Optimizing Advanced Care Planning in Hospitalized Patients With Advanced Cancers: A Quality Improvement Initiative.

Journal Article (Journal Article)


Advance care planning (ACP) that generates an advanced directive (AD) can ensure patient autonomy at end of life. ACP is challenging for healthcare providers. Delaying patient ACP may lead to poor quality end-of-life care. Facilitation of early ACP by bedside RNs and social workers (SWs) may improve end-of-life care.


To determine whether improved ACP by RNs and SWs impacts care transition times for patients with advanced cancers.


A pre-/post-educational intervention designed to reinforce the roles of RNs and SWs in facilitating early ACP and timely documentation of an AD on an inpatient oncology unit.


AD documentation increased by 12% between pre- and post-intervention period. There was a nonsignificant trend toward longer lengths of stay for patients transitioning care without an AD compared to those patients with and AD.


Bedside RNs and SWs are in a key position to facilitate early ACP which can positively impact care quality at end of life. However, ACP is a collaborative team effort, best initiated early by the primary oncology providers.


Early ACP may improve quality end-of-life care.

Implications for nursing

Continuing education for RNs and SWs to enhance coordination with primary oncology teams to facilitate earlier ACP is recommended.

Full Text

Duke Authors

Cited Authors

  • Jackson, GL; Padilla, BI; Schneider, SM; Kyte, JJ

Published Date

  • October 2019

Published In

Volume / Issue

  • 12 / 2

Start / End Page

  • 239 - 245

PubMed ID

  • 32745036

Electronic International Standard Serial Number (EISSN)

  • 2380-9426

International Standard Serial Number (ISSN)

  • 2380-9418

Digital Object Identifier (DOI)

  • 10.1891/2380-9418.12.2.239


  • eng