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January 2015, Volume 42, Number 1
Oncology
Nursing Society Position Statement
Position Statement on Palliative Care
The U.S. Department of Health
and Human Services Centers for Medicare and Medicaid Services (2008) and the
National Quality Forum defined palliative care as,
Patient and family-centered care that optimizes
quality of life by anticipating, preventing, minimizing, and treating
suffering. Palliative care
throughout the continuum of illness involves addressing physical, intellectual,
emotional, social, and spiritual needs and to facilitate patient autonomy,
access to information, and choice. (p. 32,204)
This definition demonstrates
palliative care as a multidisciplinary approach that might include care
provided by physicians, nurses, social workers, psychologists, psychiatrists,
pharmacists, spiritual care professionals, and respiratory, physical, and
occupational therapists, as well as a variety of other disciplines necessary to
manage symptoms. 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
(National Consensus Project, 2013).
Palliative care and hospice
care often are perceived as having the same goals of care. Confusion between
these two terms, however, can limit access to these important services.
Palliative care is defined as a philosophy of care and
an organized, highly structured system for delivering care (National Consensus
Project, 2013). Hospice is a form of palliative care that provides care to
individuals who have a limited life expectancy (i.e., prognosis of six months
or less).
Oncology nurses are critical
participants in the delivery of palliative care. The Oncology Nursing Society’s
(2014a, 2014b, 2014c) positions on access to quality cancer care, lifelong
learning, and certification of oncology nurses provide testimony to the role of
oncology nurses in palliative care. Of note, 50% of the test items on the
Oncology Nursing Certification Corporation (n.d.) credentialing examination are
based on the National Consensus Project’s (2013) domains of palliative
care.
It Is the
Position of ONS That
·
All patients with
cancer benefit from palliative care.
·
Palliative care
should begin at the time of diagnosis and continue throughout bereavement.
·
Physical,
psychological, social, cultural, and spiritual assessments are key components
to the development of a comprehensive care plan for each patient.
·
The family is the
unit of care, with the patient viewed as part of the family and family as
defined by the patient.
·
Palliative care
is provided by an interprofessional team that includes at least physicians,
nurses, social workers, and spiritual care professionals. Additional team
members can 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.
·
The
interprofessional team must recognize the complexity of the patient and family
experience and be prepared to adjust care and goals based on the patient’s or
family’s expressed needs.
·
Family
conferences to address goals of care are essential to ensure the team continues
to remain focused on the patient’s needs and goals of care.
·
Oncology nurses
are in a unique position to advocate for patients regarding access to and the
delivery of quality palliative care.
·
Oncology nurses
must possess knowledge and skills in certain domains to deliver safe, quality
palliative care, including (a) structure and processes of care; (b) physical
aspects of care; (c) psychological and psychiatric aspects of care; (d) social
aspects for care; (e) spiritual, religious, and existential aspects of care;
(f) cultural aspects of care; (g) care of the imminently dying patient; and (h)
ethical and legal aspects of care.
·
All healthcare
systems adopt the Physician Orders for Life-Sustaining Treatment paradigm to
ensure respect for do-not-resuscitate orders when patients change levels or
sites of care.
·
Palliative care
principles, at minimum, 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 the illness.
·
Oncology nurses
play a role in engaging the public and providing fact-based information about
care of people with advanced serious illness to encourage advance care planning
and informed choices based on the needs and values of individuals.
References
Centers for Medicare and Medicaid
Services. (2008). Medicare and
Medicaid programs: Hospice conditions of participation. Retrieved from http://gpo.gov/fdsys/pkg/FR-2008-06-05/pdf/08-1305.pdf
National Consensus Project. (2013). Clinical practice
guidelines for quality palliative care. Retrieved from http://nationalconsensusproject.org/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf
Oncology Nursing Certification Corporation. (n.d.). Test blueprint. Retrieved from http://oncc.org/TakeTest/Certifications/OCN/Blueprint
Oncology Nursing Society. (2014a). Access to quality cancer
care [Position statement]. Retrieved from https://ons.org/advocacy-policy/positions/policy/access
Oncology Nursing Society. (2014b). Lifelong learning for professional oncology
nurses [Position statement]. Retrieved from https://ons.org/advocacy-policy/positions/education/lifelong
Oncology Nursing Society. (2014c). Oncology certification for
nurses [Position statement]. Retrieved from https://ons.org/advocacy-policy/positions/education/certification
Approved by
the ONS Board of Directors, October 2014.