Integrating Palliative Care Education and Referral Standardization for Head and Neck Cancer Patients in an Outpatient Setting

Abstract

Background: Early integration of palliative care (EPC) in oncology care improves symptom management, patient satisfaction, and quality of life for individuals with head and neck cancer (HNC). Despite established benefits, EPC remains underutilized in this patient population due to misconceptions among healthcare providers and patients. Structured education and referral processes are critical strategies to enhance timely palliative care (PC) access, particularly for high-risk populations such as patients with HNC. Purpose: The purpose of this quality improvement project is to increase healthcare provider and nurse knowledge and confidence regarding EPC and to evaluate practice change by measuring the number of PC referrals placed for patients with HNC at the Banner MD Anderson Cancer Center outpatient infusion center in Phoenix, Arizona. Methods: Using the Model for Improvement with the Plan-Do-Study-Act cycle, an educational session for healthcare providers and nurses about the importance of EPC and introduction of a referral algorithm adapted from the National Comprehensive Cancer Network and American Society of Clinical Oncology to facilitate earlier identification and referral of patients with HNC were given. Pre- and post-education surveys assessed changes in knowledge and confidence levels. Implementation of the referral algorithm was measured by the number of PC referrals before and after the educational session. Results: Survey data from pre- and post-education survey responses was analyzed using descriptive analysis to summarize participant knowledge and levels of confidence. A total of 23 participants completed the pre-education survey and 19 completed the post-education survey. Knowledge scores improved from an average of 72% pre-intervention to 89% post-intervention, and confidence ratings also shifted positively, with more participants reporting being “confident” or “very confident” in discussing EPC. Seven PC referrals were placed for patients with HNC in the one month before the intervention, compared to four referrals in the one month following the intervention. These counts reflect overall referral activity but cannot be accurately evaluated because the total number of HNC patients seen during each timeframe is unknown. Conclusions: The pre- and post-education survey results demonstrated improved knowledge and confidence among participants regarding EPC. These findings support the benefits of structured education and a standardized referral algorithm in preparing oncology staff to initiate timely PC referrals. Referral data, however, showed a decrease from seven pre-intervention referrals to four post-intervention referrals, and interpretation is limited by the absence of denominator data on HNC patients during each timeframe.