help bridge the gap, reduce health disparities, and enhance patient understanding, engagement, and adherence to the treatment plan.

Literature Review

Importance of Tailored Patient Education

Personalized patient education engages, encourages, and empowers patients and involves them in their treatment plans. It has been proven to enhance patient outcomes and satisfaction (Bhattad et al., 2022). The most effective components included increasing health literacy, keeping the cultural background in mind, and the patient's preference (Andrulis & Brach, 2007).

Current Challenges in Patient Education

Patients were shown a 3-minute video made by a physician and a written palliative care information page from Vanderbilt Health which was adapted to have the same information as the video (Kozlov et al., 2017). The goal was to ascertain if a brief education intervention can enhance laypeople's knowledge of palliative care. This research showed that a straightforward information page or a quick educational video could improve understanding of palliative care and confidence in that knowledge (Kozlov et al., 2017). Brief educational interventions can fill in patients' knowledge gaps about palliative care by giving them accurate and thorough information and could reduce patient “no show/ cancellation.” A study conducted showed clinical outcomes are impacted, healthcare costs rise, and access to care and provider productivity are reduced when there is a high no-show rate at outpatient clinics (Lagman et al., 2020). This could be patients not understanding what palliative care is. The research studied a busy palliative care outpatient clinic started a quality improvement project that involved staff members calling patients to confirm appointments in an effort to lower the no-show rate. The study's objectives were to ascertain how this intervention affected the no-show rate and evaluate the financial implications of a lower no-show. It concluded that of the 1224 completed visits from September 1st to December 31st, 2015, 271 were no-shows with an average rate of 11.8%. After the intervention, there were 4368 completed visits and 562 no-shows (Lagman et al., 2020). The no-show rate for 2016 averaged 6.9% (p < 0.001), down 4.9% from the last four months of 2015 (Lagman et al., 2020). Estimated opportunity costs were about 396 no-show visits avoided, equivalent to an annual savings of about $79,200. In an outpatient palliative medicine clinic, the no-show rate was decreased by calling patients 24 hours before their appointment (Lagman et al., 2020). Significant opportunity costs were incurred by avoiding unfulfilled visits. At Briarwood Palliative Care Clinic, a cancellation/no-show report was ran for January 2022 through June 2022. There are a total of 56 patients, showing 27 cancellations and 29 no/shows prior to the primer document being distributed. Another report was ran post primer document, and it showed cancellation/no-show sheet from January 2023 through June 2023 for total of 84 patients. It showed 26 “No Shows” since January 1st, 2023 and 57 “cancellations,” and one left prior to being seen. The report showed the majority of no-show/cancellation patients were a total of seventeen, were “deceased,” and the second was a total of twenty-three patients that, “Nothing was documented as to why the “no show” in the chart. These seventeen deceased patients show from the data that referring providers misunderstand the difference between palliative and hospice care. These patients should have been referred to hospice care. In conclusion, judging by the reports ran at Briarwood Clinic from 2022 to the present, and there has been no improvement post-primer document.

Checklists are used in many different settings to standardize and reduce preventable errors in practice (De et al., 2016). Checklists are used in various settings to establish consistent techniques and cut down on preventable errors that can be avoided. The study sought to determine whether a palliative care checklist (PCC) would improve the clinical documentation regarding patient information (De et al., 2016). The documentation before and after the checklist for results on advance care planning (28%  v 41%;  P = .0008), and overall (78%  v 95%;  P ≤ .0001) improved (De et al., 2016). The study found that using a PCC enhanced the accuracy of patient visit documentation in an outpatient clinical setting.

Using a PCC improved the accuracy of the documentation of a patient visit in an outpatient clinical setting, according to a study investigating potential variations in the subject matter of end-of-life decisions and perspectives on advance directives (AD) in palliative care (Voltz et al., 1998). A survey was conducted of 159 patients in palliative care facilities and 93 healthcare providers in palliative care (Voltz et al., 1998). The development of a checklist aid physicians, particularly non-palliative care specialists, communicate with their patients and their families in difficult clinical situations. The research showed A checklist tool might help improve doctor-patient communication. Perhaps this will change how terminally ill patients view their end-of-life choices and the quality of their remaining life (Voltz et al., 1998).

Provider Perspectives and Feedback

An investigation was made into the nurses' viewpoints on the issues that could be raised to enhance patient education. It concluded that nurses strengthening total commitment to the patient's needs, reconstructing the structure of the education plan, developing motivational factors, and facilitating change are some of the effective strategies to enhance the effectiveness of patient education (Fereidouni et al., 2019).

Emphasis on the importance of engaging the patients in the clinical context and maximizing the transfer of learning to the patient can improve the outcomes of the education plan (Jeyakumar et al., 2021). Feedback from the patient can also be used to improve the education plans for the coming patients.

In regard to the primer document, feedback was received from three of the providers at Briarwood Clinic as to the effectiveness of the document. Dr. L. Marsh stated, “patients still think I am hospice or homecare provider and I believe patients breeze over the document in the portal. At the initial appointment, I know I will spend the appointment explaining what palliative care is to the patients (personal communication, July 12, 2023). Dr. A. Bigelow explained that “I have not seen any difference! But that could be based on the types of patients that I am seeing (personal communication, July 17, 2023).” Dr. J. Chargot explained that “I have to say, I don’t have a lot of new patients (they often go to our new faculty member, Dr Marsh, and the NPs as they are building their panel) but the ones I have seem much more familiar with the clinic, expectations and contact (personal communication, July 19, 2023).” There is not much of an impact for two of the providers with the initial primer document from cycle one, and one provider had shown some impact with her patients that came in at the initial appointment.

Synthesis of Overall Findings

The literature review emphasizes the need for tailored patient education material according to the patient's needs and preferences. It also explains how the inclusion of cultural aspects can enhance its effectiveness. Including the perspective of the healthcare providers can provide a better insight into the points to be improved. It also helped understand how patient education can lead to better health outcomes and improve patient compliance with the treatment plan. The overall findings support the rationale and aims of the project.

Implementation Model

The Ottawa Model of Research Use (OMRU) is selected to build a structured framework for implementing evidence-based intervention (Logan & Graham, 1998). This six-step process was developed in the context of innovations in continuity of care. The approach uses the knowledge translation model known as the Ottawa Model of Research Use to direct the process of putting research into action (see Figure 1) (Logan & Graham, 1998). Applying this model to the proposed project on improving patient education through provider survey feedback involves some key components discussed individually. The OMRU directed this project and was chosen for this project because it is adaptable and suitable for the interdisciplinary components of the project (see Figure 2).

The first is assessing the current practice and setting clear goals. It will involve a comprehensive assessment of the current patient education in practice within palliative care. Gaps and challenges will be identified. This information will be used to define the objectives of the project that would be aligned with principles of patient-centered care and improvement in patient outcomes.

The second component is the development and implementation of the intervention. It would involve designing a provider survey questionnaire that collects essential feedback on phase one, "Welcome Letter, "and its effectiveness. This questionnaire will be administered to the healthcare providers in palliative care who are involved in patient care. As well as will ask patients and their families how they felt if the initial primer document helped or what could have made it better. This is why the appropriate data collection methods, and the surety of confidentiality and anonymity will be used.

The third component is analyzing and using the data to modify educational material. Another aspect is evaluating the results, which involves figuring out whether the data was effectively communicated to and accepted by patients and providers and whether it positively affected their satisfaction with the onboarding process. In addition, the implementation process will be assessed. It is important to consider the practice environment at this time and look for areas where improvements can be made moving forward. Suitable statistical methods, tools, and qualitative analysis techniques will be used to identify common themes, patterns, and response gaps. Based on the findings regarding barriers and facilitators of patient education, the education material will be modified and sent to the patients.

The fourth component would be to evaluate the intervention's effectiveness in enhancing the education material. The knowledge will be disseminated in the final step, and further improvements will be made.

Project Purpose and Objectives

The project aims to evaluate the effectiveness of the initial primer document and improve patient readiness before the initial appointment. It enhances patient education in palliative care by incorporating feedback from healthcare providers through a checklist. The project aims to enhance the relevance and impact of educational materials sent to patients. The population will be healthcare providers involved in patient education in palliative care. The intervention is to use provider checklist/survey questionnaire feedback to improve patient readiness.

This project includes a one-page checklist given to the provider to evaluate patient preparedness at the initial appointment. In addition, a survey will be given to the providers inquiring as to any improvements that can be made from phase one’s initial primer document given to patients. This project includes 1.) a checklist will be given to the providers to evaluate and measure patient readiness at the initial appointment 2.) a post-checklist survey given to the providers on how to improve patient readiness. This project will allow for improvements in readiness at the initial appointment and allow providers to focus on patient assessment and management.

Page breaks are useful after a main section to separate the text.

References

American Association of Colleges of Nursing. (2006). The Essentials of Doctoral Education for Advanced Nursing Practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

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Figure 1. The Ottawa Model of Research Use (adapted from Logan and Graham, 1998)

Figure 2. Ottawa Model of Research Use--Adapted for Proposed Project

De, M., Reddy, A., Vidal, M., Tanco, K., Azhar, A., Silvestre, J., Liu, D. D., Wu, J., & Bruera, E. (2016). Impact of a Palliative Care Checklist on Clinical Documentation. American Society of Clinical Oncology. https://doi.org/10.1200/jop.2015.007203