• Sarah F D'Ambruoso, John A Glaspy, Sara A Hurvitz, Neil S Wenger, Christopher Pietras, Kauser Ahmed, Alexandra Drakaki, Jonathan Wade Goldman, Sidharth Anand, Wendy Simon, Jennie Kung, Anne Coscarelli, Lee S Rosen, Parvin F Peddi, WongDeborah J LDJLDepartment of Medicine, University of California, Los Angeles, CA., Katherine Santos, Peter Phung, Daniel Karlin, and Anne M Walling.
• Department of Medicine, University of California, Los Angeles, CA.
• JCO Oncol Pract. 2021 Nov 8: OP2100046.

PurposeGuidelines support early integration of palliative care (PC) into standard oncology practice; however, little is known as to whether outcomes can be improved by modifying health care delivery in a real-world setting.MethodsWe report our 6-year experience of embedding a nurse practitioner in an oncology clinic (March 2014-March 2020) to integrate early, concurrent advance care planning and PC.ResultsCompared with patients with advanced cancer not enrolled in the palliative care nurse practitioner program, in March 2020, patients who are enrolled are more likely to have higher quality of PC (eg, goals of care note documentation [82% v 15%; P < .01], referral to the psychosocial oncology program [67% v 37%; P < .01], and referral to hospice [61% v 34%; P < .01]) and less inpatient utilization in the last 6 months of life (eg, hospital days [12 v 18; P < .01] and intensive care unit days [1.2 v 2.3; P < .01]). The program expanded over time with the support of faculty skills training for advance care planning and PC, supporting a shared mental model of PC delivery within the oncology clinic.ConclusionEmbedding a trained palliative care nurse practitioner in oncology clinics to deliver early integrated PC can lead to improved quality of care for patients with advanced cancer.

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