Date of Award


Degree Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. Kimberly Hires

Second Advisor

Dr. Katherine Abraham Evans


The purpose of this project was to determine if using the Kansas City Cardiomyopathy Questionnaire (KCCQ) as a screening tool for heart failure patients leads to an increase in outpatient palliative referrals. Heart failure is a prevalent disease with both high symptom burden and mortality. Outpatient palliative care could improve quality of life for these patients, but research on outpatient palliative care is new and there is ambiguity surrounding the timing of referral. The project utilized a convenience sample of 21 adult patients in an outpatient facility over a 12-week timeframe. Participants self-completed the short form version of the KCCQ during an initial visit or hospital follow-up. Of the 21 participants, none received a palliative care referral. Ultimately, new patient visits were examined because it was unexpectedly found that no-shows dropped off the palliative clinic schedule, so retaining referral data is one paramount issue to address. Use of a screening tool did not lead to increased referrals in this project, suggesting further research is needed to identify innovative practices that will impact utilization of outpatient palliative services.