Date of Award

Fall 12-4-2023

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

First Advisor

Dr. Mary Brann

Second Advisor

Dr. Linda Valles-Gutierrez


Despite the benefits of palliative care being well-documented in studies and early palliative care services being strongly recommended by reputable organizations, such as the American Society of Clinical Oncology, many patients did not receive or received late referrals (Pigni et al., 2022). This mainly occurs because oncologists commonly base their referrals on perceived needs and clinical judgment (Smith et al., 2017). Thus, this program development project aimed to create a toolkit to improve early identification and referral to palliative care for adult patients who would benefit from palliative care services. The PICO question that guides this program is: In ambulatory adult oncology patients in the Veteran Affairs healthcare system (P), how does a toolkit for implementation of a palliative care referral protocol (I) compared to standard referral methodology (provider judgment) (C) improve the utilization of standardized trigger-based referral to palliative care (O). Literature supports the development of an ambulatory-focused toolkit for the adult oncology population and supports early intervention to maximize living benefits, including quality of life measures. The evidence supports using a toolkit to guide the associated implementation of a dedicated referral process, including a criteria-based trigger tool. This scholarly project provides a step-by-step toolkit to guide the implementation of an early palliative care referral protocol in an ambulatory oncology setting.


Scholarly project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.