Background: Patients with lung cancer often face significant rates of mortality and morbidity. The lung cancer navigators at OSF Healthcare Saint Francis Medical Center noted substantial barriers to end-of-life discussion and planning among lung cancer patients. In an effort to address this deficiency, the navigators became certified in leading advance care planning (ACP) sessions, and offered ACP to lung cancer patients at the time of diagnosis. A review of current literature showed that facilitating ACP is not currently an established role of the oncology nurse navigator (ONN), and little evidence-based research exists regarding the benefits of the ONN leading ACP sessions with their assigned cancer patients.
Objectives:To explore the benefits of ACP as an expanded role for ONNs by describing the experiences of appointed healthcare power of attorney (HCPOA) agents for lung cancer patients who had their ACP discussion led by an ONN.
Methods: A qualitative phenomenological IRB-approved study was performed by utilizing semistructured telephone interviews. The interviews gathered information about the experiences of appointed HCPOA agents whose ACP session was led by the patient’s ONN. The interviews were recorded with consent of the participant, then transcribed and blinded. Two researchers independently reviewed the interview transcriptions to pull out emerging themes representing the HCPOA’s experiences.
Results: A total of 9 HCPOA agents agreed to be interviewed for the study. Two of the interviews met exclusion criteria. The researchers were able to extract 6 strong themes across the remaining interviews that met qualifications for the study. The key themes identified were the helpfulness of the navigator, increased confidence in decision-making, emotional support throughout the ACP process, the navigator as an advocate, the thoroughness of the ACP session, and the emotional challenges of the ACP session.
Conclusions: Although discussing end-of-life concepts remains emotionally challenging for cancer patients and their families, the interviews demonstrated that ONNs having an expanded role of leading ACP sessions provides a therapeutic and supportive environment for patients and families to explore end-of-life decision-making. The interviews also revealed that it was often difficult for the HCPOA to separate the ACP session from the entire experience of having an ONN. Further exploration may be warranted on whether this indicates that having the ONN lead the ACP session allows for it to be a more naturalized, seamless part of their cancer journey.
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