Palliative Care and the Role of Nurses

TON July 2015 Vol 8 No 4

Palliative care is a key component of quality care. Oncology nurses have many of the skill sets for providing generalist quality care and are poised to play a major role in advocating and transforming palliative care for patients with cancer.

“I want you to leave here with the confidence that you can provide generalist palliative care and so can your colleagues. Oncology nurses know the trajectory of common cancers. We know how to assess pain and common symptoms. We know how to provide emotional support and psychosocial needs,” said Polly Mazanec, PhD, ACNP-BC, AOCN, FPCN, Frances Payne Bowden School of Nursing, Case Western Reserve University, speaking at the 2015 annual meeting of the Oncology Nursing Society (ONS).

“Both ONS and the NCCN [National Comprehensive Cancer Network] guidelines support the role of nurses in providing palliative care. Evidence shows that palliative care will improve quality of life, symptom burden, mood, and length of life, and improves healthcare services utilization, decreasing cost of care,” she continued.

Palliative care is defined as “patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care is for life-limiting illnesses, and encompasses all stages of cancer.”

Nurses can advocate for implementing and adhering to NCCN guidelines and practice recommendations. The generalist’s role is to provide uncomplicated pain and symptom management, participate in discussions of patient goals, and participate in or lead discussions about advance directives, including code status. This is distinct from specialist palliative care for more complex problems.

Even though ONS, NCCN, and other organizations recognize the importance of providing palliative care, only 41% of National Cancer Institute–designated centers have outpatient palliative care services, Mazanec told listeners.

Demographic trends underscore the need for generalist palliative care. These include an aging population, cancer statistics, the growing number of survivors with late effects from cancer treatment, and limited oncologic and specialist palliative care resources.

“We will have a huge shortage of oncology doctors, nurses, and palliative care providers in the future. The time to pay attention to this is now,” she said.

Mazanec was involved with a pilot project at a community oncology out­patient clinic where palliative care was provided by an oncology-certified nurse. Patients and caregivers perceived this intervention as helpful in addressing symptoms (85%), coping (91%), and planning for the future (82%).

“This pilot study showed this was feasible, accessible, and flexible, and we plan to do a larger study,” Mazanec said.

Skills required for generalist palliative care include fostering good communication with the patient to develop a trusting relationship. “You will have to discuss prognosis, treatment options, goals of care, and addressing code status,” she said. “You have to make sure the patient’s care is in alignment with their goals of care,” she continued.

“A mindful presence acknowledges vulnerability, is empathic, requires ‘being in the moment,’ and offers serenity and silence. Your patients have to know that you are there with them for the whole cancer journey and you will not abandon them. A trusting relationship is the most important thing you can do for patients and families,” Mazanec stated.

She gave several examples of empathic communication and emphasized that your role is not to be a cheerleader or a fixer. Respond to what patients want, she said.

“If a patient asks if he/she is going to die, it is best to be empathic and respond with ‘What makes you ask that today?’ Her answer might be very different than what you expect,” Mazanec noted. Another empathic response to that question is “It sounds like you are thinking about how you want to spend your time. What is most important to you now?”

Understanding the patient’s wishes is necessary when addressing code status. The patient may be confused about what artificial life support interventions he/she is being asked about. You could respond with “You are asking important questions, and I am here to help you understand what the team is talking about and how that fits with your wishes.”

SPIKES: A Tool for Having Difficult Conversations
S = setting up the conversation (private space)
P = assessing patient’s perception
I =obtaining the patient’s invitation
K = giving knowledge and information
E = addressing emotion with empathic response
S = strategize and summarize

NURSE: A Tool to Guide Conversations with Patients
N=name
U = understand
R = respect
S = support
E = explore

Reference
Mazanec P. Palliative care: the essence of nursing. Presented at: Oncology Nursing Society 40th Annual Congress; April 22-26, 2015; Orlando, FL.

Related Items


Subscribe Today!

To sign up for our newsletter or print publications, please enter your contact information below.

I'd like to receive: