Nurses Must Include Palliative Care Early for Their Patients
By Rebecca Collins, MS, RN, OCN®, CHPN, NE-BC, CENP
At a recent conference I attended, a presenter asked the audience to choose the best treatment option for a case study review. The choices were introduced as three separate viable treatments with the fourth option being “or just refer to palliative care.”
This unfortunate view of palliative care—one that suggests implementing it when treatment options no longer exist—has been a barrier to consulting with palliative care providers at the appropriate time. This is not an aggressive treatment versus no treatment discussion. It should be a discussion on why palliative care should be part of the oncology treatment plan from the very beginning.
When Is Palliative Care Needed?
In oncology, healthcare providers encounter many difficult conversations. However, involving palliative care in a patient’s treatment plan should not be one of them. The 2017 National Comprehensive Cancer Network (NCCN) guidelines (https://jnccn.org/view/journals/jnccn/15/8/article-p989.xml) support palliative care being initiated at the beginning of the patient’s cancer journey by the oncology team. It’s been shown to be an integral part of comprehensive care (https://doi.org/10.6004/jnccn.2017.0132).
Introducing palliative care at the initial visit is a vital part of delivering successful patient-centered care. As more institutions and healthcare professionals advocate for its early inclusion, we can help normalize including palliative care as a standard component of the cancer care process. Continuing palliative care throughout the course of treatment also helps the oncology team provide a multidimensional approach to care (https://doi.org/10.6004/jnccn.2017.0132) for patients and their families.
Supporting Palliative Care Efforts
Including palliative care as part of a patient’s cancer treatment journey has shown to be beneficial for quality of life and symptom management efforts. However, healthcare professionals still require further training to understand and incorporate palliative care into practice. As such, ONS and its advocates have just successfully supported the passage of the Palliative Care and Hospice Education and Training Act (PCHETA) in the U.S. House of Representatives (https://voice.ons.org/advocacy/us-house-of-representatives-passes-two-ons-priority-bills) and are now working to secure passage in the U.S. Senate. One of the elements of this bill provides for palliative care education and awareness (https://www.ons.org/podcasts/episode-41-advocating-palliative-care-and-hospice-education) to teach patients, families, and healthcare professionals about the positive outcomes of palliative care.
Education will help support the timely involvement of the palliative care team to increase patients’ quality of life, provide symptom management, and support a true person-centered plan of care. Incorporating the principles of palliative care in cancer care can achieve many positive outcomes (https://evolve.elsevier.com/cs/product/9781455776269?role=student) such as increased survival, less-aggressive end-of-life care, and improved patient and caregiver satisfaction.
How to Get Patients Palliative Care
Even with guidelines supporting palliative care collaboration, research has shown (https://doi.org/10.1136/bmj.j878) that referrals to palliative care are often delayed until the illness has advanced and the patient only has weeks or days of life left. The benefits of palliative care are reinforced by NCCN guidelines, PCHETA, ONS (https://www.ons.org/acq-search?search=palliative), and multiple studies (https://doi.org/10.1007/s00520-015-2630-z), but to be successfully implemented in cancer care it requires support from the oncology team.
Nurses are at the forefront of patient-centered care and can advocate for their patients by starting the palliative care conversation early with the oncology team. Opening lines of communication, educating patients about the details of palliative care, and advocating for strong symptom management and a focus on quality of life can help connect patients to the resources they need. Ongoing assessment and follow up is crucial to reinforce patients understanding while also adapting to emerging patient needs.
Sharing Palliative Care Education
Presenting palliative care as an extra layer of support for patients and families during their cancer journey can be one way to frame it and help them understand. Patients need to know that the inclusion of palliative care doesn’t mean their life will be shortened. Quite the opposite; in fact, as it’s proven to prevent both mental and physical suffering (https://journals.sagepub.com/doi/10.1177/1178224216688887).
Consistent messaging from oncology professionals is key. Assuring patients that palliative care is part of the team-based cancer plan from the beginning will alleviate their concern that it is only offered at the end of life. It’s important to help patients understand that palliative care is appropriate at any stage of a life-limiting illness and can be provided alongside aggressive treatment.