Abstract
ACP is the process of thinking about and sharing your values, beliefs, and preferences towards care with your loved ones and health-care team. The goal of advance care planning is to ensure that the health and personal care a patient receives is in line with what they want, even in the event that they’re unable to speak for themselves. While working in systemic therapy at BC Cancer Vancouver, a registered nurse identified an opportunity to improve nursing practices related to advance care planning, launching a provincial research project to understand how to better support oncology nurses. The foundational research revealed that nurses recognized the value ACP brings to both nursing care and patient outcomes yet reported limited engagement in ACP in their workplace. Specific barriers to engagement included structural factors alongside uncertainties related to role clarity and organizational approach. To bridge this knowledge-to-practice gap, a knowledge mobilization (KMb) project was initiated to mobilize the research findings and inform an ACP nursing practice change to better support nurses in conducting ACP across BC Cancer. Drawing on the Implementation Roadmap and the Psychology of Change, we launched a 3-phase plan to mobilize our research findings into practice through a provincial nursing practice change. In Phase 1, we established an ACP Nursing Working Group consisting of nursing researchers, direct care nurses, patient and family partners, nursing leaders, clinical nurse specialists, and members of the BC Centre for Palliative Care. The working group reviewed evidence on best practices for ACP, identified current ACP tools and resources, and gathered evidence about current practices from our local contexts. In Phase 2, the ACP Working Group co-created a new ACP workflow informed by ACP evidence, including our nursing research, and local practice insights. The project team subsequently conducted feedback sessions with more than 200 nurses across six regional cancer centres to evaluate localized barriers and enablers. In Phase 3, following our pilot tests at two regional cancer centres, we launched the ACP practice change provincially, using our implementation strategies to raise awareness and provide education, evaluated the overall impact of the change, and built a comprehensive sustainability plan. Following the KMb project, survey results showed (1) improvements in reported ACP confidence, knowledge, and access to resources, and (2) increases in nurses reporting ACP initiation and follow-up. To ensure sustainability of our provincial practice change we integrated ACP education and sustainment into the professional practice nursing portfolio, embedded the new ACP practice and educational resources into nursing orientation, established ACP Champions, and plan to re-launch ACP education yearly during ACP day. Using an advance care planning project as an example, this report details the pathway from issue identification in the clinical practice setting, to nursing-led research to better understand the issue, to knowledge mobilization to inform a provincial practice change. This work was supported by a Michael Smith Health Research BC Reach Award (#RA-2023-3456) co-funded by the BC Nurses’ Union and is titled: Embedded Knowledge Mobilization: Strengthening Oncology Nurses’ Capacity for Effective Advance Care Planning Conversations. Heather Kilgour (Clinical Nurse Specialist, BC Cancer Vancouver) is co-leading this work with Dr. Leah Lambert (Senior Scientist, Clinical Research Department, BC Cancer Research Institute) and Ruby Gidda (Executive Director of Professional Practice Nursing and Executive Director of Abbotsford). We acknowledge the valuable contributions of the broader study team through the foundational research that informed the development of this work. doi:http://dx.doi.org/10.14288/1.0452610