HCPOA Experiences with Nurse Navigator–Led Advance Care Planning

November 2021 Vol 12, No 11
Catherine Bailey, RN, BSN
OSF Healthcare Saint Francis Medical Center
Peoria, IL
Megan Rappleyea, RN, MSN, OCN, CNE
Mennonite College of Nursing
Illinois State University
Normal, IL
Tenille Oderwald, RN, MSN, CN-BN
OSF Healthcare Saint Francis Medical Center
Peoria, IL

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.


Academy of Oncology Nurse & Patient Navigators. Helpful definitions. https://aonnonline.org/31-aonn/18-helpful-definitions.

American Cancer Society. Cancer Facts & Figures 2021. Atlanta, GA: American Cancer Society. www.cancer.org/content/dam/cancer-org/re search/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2021/can cer-facts-and-figures-2021.pdf. 2021.

Boot M, Wilson C. Clinical nurse specialists’ perspectives on advance care planning conversations: a qualitative study. Int J Palliat Nurs. 2014;20:9-14.

Clark MA, Ott M, Rogers ML, et al. Advance care planning as a shared endeavor: completion of ACP documents in a multidisciplinary cancer program. Psychooncology. 2017;26:67-73.

Holland DE, Vanderbroom CE, Dose AM, et al. Nurse-led patient-centered advance care planning in primary care. A pilot study. Journal of Hospice & Palliative Nursing. 2017;19(4):368-375.

O’Donnell A, Buffo A, Campbell TC, Ehlenbach WJ. The critical care nurse communicator program: an integrated primary palliative care intervention. Crit Care Nurs Clin North Am. 2020;32:265-279.

Ólafsdóttir KL, Jónsdóttir H, Fridriksdóttir N, et al. Integrating nurse-facilitated advance care planning for patients newly diagnosed with advanced lung cancer. Int J Palliat Nurs. 2018;24:170-177.

Rocque GB, Dionne-Odom JN, Huang SCH, et al. Implementation and impact of patient lay navigator-led advance care planning conversations. J Pain Symptom Manage. 2017;53:682-692.

Schabath MB, Cress D, Munoz-Antonia T. Racial and ethnic differences in the epidemiology and genomics of lung cancer. Cancer Control. 2016;23:338-346.

Su Y, Yuki M, Hirayama, K. The experiences and perspectives of family surrogate decision-makers: a systematic review of qualitative studies. Patient Educ Couns. 2020;103:1070-1081.

Wasylynuk BA, Davison SN. An overview of advanced care planning for patients with advanced chronic kidney disease: the basics. CANNT J. 2016;26:24-29.

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