Assessment of a clinical nurse specialist-led early palliative care initiative for patients with advanced pancreatic cancer.

[PURPOSE] Adenocarcinoma of the pancreas (PANC) is an aggressive and often incurable cancer, associated with disease-related symptoms and poor outcomes. A comprehensive approach to care, including a focus on symptom management and quality of life, is essential. Introducing a palliative care approach early in the cancer journey improves survival and quality of life and decreases healthcare costs. However, barriers exist to providing early palliative care. This study is aimed at assessing the acceptability and impact of a novel clinical nurse specialist (CNS)-led early palliative care initiative on quality of care for patients with PANC.

[METHODS] Patients with PANC in the pre- and post-CNS eras were identified using the Manitoba Cancer Registry and CNS clinical database. Acceptability of the CNS initiative was measured by capturing those who agreed to CNS consultation. Quality measures included the proportion enrolled in a community-based palliative care program early (within 8 weeks of diagnosis) and late (within 2 weeks of death). Descriptive statistics were used. Chi-square tests were used to test for significance between the two eras.

[RESULTS] The CNS model was acceptable, with 93.3% of patients accepting consultation. There were fewer late referrals to community palliative care programs with the involvement of a CNS (p = 0.02) and a trend towards more early referrals (p = 0.07), suggesting an improvement in quality of care. After CNS consultation, 33% of patients declined either a diagnostic biopsy, medical oncology consultation, or both, facilitating decisions in line with patient goals of care.

[CONCLUSIONS] The CNS-led model for PANC was acceptable to patients and associated with timely referral to community-based palliative care. This model provides an opportunity to address patient goals of care early and decrease unwanted procedures and consultations.