Cancer Centers Should Integrate Palliative Care to Ensure Dignity at End of Life

Cancer patients on palliative care wards were more likely to experience a dignified death than patients in other parts of cancer centers, suggesting that palliative services should be integrated into all cancer care, a recent study found.

In a survey of physicians and nurses working in hospitals at 10 cancer centers in Germany, almost all participants who worked on palliative care wards (95%) reported that patients died with dignity in their units, compared with 57% of respondents overall. Half of all respondents said they rarely had enough time to care for dying patients, and less than 20% felt prepared to care for the dying. The results were published online in Cancer.

The authors cited several possible reasons for the differences between palliative care wards and other units, including insufficient staff training; reimbursement issues that encourage futile, aggressive end-of-life care; and poor communication and advance care planning.

“Especially because respondents reported deficits in working environment, pain management, use of life-prolonging interventions, communication with patients, and dignified death, the dramatic differences between palliative care wards and other wards are disquieting,” the authors wrote. “It appears that there is a greater acceptance of death as a natural outcome on palliative care wards, indicated by the fact that palliative care staff rarely reported the overuse of life-prolonging measures.”

The study also highlighted that physicians and nurses have different views about the care of dying patients. For example, nurses were more likely to believe that life-prolonging measures are used too frequently, possibly because they spend more time with patients and experience the effects of aggressive end-of-life care. Nurses also were more likely to report poor communication with patients about potentially difficult treatments.

Teamwork also appears to be stronger on palliative care wards, the study reported. Eighty percent of participants on palliative care wards said they had good or very good interactions with different professions (such as physician-nurse) compared with 58% overall.

In general, nurses were less likely than physicians to perceive positive working relationships, with 51% of nurses reporting good or very good interactions with colleagues of other professions vs 81% of physicians. The differences are concerning considering that interdisciplinary teamwork is essential to providing comprehensive cancer care, the authors noted.

Researchers suggested several ways that cancer centers can improve the care of dying patients throughout the hospital, including:

• ensure sufficient staffing and rooms to adequately care for dying patients;

• provide training in basic palliative care for all staff;

• adopt standards for advance care planning to help physicians follow patients’ end-of-life wishes; and

• introduce palliative care earlier with specialist palliative care consultations.

State-of-the-art cancer care “involves not only curative treatments but also care for patients with advanced, incurable cancer and for dying patients,” the authors concluded. “It is crucial that cancer centers strive to improve conditions for dying patients by ensuring that there are adequate structural conditions and by promoting the integration of palliative care principles on all hospital wards.”