Nursing-Specific Strategies Support Early Palliative Care in Oncology

Outpatient oncology nurses implement unique clinical strategies that adhere to the nursing framework and utilize multiple components of clinical practice to introduce early palliative care, according to results from a recent constructivist-informed grounded theory study. These results were published in Cancer Nursing.¹

Palliative care is a critical component of a high-quality oncology care continuum. Accordingly, the American Society of Clinical Oncology, the National Academy of Medicine (formerly known as the Institute of Medicine), and the National Comprehensive Cancer Network all support the implementation of palliative care into standard oncology care.^2-4 Furthermore, research shows that consultations for early palliative care improve quality of life, symptoms, and even clinical outcomes.⁵

Early palliative care is associated with improvements in health-related quality of life, management of symptoms, and satisfaction with care, and this study assessed the clinical strategies used by oncology nurses to actively start communication about early palliative care.

Researchers used a constructivist-informed grounded theory study in a tertiary oncology center in Toronto, Canada, to assess how nurses’ clinical strategies for introducing early palliative care aligned within a clinical framework.¹

In total, 20 nurses comprised of 6 staff nurses, 4 advanced practice nurses, and 10 nurse practitioners across outpatient oncology clinics from different histologies including breast, pancreatic, and hematologic malignancies participated in and completed semistructured interviews. Analysis concurrent to data collection coupled with constant comparison enabled cessation of the study once the study reached theoretical saturation.¹

In this study, the overarching core domain of “pulling it all together” delineates the strategies utilized by oncology nurses to enable optimal early palliative care referral. The relational, advocacy, collaborating, and coordinating dimensions of clinical practice support this domain of “pulling it all together.”

Notably, this core domain incorporates 3 subcategories: broadening the focus from disease-focused therapy to emphasizing how to live well with cancer; inducing and supporting synergy across the multidisciplinary oncology care continuum; and promoting and individualizing palliative care within each patient’s individual trajectory with cancer.¹

Results from this study showed that across outpatient oncology nurses, unique clinical strategies were used to support the multiple domains of care and to introduce early palliative care. The authors stated, “Our findings have clinical, educational, and policy implications for fostering the conditions in which nurses are supported to maximize their full potential in the introduction of early palliative care.”¹

References

1. Mohammed S, Swami N, Pope A, Rodin G, Zimmermann C. Strategies used by outpatient oncology nurses to introduce early palliative care: a qualitative study. Cancer Nurs. Published online July 5, 2023. doi:10.1097/NCC.0000000000001258
2. Institute of Medicine of the National Academies. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: The National Academies Press; 2015. doi:10.17226/18748
3. Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline update. Am J Clin Oncol. 2017;35(1):96-112. doi:10.1200/jco.2016.70.1474
4. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Palliative Care Version 2.2023 — April 24, 2023. Accessed August 4, 2023. https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf
5. Vanbutsele G, Van Belle S, De Laat M, et al. The systematic early integration of palliative care into multidisciplinary oncology care in the hospital setting (IPAC), a randomized controlled trial: the study protocol. BMC Health Serv Res. 2015;15:554. doi:10.1186/s12913-015-1207-3