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Background: Postgraduate fellowship training for nurse practitioners (NP) in palliative care can ameliorate workforce shortages; however, currently there are few NP fellowships and little evidence about outcomes, such as retention in hospice and palliative nursing, job satisfaction, or professional contributions. Objective: To describe the impact of palliative care fellowship training on the careers of NP alumni. Methods: A survey was electronically distributed to all NP alumni of an interprofessional palliative care fellowship since adult and pediatric nursing cohorts were added (2009–2022). Results: Most respondents still worked in hospice and/or palliative care; a majority of them engaged in professional activities beyond clinical work and reported high career satisfaction. Alumni endorsed multiple benefits of postgraduate fellowship except for post-fellowship compensation. Conclusions: NP palliative care fellowship alumni reported multiple career benefits including job satisfaction, professional accomplishment, and ongoing employment at their training institutions. [ABSTRACT FROM AUTHOR]

Background: Access to supportive services in community-based oncology is challenging but essential, particularly for underserved populations. Methods: We developed the Supportive Oncology Collaborative (SOC), built upon the tenets of Collaborative Care, an existing model used to increase access to behavioral health in community settings. Using a population-health-based approach with screening, a registry, and shared care, we added palliative care specialists to a team of social workers and a consulting psychiatrist. We provided integrated psychosocial and palliative care at community-based sites of a large comprehensive cancer center. Results: We implemented the model in 2020 at a community site with a racially and ethnically diverse patient population. Encounters grew from 527 in our first year to 2,130 in 2022. Using screening tools, we identify the highest-risk patients for discussion in team meetings. Discussion: We are expanding the SOC across the Dana-Farber Cancer Institute regional campuses and believe it can increase access to integrated psychosocial and palliative care in cancer centers across the country. [ABSTRACT FROM AUTHOR]

Outcomes 1. Discuss a novel model for providing integrated supportive oncology services in community settings 2. Demonstrate benefits of providing integrated supportive oncology services using patient case examples 3. Describe process and outcome metrics associated with implementing community-based psychosocial and palliative care services There is an unmet need for palliative care and psychosocial oncology in community settings and a limited workforce to provide these services. When faced with a similar challenge, the field of psychiatry developed a model called collaborative care to increase access to psychiatry in primary care and other settings. Collaborative care uses a mix of onsite behavioral health workers and offsite psychiatrists to provide evidence-based behavioral healthcare in community settings. There is an extensive literature demonstrating improved outcomes associated with collaborative care. At Dana-Farber, we have well-established palliative care and psychosocial services, but, historically, they were not easily available to patients in the community satellites. To bridge this gap, we developed an integrated model of psychosocial oncology and palliative care services called the Supportive Oncology Collaborative (SOC). Based on the collaborative care model, this program integrates onsite and virtual resources to create a cohesive team composed of palliative care clinicians, a psychiatrist, and social workers. We do not offer discrete palliative care, social work, or psychiatric services in the SOC but rather provide a comprehensive team approach for each clinical concern. This model is currently implemented in the Dana-Farber satellite location in Merrimack Valley, which serves a diverse general oncology adult population. There are plans to expand to 4 additional locations over the next 2 years. In this session, we will present information about collaborative care and how it was adapted into the SOC. We will provide case studies of treatment by the SOC to demonstrate the team-based approach and how it differs from standard clinical care. We will share information about the structure and function of the SOC and lessons learned from implementation, and finally we will share process and outcome metrics associated with the intervention. [ABSTRACT FROM AUTHOR]

Outcomes: 1. Describe a novel model for providing integrated supportive oncology services in community settings 2. List process and outcome metrics associated with implementing community-based psychosocial and palliative care services An unmet need for palliative care and psychosocial oncology in community settings and a limited workforce to provide these services necessitates innovation. When faced with similar challenges, the field of psychiatry developed the Collaborative Care model. Collaborative Care uses a mix of onsite behavioral health workers and offsite psychiatrists, as well as a measurement-based approach, to provide evidence-based behavioral health care in community settings. At Dana-Farber Cancer Institute, we aim to increase access to palliative care and psychosocial services in our diverse community satellites by enhancing collaborative care. We developed the Supportive Oncology Collaborative (SOC), a clinical model that integrates onsite and virtual resources to create a cohesive team of palliative care clinicians, a psychiatrist, and social workers. We do not offer discreet palliative care, social work, or psychiatric services in the SOC, but rather provide a comprehensive team approach for each clinical concern. This model is currently implemented in two Dana-Farber Cancer Institute satellite locations, with plans to expand to three additional locations over the next 2 years. In this session, we will present information about Collaborative Care, how it was adapted into the SOC, and how this differs from standard care delivery models. We will identify 10 common reasons for referral (eg, pain, goals of care, behavioral health, coping with illness) and the interdisciplinary clinical pathways we have developed for each. We will share process metrics such as clinical volume, patient risk stratification, and proportion of high-risk patients presented for clinical discussion at interdisciplinary team meeting. We will share an evaluation plan based on patient goals and linked to referral indications. Finally, we will share case studies to demonstrate how care is provided in this model in alignment with the clinical pathways. [ABSTRACT FROM AUTHOR]

1. Distinguish unique challenges of engaging in and documenting Serious Illness Conversations (SICs) in the community oncology setting 2. Design a systemic approach to increasing documentation of SICs in the community oncology setting 3. Implement opportunities to engage in and document SICs into already established workflows in the community oncology setting Serious Illness Conversations (SICs) are essential to providing patient-centered care driven by patient goals and values. Clinicians need to be able to quickly find documentation of these conversations so they can be used to guide decision making. The Epic Advanced Care Planning (ACP) module centralizes these conversations to allow providers to track changes in goals and preferences over time. Our large integrated healthcare system has agreed to prioritize use of the ACP module; however, at our community oncology clinic, few patients have documentation in the ACP module. We will increase the number of SICs documented in the ACP module by 20% and increase the number of clinicians and RNs using the ACP module by 100% in 4 months. This will necessitate documentation from oncology clinicians and RNs other than our Supportive Oncology Collaborative. Surveys of clinic and infusion nurses (N = 20, 76% response rate) and MD/NP providers (N = 10, 50% response rate) indicated weekly engagement in SICs. Chart review indicated SICs were occasionally occurring and documented in places other than the ACP module. 80% of MD/NP providers identified an education gap regarding the ACP module as greatest challenge. Individual and group education and individual MD/NP provider support in documentation were provided. Computer-side tip cards were also provided. Average weekly SICs documented in the ACP module did not significantly increase. The number of unique clinicians and RNs using the ACP module increased by 100%. Solicited feedback indicated providers were open to education but not to changing their practice. There is substantial interest in increasing documentation of SICs, but community oncology clinics may have unique challenges around changing workflows. We will use a multidisciplinary approach and next focus on standardization of SIC documentation in existing clinic workflows (eg, using RNs during chemo teaching) in future Plan-Do-Study-Act cycles while also supporting community clinicians during this cultural shift to prioritizing ACP. [ABSTRACT FROM AUTHOR]