Background: Palliative care specialists are experts in conducting advance care planning (ACP), but are a limited resource. We sought to determine the impact of a nurse-led primary palliative care intervention on ACP completion among patients with advanced cancer. Methods: We performed a secondary analysis of a cluster randomized controlled trial looking at the impact of nurse-based primary palliative care at community cancer centers. In the parent trial, patients with advanced cancer received either monthly primary palliative care visits with trained nurses within their cancer center or usual care. Nurses in the intervention arm received special training in addressing symptom management and ACP. ACP uptake was assessed at enrollment and 3 months later via validated questionnaire in the forms of an end-of-life conversation (EOLC) with one’s oncologist or completion of an advance directive (AD). The present analyses were restricted to patients without ACP at baseline. Multivariable logistic regression tested differences in ACP uptake by treatment arm when adjusting for age, religious importance, education, time with current oncologist, and ECOG. Results: Of 672 patients enrolled, 182/336 in the intervention arm and 196/336 in usual care lacked an EOLC at baseline and completed three-month assessments. Of those, 82/182 (45.1%) in the intervention arm and 29/196 (14.8%) in the usual care arm reported having an EOLC at three months (Table). Similarly, 111/336 in the intervention arm and 105/336 in usual care lacked an AD at baseline and completed the three-month assessments. Of those, 48/111 (43.2%) in the intervention arm and 19/105 (18.1%) in usual care completed an AD over the study period (Table). For both types of ACP, the treatment effect suggested increased uptake of new ACP in the intervention arm after controlling for variables known to be associated with ACP (Table) Conclusions: Nurse-led primary palliative care increased the uptake of ACP among patients with advanced cancer. Training oncology nurses embedded within community cancer centers may represent a feasible mechanism to improve access to primary palliative care and uptake of advance care planning. Clinical trial information: NCT02712229.

Adjusted for age, religious importance, education, time with current oncologist, and ECOG.