An Oncology Nurse Brings Palliative Care to Rural Communities

elderly man being pushed in wheelchair

Many oncology nurses say they naturally gravitated toward their profession, but that’s not quite the story of Marie Bakitas. “I didn’t go into oncology nursing willingly. I didn’t even go into being a nurse willingly,” laughs Bakitas, who has a long trail of nursing and palliative care credentials following her name.

Marie BakitasThe longtime American Cancer Society grantee says her path was initially based on practical considerations, like professional opportunities. But while working with a bone marrow program at Dartmouth-Hitchcock Medical Center in New Hampshire early in her career, she was especially struck by the psychosocial needs of advanced cancer patients.

“Everybody was all jazzed about the people that were getting cured. It seemed like nobody wanted to talk about the rest of the people who weren’t,” Bakitas says. “Those patients really needed a palliative care approach.”

In the decades since, she has become an internationally recognized, practice-changing researcher and leader in palliative care, especially in rural communities, where palliative care specialists and resources are often limited.

Project ENABLE

Bakitas has authored dozens of studies, but is perhaps best known for leading Project ENABLE (an acronym for educate, nurture, advise, before life ends). The ENABLE trials involve a phone-based intervention in which a nurse coach leads patients and their caregivers through a series of structured sessions on topics such as communication and medical decision making.

The most recent ENABLE-III randomized trial explored timing of the palliative care intervention. For part of the trial, patients received an in-person consultation, phone-based coaching with a nurse, and monthly follow-up. One group of participants received the intervention at diagnosis; the other got it 3 months later. The results: Timing didn’t make a significant difference in outcomes like mood and symptoms – but the “early entry” group had better survival rates at the one-year mark. This finding supports other research indicating that palliative care may help cancer patients live longer.

The other part of ENABLE-III tested a similar intervention in family caregivers of patients with advanced cancer. The early group had less depression and stress, suggesting that palliative care for caregivers is important and should be initiated as early as possible. This aspect of ENABLE-III, led by Bakitas’ mentee Nick Dionne-Odom, PhD, was recently highlighted as a top cancer achievement in Clinical Cancer Advances 2016, an annual report from the American Society of Clinical Oncology.

American Cancer Society Research

ENABLE’s palliative care model has been successfully implemented at sites in New Hampshire and Vermont, but about 3 years ago Bakitas moved from the Northeast to Alabama – and took ENABLE with her. Through an American Cancer Society research scholar grant she is now disseminating ENABLE in the South. Part of this involves creating a community-academic “learning collaborative” to assess current palliative care practices and outcomes. Then, she and her team of researchers aim to train local providers to deliver the ENABLE model.

She hopes to ultimately create a palliative care toolkit that other cancer centers could use nationwide, but her current focus is on the Southeast, as she now holds several positions at the University of Alabama at Birmingham (UAB). Bakitas is a professor and the Marie L. O'Koren endowed chair at the School of Nursing. She is also associate director of the UAB Center for Palliative and Supportive Care.

“My next big thing will be continuing to extend palliative care access in the Southeast. In addition to my American Cancer Society grant, I have another grant to research patients and family caregivers with heart failure,” Bakitas said. Her research and clinical practice goals: “Try to proliferate and improve access to palliative care for patients with any disease.”

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