ONS: Start Palliative Care at Diagnosis for All Cancer Patients

Nurses are in an ideal position to advocate for improving patient access to palliative care

The Oncology Nursing Society (ONS) has released a position paper on palliative care, emphasizing its importance throughout cancer treatment and the critical role of nurses in advocating for patients and educating the public.

“Palliative Care for People with Cancer,” recommends that palliative care begin at diagnosis and continue throughout treatment and bereavement. Care should be provided by a multidisciplinary team made up of physicians, nurses, social workers, spiritual caregivers, and others involved in cancer care, such as pharmacists and physical therapists.

“All healthcare professionals should focus on patient-centered care and communication, aggressively managing symptoms, and coordinating care across care settings to ensure that the patient’s goals of care are being met,” the authors note.

Nurses are in an ideal position to advocate for improving patient access to palliative care services, the paper states. They also play an important role in educating the public about the difference between palliative care and hospice. Palliative care emphasizes improving patients’ overall quality of life throughout the continuum of illness whereas hospice focuses more narrowly on patients with prognoses of 6 months or less.

“Palliative care and hospice care often are perceived as having the same goals of care,” the authors note. “Confusion between these two terms, however, can limit access to these important services.”

ONS also responded to the Institute of Medicine’s recent report, “Dying in America: improving quality and honoring individual preferences near the end of life.” Instead of focusing exclusively on end-of-life, ONS recommends developing systems and processes that support palliative care for all people with cancer, beginning at diagnosis.

The ONS position paper also makes the following recommendations:

• In addition to physicians, nurses, social workers, and spiritual care professionals, multidisciplinary teams might include pharmacists; nursing aides; respiratory, occupational, and physical therapists; psychologists; psychiatrists; bioethicists; volunteers; and allied personnel who are skilled, credentialed, or certified in the essentials of palliative care.

• Oncology nurses must possess knowledge and skills to provide the best evidence-based palliative care for patients and survivors, including content related to the structure and processes of care, and the physical, psychological, psychiatric, social, spiritual, religious, and cultural aspects of care. They must be trained in caring for the imminently dying patient and in the ethical and legal aspects of care. The inclusion of this content is essential and should be included in the continuing education of practicing nurses and integrated into undergraduate and graduate nursing education.

• Minimally, palliative care principles are incorporated into all oncology care sites and access to palliative care experts is available for patients in all settings. Ideally, dedicated palliative care units and outpatient clinics are available for patients and families throughout the continuum of their illness.