Before the Blue—Implementing the SAGE Team to Support Oncology Clinicians

PURPOSE: Frontline staff frequently experience discomfort caring for patients with cancer nearing the end of life who have no further treatment options and request cardiopulmonary resuscitation (CPR). We developed a program to address staff concerns while honoring patient/family preferences for CPR. METHODS: Following the Institute for Healthcare Improvement Model for Improvement, a 24/7 interdisciplinary response team, the Staff Assistance Guiding End-of-life resuscitation and care (SAGE) Team, was created to provide support and minimize staff distress before anticipated cardiopulmonary arrest. The SAGE Team is composed of a rapid response advance practice provider, rapid response nurse, respiratory therapy supervisor, social worker, and spiritual care provider. Together, they identify needed resources for staff, provide education to perform patient care, recommend team composition and roles in advance, address perceived ethical dilemmas and moral distress, and provide psychosocial support to frontline staff before impending resuscitation. The program was evaluated by monitoring team activations, case reviews, and postactivation surveys measuring staff comfort. RESULTS: The SAGE Team was activated 62 times within its first year-three times the expected yearly volume. Nurses primarily used the resource, along with members of the interdisciplinary team across specialties. Thirteen patients required resuscitation and expired within the hospital. The team was activated earlier than expected 54% of the time. Postactivation surveys revealed a 31% increase in staff comfort caring for this patient population. CONCLUSION: Patients with terminal illness are often medically complex, and aligning goals of care and preferences regarding CPR at end of life is nuanced and distressing to clinicians. Supporting frontline staff before cardiopulmonary arrest in this population can increase comfort in providing direct care. SAGE offers a holistic approach to support and decrease staff distress.