Due to the tremendous physical, psychological, and economic burdens of end-stage diseases, there now is an increasing need for palliative care as an integral part of the treatment plan in the management of radiation oncology patients, according to Marilyn Haas, PhD, nurse practitioner at CarePartners Supportive and Palliative Services, Asheville, North Carolina. In addition, she said that integrating palliative care earlier rather than later may be especially important in those patients with metastatic disease.
Haas presented a comprehensive model on integrating palliative care for radiation therapy patients at the 53rd Annual Meeting of the American Society for Radiation Oncology (ASTRO), held October 2011 in Miami Beach, Florida. She noted that we are now in a new era for palliative care, and it is the oncology nurses who can help set up palliative care programs at their individual facilities.
“The nurses are the ones who are going to drive this to get this into their practice. The physicians are a little bit skeptical because they relate palliative care to hospice care,” said Haas in an interview with The Oncology Nurse–APN/PA.
She said this is a common misconception among many healthcare workers who do not realize that palliative care is very different than hospice care. Palliative care patients receive treatment (radiation, chemotherapy, etc) to control their disease even though it may not be responsive to care. “It is not hospice care nor is it just end-of-life care,” said Haas. However, palliative care can be part of hospice care.
Palliative medicine was first defined as a specialty in the United Kingdom in 1988. Within 2 years, the concept was brought to Montreal, Canada, by Balfour Mount, MD, a Canadian surgeon, and introduced in the hospital setting, where the term “palliative care unit” was established. Today Mount is considered the father of palliative care in North America. The World Health Organization defines palliative care as “the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best possible quality of life for patients and their families.”
Haas said that palliative care affirms life and regards dying as a normal process. It intends to neither hasten nor postpone death and integrates the psychological and spiritual aspects of patient care. Palliative care also offers a support system to help patients live as actively as possible until death. Using a team approach, palliative care occurs in multiple settings, including in-patient, community, nursing home, and a patient’s home.
Palliative care can significantly improve quality of life of patients and their families. However, Haas noted there are barriers to referral for palliative care “due to misconceptions and confusion.” She said other barriers to referral for palliative care are discomfort communicating the prognosis and fear of losing control of the patient. However, she said these barriers can be overcome, and nurses can play a key role in establishing a palliative care clinic within radiation oncology departments. “These are very time-consuming patients,” said Haas. “Nurses are going to be leaders in integrating palliative care.”
She said a palliative care team consists of an MD and/or nurse practitioner or physician assistant, RNs, medical social workers, and clergy. Haas said palliative care programs also must define the immediate and long-term goals of care and promote advanced planning. In addition, palliative care programs can help educate patients and their families to help them better understand the underlying disease process. Haas said palliative care programs help establish an environment that is comforting and healing and are a natural complement to traditional medical care.
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