What difference(s) did the PSE change make in the short-term?
Seven hundred nurses and other professionals from 21 Kansas counties registered for and completed the training (22% via ITV). The six-month follow-up survey indicated continued improved confidence in discussing with patient his/her own dying, empowerment to work within multi-professional team, ability to assess patients’ needs and knowledge that palliative care is compatible with aggressive treatment. Additionally, a ZOOM2 cloud meeting platform was implemented in 2016 to reach a broader audience throughout the state.
The process of developing relevant BRFSS questions led to discussions about the definition and scope of palliative and end-of-life care. As a result, state cancer coalition members have a better understanding of these issues.
What difference(s) did the PSE change make in the long-term?
Successful ELNEC training facilitated the development of a system-level strategy to embed palliative care nurse “coaches” at unit and programmatic levels to implement a standard palliative care bundle for seriously ill patients. ELNEC became a core training for frontline providers. Another success for the Palliative Care Program at the University of Kansas Hospital was increased capacity for evaluation through the development of a population-based palliative care module for the Kansas BRFSS. This will result in the collection of data that may be used to establish baselines and targets for evaluation of activities intended to further progress towards a state cancer plan objective aimed at improving access to palliative care in Kansas. These data align with two key measures that are among those recommended by the American Academy of Hospice and Palliative Medicine (AAHPM) and Hospice and Palliative Nurses Association (HPNA). See AAHPM and HPNA’s Measuring What Matters.
Measuring What Matters (MWM) is “a consensus recommendation for a portfolio of performance measures for all hospice and palliative care programs to use for program improvement.” (AAHPM, n.d.). For the purposes of Kansas’s enhanced evaluation, the relevant measures are:
- Seriously ill palliative care and hospice patients have a documented discussion regarding emotional needs (Hanson et al., 2012; Schenck et al., 2014).
- Seriously ill palliative care and hospice patients have documentation of their preferences for life-sustaining treatments (Hanson et al., 2012; Schenck et al., 2014).
How did you measure/document the impact of the PSE change intervention?
The PSE change intervention has led to two major outcomes:
- Increased number of certified palliative care providers around the state.
- Increased capacity for evaluation due to the development of a palliative care module for the Kansas BRFSS.
More than 5,100 people responded to the nine new palliative care questions in 2016. Results from the 2016 BRFSS palliative care module show that less than one third (32.3%) of Kansas adults age 18 years and older have a health care directive or living will and about 3.3% received palliative care for a serious and chronic illness. Among those who received palliative care, 72% experienced physical pain caused by their illness or its treatment and about 57% experienced stress, depression or problems with emotions caused by their illness or its treatment.
Detailed data on all nine questions are available on the Kansas BRFSS website. This information will provide an opportunity to help partners understand the baseline of access to palliative and end-of-life care among cancer survivors in Kansas through the BRFSS. Over time, monitoring BRFSS responses to palliative care questions will provide data to indicate how well the expanded ELNEC-certified workforce has resulted in improved access to palliative care for the state.
Were there barriers to implementing the PSE change? If so, what were the lessons learned?
It was difficult to limit the number of BRFSS palliative care questions. The addition of questions is problematic, due to the combination of expense ($2,500 per question) and wanting to keep the overall survey length to a minimum. The final state-added module contained nine questions.
2 ZOOM is a video and web conferencing service.