Related Experiment Video
Updated: May 12, 2026

Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum
Published on: August 5, 2020
Training mid-level providers on palliative care: bringing advanced directives and symptom assessment and management
Mary Lesperance1, Robert Shannon, Phyllis K Pumphrey
11Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA.
Abstract:
Palliative care services are not available in most outpatient oncology practices. A program training 11 mid-level providers from oncology practices on advanced directive discussions and supportive symptom assessment and management performed by palliative care specialists was completed. A follow-up session 9 months later identified barriers to implementation. Of the 11 mid-level providers, 8 participated in the follow-up session, and 9 of the 11 providers implemented advanced directive's discussions and symptom assessment and management for patients with metastatic cancer. Main barriers included uncertainties about reimbursement, patients' lack of knowledge about palliative care, and lack of access to supportive services. This program successfully promoted advanced directive discussions and supportive/palliative care symptom assessment and management to community oncology practices, which will hopefully translate into improved quality of life for patients with metastatic cancer.
Related Concept Videos
Continuing Care
Ethical Issues
Ethical Concerns in Healthcare:
Peripheral Artery Disease III: Interprofessional Care
Ethical Dilemmas II
Nursing Ethical Principles II
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's cancer...
Peripheral Artery Disease IV: Nursing Management