Student Theses
Date of Award
Spring 6-1-2026
Document Type
Dissertation
Language
English
First Advisor
Heyward Michael Dreher
Second Advisor
Debra Guss
Third Advisor
An-Yun Yeh
Abstract
Background: Advance care planning (ACP) is essential in achieving goal-concordant care for patients with metastatic lung cancer (MLC), yet it remains underutilized.
Local problem: Despite its benefits, ACP has been inconsistently integrated into outpatient oncology settings, and a baseline evaluation at the project site revealed that only 11% of patients with MLC had ACP documented in the outpatient care clinic.
Methods: This Quality Improvement initiative implemented a formal, Nurse Practitioner (NP)-led intervention into routine oncology care. Using a quasi-experimental nonrandomized design, 13 eligible patients diagnosed with MLC without prior ACP documentation were enrolled in a four-week study. These participants were non-randomized into two comparison groups through self-selection of the intervention: Group 1 was given an ACP Informational Packet only or Group 2 was given an ACP Informational Packet with a follow-up NP Visit. ACP readiness was assessed using the validated 4-item ACP Engagement Survey (ACP ES) at baseline and four weeks post-intervention.
Results: ACP engagement scores significantly improved across the total sample (mean increase = 2.08, p = .014), representing a 15.4% rise from the baseline survey. Post-intervention scores were higher among those receiving the NP visit, though not statistically significant, and ACP documentation completion increased from 11% at baseline to 61.5% overall, with high completion rate in the NP-led group (80%) compared to the packet-only group (50%).
Conclusion: Integrating a structured, NP-led ACP intervention into outpatient oncology workflows is a feasible and highly effective strategy to increase ACP engagement and documentation. By shifting these vital discussions from crisis-driven inpatient settings to proactive outpatient care, this scalable model ensures goal-concordant care for patients with MLC and establishes a replicable framework for broader oncology sub-specialties.
Recommended Citation
Thai, Khanh H., "Advance Care Planning in Metastatic Lung Cancer Patients: A Quality Improvement Initiative" (2026). CUNY Academic Works.
https://academicworks.cuny.edu/si_etds/21
