Palliative care is an integral part of comprehensive cancer care. Every oncology nurse, regardless of specialty, integrates elements of palliative care into daily practice—whether meeting a newly diagnosed patient for the first time or helping a patient and family through the final phase of life.
It is also not uncommon for a patient to present to his or her nurse and physician for the first time with far advanced disease, for example in cancers of the pancreas or ovaries when symptoms may have been absent, nonspecific, or mild. Other reasons for patients to present late in their disease can be associated with cultural, social, psychological, economic, or access barriers.[1,2]
The oncology nurse is frequently a central figure and linking force to other team members in providing patients and their families care and support throughout the cancer trajectory, regardless of outcome. Especially when the patient and family are new to the world of cancer, many stressors are encountered—physical, psychological, social, spiritual, and existential.
This is an unknown territory for them, a foreign land they did not choose or want to visit, an experience that has been forced on them. There is a new language to be learned by necessity and a path of safety and support to be shown. This is palliative care: attention to detail and to the patient and family. Oncology nurses provide this attention every day but do not necessarily recognize it as an aspect of palliative care.
In 2000 and 2004, the Oncology Nursing Society (ONS) surveyed their general membership regarding research priorities. Eight topics clearly related to palliative care and/or end-of-life care were identified among the top 20 priorities: Health-related quality of life, participation in treatment in patients with advanced disease, pain, palliative care, fatigue/lack of energy, cognitive impairment/mental changes, hospice/end-of-life, and ethical issues. These results indicate interest in palliative care among oncology nurses, and recognition of the need to know about these various areas. Surprisingly absent in these “top 20” lists was “communication.”
Communication is the underpinning of oncology nursing and palliative care, and poor communication has been identified as a major cause of suffering for oncology patients and their families. This is a crucial area of expertise for the nurse to develop. Many of us are adept at communication, and though some of us may not communicate well, this skill can be learned.
As outlined in the article by Michelle Gabriel, there is a wealth of information and key resources in various formats for the oncology nurse to tap into regarding palliative care. A particularly useful comprehensive palliative care resource list can be found in the Textbook of Palliative Nursing compiled by Rose
Virani and Stacey Pejsa, including bibliographies, references, and texts; guidelines; journals and newsletters; organizations and web sites (patient, professional, and state pain initiatives); position statements; reports; research instruments; and videos.
It is never possible to be all-inclusive when sharing this type of information, but that is not important. What is important is for the oncology nurse to be aware that palliative care is an integral part of oncology nursing, that information is readily accessible, and that seasoned nursing colleagues in cancer centers’ palliative care programs are always available as a resource.
The main article can be found here:
1. Ahmed N, Bestall JC, Ahmedzai SH, et al: Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health social care professionals. Palliat Med 18(6):525–542, 2004.
2. Davies B, Sehring SA, Partridge JC, et al: Barriers to palliative care for children: Perceptions of pediatric health care providers. Pediatrics 121(2):282–288, 2008.
3. Cohen MZ, Harle M, Woll AM, et al: Delphi survey of nursing research priorities. Oncol Nurs Forum 31(5):1011–1018, 2004.
4. Thorne SE, Bultz BD, Baile WF; SCRN Communication Team. Is there a cost to poor communication in cancer care?: A critical review of the literature. Psychooncology 14(10):875–884, 2005.
5. Virani R, Pejsa S: Palliative care resource list, in Ferrell B, Coyle N (eds): Textbook of Palliative Nursing, 2nd ed, pp 1217–1220. New York, Oxford University Press, 2006.