Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dianne Conrad

Second Advisor

Robert F. Johnson

Third Advisor

Simin N Beg

Fourth Advisor

Rachel Cardosa


As cancer related mortality decreases, the number of patients living with cancer symptoms and the side effects of cancer treatment will continue to grow. In 2016, over 1.5 million Americans were newly diagnosed with cancer (American Cancer Society, 2016). Several major medical organizations including the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), and the World Health Organization (WHO) endorse the integration of palliative care into cancer care (Ramchandran, 2015). Although many cancer centers report offering palliative care, this remains largely limited to inpatient services.

The stakeholders of the hospice and palliative care division of a large Midwest healthcare system have identified that there are many cancer patients who may benefit from palliative care, but fail to receive these services. This is substantiated by a low number of oncology palliative care referrals, a large portion of inpatient palliative care referrals occurring when patients are critically ill, low median length of hospice enrollment among oncology patients, and a low rate of oncology patients completing advance care planning prior to a hospice referral. The development of an evidence-based toolkit to improve oncology referrals to palliative care could improve timely and appropriate oncology referrals to palliative care. The Theory of Symptom Management and the PARIHS framework were used to develop a toolkit to increase timely and appropriate referrals to palliative care in this Midwest healthcare system. The toolkit includes a cost savings analysis, referral recommendations based on analysis of current oncology quality measure performance, marketing and educational materials for referring providers, an implementation protocol, and a sustainability plan.

Included in

Nursing Commons