Prognosis discussion and referral to community palliative care services in patients with advanced pancreatic cancer treated in a tertiary cancer centre

Sarah Clelland, Christina L. Nuttall, Helen E. Stott, Joseph Cope, Natalie L. Barratt, Kelly Farrell, Manyi Eyong, Jack P. Gleeson, Angela Lamarca, Richard A. Hubner, Juan W. Valle, Mairead G. Mcnamara

Research output: Contribution to journalArticlepeer-review

Abstract

Advanced pancreatic cancer is associated with a poor prognosis, often less than one year. Honest prognosis discussions guide early community palliative care services input, facilitating timely advance care planning and improving quality of life. The aims were to assess if patients were offered prognosis discussions and community palliative care services referral. A retrospective analysis of consecutive case-notes of new advanced pancreatic cancer patients was conducted. Chi-squared test assessed association with prognosis discussion and community palliative care services referral. 365 cases (60%) had a documented prognosis discussion at any time-point in the treatment pathway; 54.4% during first appointment. The frequency of prognosis discussion was greater with nurse clinician review at first appointment (p<0.001). 171 patients (28.1%) were known to community palliative care services at first appointment. Of those not known, 171 (39.1%) and 143 (32.7%) were referred at this initial time-point and later, respectively. There was a significant association between referral to community palliative care services at first appointment and reviewing professional (this was greatest for nurse clinician (frequency 65.2%)) (p<0.001), and also if reviewed by clinical nurse specialist at first visit, or not (47.8% vs 35.6%) (p<0.01). Prognosis discussions were documented in approximately two thirds of cases, highlighting missed opportunities. Prognosis discussion was associated with clinician review and was most frequent for nurse clinician, as was referral to community palliative care services. Clinical nurse specialist review increased referral to community palliative care services if seen at the initial visit. Multi-disciplinary review, specifically nursing, therefore, during the first consultation is imperative and additive. It should be considered best practice to offer and negotiate the content and timing of prognosis discussions with cancer patients, and revisit this offer throughout their treatment pathway. Greater attention to prognosis discussion documentation is recommended.
Original languageEnglish
JournalHealthcare
Publication statusAccepted/In press - 16 Oct 2023

Keywords

  • prognosis; pancreatic cancer
  • palliative care
  • advance care planning
  • nurse practitioner
  • Clinical nurse specialist

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