Role of Oncology Nurses in Primary Palliative Care Growing

Oncology advanced practice registered nurses (OAPRNs) can play a critical role in providing primary palliative care to patients with cancer, according to a new study.

By 2020, cancer is expected to surpass cardiovascular disease as the leading cause of death in the United States. Not only is the number of people with cancer expected to increase, but also the number of cancer survivors.

In order for OAPRNs to be an active part of meeting these growing demands, they will need to be educated in primary palliative care, according to a presentation by Pam Malloy, MN, RN, FPCN, FAAN, of the American Association of Colleges of Nursing (AACN), at the Oncology Nursing Society (ONS) 44th Annual Congress, held April 11–14 in Anaheim, California.

To address the role of nurses in primary palliative care, the End-of-Life Nursing Education Consortium (ELNEC) began almost 20 years ago as a partnership between the City of Hope and AACN. This consortium provides knowledge on excellent communication strategies to assist patients, families, and the interdisciplinary team to outline goals of care, to manage pain and symptoms, and to lead systems of care in promoting palliative care for all cancer patients at the time of diagnosis.

“Through these programs, we hope that nurses start to see palliative care as a routine part of their practice, so that when they are caring for a patient with cancer they understand the importance of quality of life, symptom assessment and management, and goals of care,” Malloy explained. “Many OAPRNs are already doing some of these things and may not realize this is palliative care. We want to help them collaborate and coordinate this care.”

In 2017, Betty Ferrell, PhD, MA, CHPN, FPCN, FAAN, at the City of Hope received a grant from the National Cancer Institute to develop a program for advanced practice nurses who work in oncology. To date, more than 150 OAPRNs have attended two of the five national workshops designed to provide primary palliative care education.

As part of the grant, participating advanced OAPRNs had to spend between 40 and 80 hours with a palliative care team upon returning to their institution. This time included making rounds with the team, attending family meetings, and more.

“This interaction was really the icing on the cake for these advanced practice nurses … to be able to see and do the work first hand,” Malloy said.

At ONS, Malloy presented data from a 6-month post-course survey investigating the challenges and opportunities in developing and instituting primary palliative care in their oncology setting.

With a rating scale from 1 to 5 (with 5 being the highest), participants rated the materials and resources as highly applicable to their practice (4.94), and responded that information was stimulating and thought-provoking regarding palliative care issues (4.95).

Malloy also discussed more specific feedback from nurses upon returning to their institution.

Participants reported increased confidence in having goals-of-care conversations with their patients and referring them to the palliative care team for consult, Malloy said.

“I hope that at the end of my presentation people will feel more confident about palliative care and the role it plays in the treatment of seriously ill cancer patients,” Malloy told Cancer Network. “Many nurses experience moral distress because they feel that patients never had full disclosure to friends or family about how seriously ill they were. I hope nurses will feel more empowered to take this course and get this type of education.”