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Oncology Nursing Society and Association
of Oncology Social Work Joint Position
on Palliative and End-of-Life Care
Despite the clear benefits of hospice care, too many patients die in settings that do not support an optimal death
experience (Teno et al., 2004). Technical advances in healthcare have, in some cases, prolonged suffering. A proactive
and integrated approach to palliative and end-of-life care will improve quality of life across the care continuum. The
National Quality Forum (2006) affirmed the necessity of integrating timely and appropriate palliative care practices
across the illness trajectory. That care involves addressing physical, intellectual, emotional, social, and spiritual needs
and facilitating patient autonomy, access to information, and choice.
It is the Position of ONS
and the Association of Oncology
Social Work That
Patient and Family Rights
• Patients and families understand and evaluate the ben-
efits and burdens of potential treatment options as well
as accompanying financial costs.
• Patients and families consider hospice care when pa-
tients are likely to die within a year or the reintroduc-
tion of hospice as patients decline.
• Assistance in adapting to altered goals of treatment and
role responsibilities as well as other difficult decision-
making circumstances is provided to patients and
families.
• Families and significant others are included in the unit
of care as evidenced by patient and family care confer-
ences with appropriate members of the interdisciplin-
ary team.
• Designated surrogates and decision makers are docu-
mented in accordance with state law.
• Patients and families have access to ethics committees
or ethics consultation across care settings.
• A bereavement care plan is implemented after patients’
deaths.
measured comprehensively and documented using
available standardized scales.
• Pain, dyspnea, constipation, and other symptoms are
measured comprehensively and documented using
available standardized scales.
• Physical and psychological symptoms are assessed, man-
aged, and reassessed in a timely, safe, and effective man-
ner to a level that is acceptable to patients and families.
• Therapies traditionally considered part of active care
are provided if they improve patients’ symptoms and
enhance quality of life.
• A comprehensive social care plan addresses the social,
practical, and legal needs of patients and caregivers.
• Sensitive and appropriate spiritual care issues are as-
sessed and integrated into the care plan to promote
adequate coping for patients, families, and significant
others.
• Professional interpreter services and culturally sensi-
tive materials are provided in patients’ and families’
preferred languages.
• Clinical and behavioral research related to the care of
patients who are near the end of life are strengthened
and support evidence-based practice and improved
patient outcomes.
Interdisciplinary Team
• Healthcare providers receive adequate training in pal-
liative care at undergraduate and graduate levels and
in required continuing education programs.
• Interdisciplinary team members are credentialed or
certified in their areas of expertise.
(Continued on next page)
Skilled Palliative Care
• A timely care plan is based on a comprehensive inter-
disciplinary assessment of values, preferences, goals,
and needs of patients and families.
• Psychological symptoms, including anxiety, depres-
sion, delirium, and behavioral disturbances, are
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(Continued from previous page)
• The interdisciplinary team includes adequate numbers
of physicians, nurses, social workers, pharmacists,
nursing aides, spiritual care professionals, bioethicists,
volunteers, and allied personnel who are all skilled in the
essentials of palliative care pertinent to their positions.
• The interdisciplinary team values shared decision mak-
ing and supports culturally competent practice (i.e.,
the ability to respectfully inform patients and families
about prognosis, interventions, and outcomes in the
context of differing value systems).
• Interdisciplinary team members are informed and up-
dated as necessary on values, preferences, goals, and
needs of patients and families.
includes (a) patients’ values, goals, preferences, and
needs; (b) physical and psychosocial issues; (c) current
treatment interventions and requirements; (d) potential
complications; and (e) expected outcomes across sites of
care.
Public Advocacy
• Public and professional education regarding the
preparation of advanced healthcare directives and the
right of each individual to excellent end-of-life care is
increased.
• Skilled advocacy in collaboration with national and re-
gional policy makers, consumer groups, and licensing
and regulatory agencies focuses on equal and afford-
able access to end-of-life care and the elimination of
prescribing laws that impede adequate relief of pain.
Integrated Care Systems
• Healthcare systems adopt the Physician Orders for
Life Sustaining Treatment paradigm (Oregon Health
and Science University, 2005) to ensure respect for
do-not-resuscitate orders when terminally ill patients
change sites of care.
• Acute, critical care, outpatient, emergency department,
home health, and long-term care services incorporate
palliative care principles and provide timely and ap-
propriate care to patients and families 24 hours a day,
seven days a week.
• Communication about patients (especially when tran-
sitioning between healthcare facilities or providers)
References
National Quality Forum. (2006). A
national framework and preferred
practices for palliative and hospice care quality: A consensus report.
Washington, DC: Author.
Oregon Health and Science University. (2005). History of POLST
paradigm development. Retrieved January 5, 2007, from http://www
.ohsu.edu/polst/background.shtml
Teno, J.M., Clarridge, B.R., Casey, V., Welch, L.C., Wetle, T., Shield,
R., et al. (2004). Family perspectives on end-of-life care at the last
place of care. JAMA,
291,
88 –93.
Approved by the ONS Board of Directors, 7/07.
To obtain copies of this or any ONS position, contact the Customer Service Center at the ONS National Office at
125 Enterprise Drive, Pittsburgh, PA 15275-1214 (866-257-4ONS; customer.service@ons.org). Positions also may
be downloaded from the ONS Web site (www.ons.org).
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