Use This Guide to Navigate Difficult Conversations
“I don’t want to die.” “What is my prognosis?” “Is this a death sentence?”
As oncology nurses, heart-wrenching questions like these are part of our day-to-day work. So how do we address patient concerns in a compassionate yet professional way? How do we respond to a patient with stage IV cancer who exclaims they only have two more cycles of treatment until they’re cured? How do we explain to patients with cancer that their journey is not short term?
End-of-Life Care Helps Patients Pursue Purpose in the Presence of Pain
“It’s going be okay.”
That common phrase is full of meaning, yet so vague. Often, it’s a patient’s response when they’re first diagnosed or are told that all of the treatments have failed and they only have a few months to live. Other times, a family member will voice the remark when holding a patient’s hand as they provide comforting hope or temporary relief from distress. Sometimes an oncology nurse shares the phrase in an attempt to calm the agony their patients face each day.
Oncology Nurses Enable Patients and Caregivers to Cope at the End of Life
Caregivers for patients with advanced cancer provide crucial support but often have unmet needs. During a session at the ONS 44th Annual Congress in Anaheim, CA, J. Nick Dionne-Odom, PhD, RN, ACHPN, of University of Alabama at Birmingham, and Tara Albrecht, PhD, ACNP-BC, RN, of Virginia Commonwealth University School of Medicine in Richmond, discussed new research in palliative care and the role of nurses in supporting patients and their families.
When a Child Is Dying, Parents Need to Hear “We’ve Done Everything We Could”
What the parents of a child dying from cancer need to hear above all from the healthcare professionals caring for their child is that everything possible has been done, to the best of the health care team’s ability, said Pamela S. Hinds, PhD, RN, FAAN, in the 2019 Mara Mogensen Flaherty Memorial Lecture on Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
Advance Care Planning: It’s About Life
Many times, when patients are asked about their wishes at the end-of-life, they perceive it as asking how they want to die, which can be scary for patients and a hard conversation for nurses. What if there was a way to change that conversation to suggest that it is way more about how the patient would want to live? In her session “Advance Care Planning: It’s About Life,” on Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Erin Dickman explained how the advance care planning process can help nurses hold those conversations.
Communication and Conflict Resolution Become More Important in End-of-Life Care
The communication deficit among healthcare professionals, families, and patients is a barrier in the delivery of end-of-life care and can result in conflict, according to Elizabeth Thiel, MD, MS, of the Medical College of Wisconsin in Milwaukee, and Andria Caton, BSN, RN, OCN®, CHPN, of Northeast Georgia Medical Center in Gainesville. Thiel and Caton discussed end-of-life communication and the role that nurses play in those conversations during a session on Wednesday, April 10, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
McCain Announcement Sheds Light on Nurses’ Role in Advance Care Planning
Senator John McCain’s (R-AZ) family announced on August 24, 2018, that McCain has elected to stop treatment for his glioblastoma, a rare and aggressive form of brain cancer. Although his health had surpassed his original prognosis for many months, “the progress of disease and the inexorable advance of age render their verdict. With his usual strength of will, he has now chosen to discontinue medical treatment,” his family explained.
Medical Aid in Dying Patient Chooses His Last Day; Arkansas Medicaid Work Requirements Could Cost Thousands Coverage; CVS Launches Program in Response to Trump Administration Blueprint to Lower Drug Costs
With more states legalizing medical aid in dying options for patients, the process is often vague and misunderstood. One patient, Aaron McQ, shared his story as he prepared to self-administer his life-ending medication. His story explains the nurse's key role in education and shared decision making to address the concerns of the patient.
Is Palliative Care the Answer to the Medical Aid in Dying Discussion?
Oncology nurse scientists have pioneered efforts in symptom management research, including palliative and end-of-life care studies. Healthcare providers and researchers have strong consensus that palliative interventions should begin at the time of diagnosis for patients with cancer. The Clinical Journal of Oncology Nursing and Oncology Nursing Forum have published excellent articles in nearly every issue on topics of palliative care, quality of life, and symptom management issues.
How Can Nurses Help Patients Understand End-of-Life Options?
When physician-assisted death mandates were passed in states like Oregon, Washington, and California, guidelines were established for practitioners as part of election mandates. However, in states like Montana and Vermont, the legalization of assisted death went through the legislature without process and practice guidelines. Therefore, practitioners have little or no framework to implement the process of medical aid in dying.
What to Do When Your Patients Talk About Medical Aid in Dying
Despite groundbreaking treatments, novel medications, fast-tracked drug approvals, and cutting-edge science, a terminal diagnosis is still a reality for many patients with cancer. Having end-of-life discussions with patients and their family members is a difficult part of oncology nursing, but it’s necessary to provide the highest quality of care and education possible. With more news reports emerging about states introducing—and passing—medical aid in dying legislation, oncology nurses will face questions about the process from patients and caregivers.
How to Have Ethical Discussions in Your Practice
Having an outlet to consider, discuss, and reflect on oncology ethical issues that affect our daily practice is important in caring for each other in our profession. On our solid tumor oncology unit, monthly nursing ethics lunch and learns allow our nurses the opportunity to identify and discuss their concerns with recent patient cases involving ethical issues. Our hospital’s ethics committee chair facilitates the hour-long discussions held on the unit, along with a senior oncology nurse with significant training and background in clinical ethics.
GOP Steers Away From Obamacare Repeal, Replace; Is Cigarette Prohibition on the Horizon?; Barbara Bush’s End-of-Life Decision Makes Waves
After a flurry of proposed legislation to repeal and replace Obamacare—the unofficial name for the Affordable Care Act (ACA)— the GOP has shifted its focus to other policy issues. In fact, many Republican senators and congressional representatives have removed any mention of the healthcare law from their websites. With the 2018 midterm elections approaching, GOP lawmakers are seemingly breaking with the Trump administration’s stance on the healthcare law, recognizing that their constituents may be in favor of the ACA’s many protections.
What Oncology Nurses Need to Know About Cultural Differences During End-of-Life Care
Beyond the emotional complexities of end-of-life care, a multitude of cultural nuances and differences can affect the care that oncology nurses need to provide to their patients and family members. As the face of the healthcare team, oncology nurses are often called on to navigate this delicate area within the cancer continuum.
The Case of the Comfort Care Concerns
Phil is a 63-year-old man who is admitted to the inpatient oncology unit for severe pain resulting from metastatic small cell lung cancer. His wife and two daughters are at his bedside. Earlier in the day, the medical oncologist discussed additional treatment options or hospice care. Phil decided on comfort care with the hope of getting his pain managed and going home on hospice.
Ethnic Minority Patients May Receive Inferior End-of-Life Care
According to the results of a study published in the Journal of Clinical Oncology, African American and Hispanic patients with ovarian cancer who lived in Texas were more likely to receive invasive or toxic treatment and be admitted to intensive care in their final month of life than their Caucasian counterparts.
Chemotherapy Use Near the End of Life Is More Common in United States
National guidelines suggest that the use of chemotherapy near end of life (EOL) is aggressive and is associated with poorer patient quality of life. In addition, Medicare payments for outpatient chemotherapy have decreased since around 2005–2006. In a recent study presented at the 2017 ASCO Annual Meeting, researchers evaluated the impact of U.S. payment reform and guidelines on chemotherapy use at EOL, comparing chemotherapy use at EOL in the United States and other countries.