Making Wishes Known: An Evidence-Based Practice Project for Advanced Care Planning in Oncology

Practice Problem: An advance directive is a tool that patients use to maintain control of their care, plan for potential life events, identify their health proxy and communicate their wishes with their healthcare team. Despite the stated importance, the percentage of patients with completed advance directives in the Oncology clinic was less than 10%. This meant that the majority of patients did not have the tools to make their wishes known to the healthcare team. PICOT: The PICOT question that guided this EBP project is In adult oncology patients within the outpatient setting, does implementing a formal advanced care planning (ACP) process as compared to usual practice affect completion of advance directives over 8 weeks? Evidence: Evidence revealed that incorporation of the ACP process into patient interactions by members of the healthcare team increase patients’ completion of advance directives. EMR documentation is evidenced to provide the team with ease of use and ability to track the ACP process. Intervention: The project incorporates the ACP process into patient interactions with the staff. Incorporation of the ACP process and completion rates for advance directives are drawn from EMR data. Outcome: There was no statistical difference in the percentage of patients who had advance directives after four weeks. However, the project highlights how nurses in ambulatory care affect metrics associated with quality outcomes through patient advocacy. Furthermore, the project provides a process for nurses to provide their patients the resources they need to take control of their care. The project will be sustained because of the clinical significance. Conclusion: A formalized ACP process improves ambulatory nursing care by providing patients with resources to make their wishes known.