Perceived Barriers to MOLST Form Completion Among Acute and Critical Care Oncology Registered Nurses and Nurse Practitioners Working in Comprehensive Cancer Centers Across the Nation
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Completion of MOLST (Medical Orders for Life-Sustaining Treatment) forms are historically low among oncology patient populations. The purpose of this Doctor of Nursing (DNP) project was to qualitatively explore the perceived barriers to patient MOLST form completion among acute and critical care oncology registered nurses (RNs) and nurse practitioners (NPs) working in national comprehensive cancer centers across the United States (US). The project aim was to increase understanding of MOLST form completion barriers among acute and critical care oncology RNs and NPs to promote MOLST form completion rates among cancer patients. Project objectives were to 1) conduct individual interviews with critical care oncology RNs and NPs working in national comprehensive cancer centers to understand perceived patient MOLST form completion barriers; and 2) utilize findings to develop an educational in-service outline for RNs and NPs with recommendations on how to promote patient MOLST form completion. Ruland’s Peaceful End of Life Theory acted as the theoretical framework. RNs and NPs were recruited through purposive sampling. Data was analyzed using Braun and Clarke’s (2006;2013) reflexive thematic analysis method. Knowledge Gives Them Power was found as the central organizing theme with the following four key themes: Being an Advocate for My Patient’s Wants; Timing and Situation is Everything; Fears; and Educational Needs. Research is needed exploring the optimal time to approach critical care cancer patients with the MOLST form discussions as well as how to improve interdisciplinary teams’ goals of care discussions with patients and their family.