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Examining the implementation of outpatient palliative care and its influence on quality of life in patients with a life-limiting condition
Dissertation   Open access

Examining the implementation of outpatient palliative care and its influence on quality of life in patients with a life-limiting condition

Jessica L. Mendez
Doctor of Nursing Practice (D.N.P.), Drexel University
Jun 2019
DOI:
https://doi.org/10.17918/bje6-aw35
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Abstract

Nursing--Practice Palliative treatment Ambulatory medical care Nursing Quality of Life
Background: Incorporating home-based palliative care is a new frontier within health care. Many health systems do not have patient access to such services. The need for comprehensive palliative care is inevitable with the aging population. Benefit of initiating palliative medicine for patients with life-limiting illness is known within present literature. The practice gap that exists within palliative medicine is well supported by existing evidence, as is the need to improve access to this style of care. Purpose: The purpose of this study is to embed outpatient palliative care services within the visiting nurses association (VNA) within Wellspan Health. By embedding this service as a needs assessment project, the investigator attempts to demonstrate improved quality of life outcomes and overall improved symptom management. Methods: a pre-test and post-test survey method using a convenience sample within the VNA was conducted assessing symptom control, wellbeing and level of distress. Initial ratings of symptoms including pain, nausea, anxiety, depression, sleep wellbeing, and distress level was documented using the Edmonton Symptom Assessment System and the distress thermometer. Weekly surveys were provided to participants on week one through eight during home visits. Evaluation: Descriptive statistics was used to evaluate the data collected. A Wilcoxon Signed Rank test was used to compare pain, wellbeing and distress scores from initial home visit to the final visit at the end of three weeks. Results: A non-parametric Wilcox Signed Rank test was used to analyze symptom data. When comparing the mean rating from the ESAS from week one (M=35.20, SD= 20.85), to week three (M=30.30, SD= 17.84), overall improvement cannot be generalized with the implementation of palliative care within the home health model. No statistical significance was identified (z= -1.07,p= 0.284). The same was true for the NCCN Distress Thermometer at week one (M= 3.60, SD=2.80), as compared to the end of the study at week three (M= 2.69, SD= 2.69, z= -.049, p=0.623). Clinical Implications: Review of the results does demonstrate some improvement toward improved symptom management, but because of time constraints and limited participation, results were not supportive of the hypothesis of suggested improvement with implementation of outpatient palliative care services within the VNA. Results suggest increase support for completion of symptom management tools and increased study length to demonstrate a more generalizable finding.

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