APRNs Can Lead by Example When Integrating Palliative Care in Practice
Early and regular integration of palliative care (PC) improves patient and caregiver outcomes in symptom management, quality of life, psychosocial health, communication, shared decision-making, overall satisfaction—and even survival. Health systems also benefit through reduced emergency department visits, hospitalizations, and intensive care stays; increased completion of advanced directives; and improved quality of end-of-life care. Both the Centers for Medicare and Medicaid Services’ (CMS’s) Oncology Care Model and many oncology organizations, including ONS, support the approach for patients with cancer.
When Everything Still Isn't Enough
Last year, I was involved in the care of Emma (not her real name), a 22-year-old woman with duodenal adenocarcinoma. Cancers of the small intestine are very rare, accounting for less than 1% of all cancers diagnosed in a given year. Because the average age at diagnosis is 66 years, Emma was unusual to have been diagnosed at only 20. But Emma was an exceptional patient in many ways beyond her rare diagnosis: she was remarkably resilient for one so young and came armed with an incredible support system of loved ones.
The Case of the Sensitive Staging System
Marianne, an oncology nurse navigator, is preparing a cancer treatment summary and survivorship care plan for Sylvia, who finished breast cancer treatment six weeks ago. Sylvia was treated with neoadjuvant therapy followed by mastectomy, reconstruction, and radiation. Her tumor was characterized as multifocal invasive ductal carcinoma, grade 2, estrogen and progesterone positive, and HER2/neu negative. Sylvia has no family history of breast cancer. Marianne notices that the oncologist recorded Sylvia’s cancer as a stage IB. Marianne wonders if the stage was determined before or after chemotherapy and surgery.
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.
Advance Care Planning Initiative Promotes Patient Preference
Advance care planning (ACP) involves communication with the patient, his or her family and/or caregivers, and the healthcare team to plan for the future and promote shared decision making that incorporates patient preferences. Guidelines from the American Society of Clinical Oncology and National Comprehensive Cancer Network recommend that ACP discussions take place within three months of a diagnosis of incurable cancer; however, ACP conversations may not occur because patients, family members, and providers each wait for the other to initiate the discussion.
ONS and Other Groups Ask Nurses to Lead by Example to Promote Advance Care Planning
Advance care planning (ACP) is a process for patients and their families to discuss their wishes and goals of care for treatment and end-of-life care, clarify related values and goals, and state preferences through written documents and medical orders. In situations where a patient’s decision-making capacity is limited, healthcare providers turn to family members to make decisions. When no ACP conversations have occurred between patients and their families, family members are left to make decisions regarding life-sustaining treatment without input from the patient or with little knowledge of the patient’s wishes.
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.
ONS Shares Views on Advance Care Planning, Patient Access to Opioids in Comment Letter to CMS
ONS joined the Patient Quality of Life Coalition (PQLC) in signing a final comment letter to the Centers for Medicare and Medicaid Services (CMS) administrator, Seema Verma, on the agency’s proposed 2018 updates to the Quality Payment Program, CMS-5522-P. PQLC, which represents patients, health professionals, and healthcare systems, advocates for palliative care for patients and families facing serious illness.
Becoming a Healthy You Contributes to a Healthy Nation
The American Nurses Association (ANA) launched a grand challenge this year: Healthy Nurse, Healthy Nation. The premise is that we are the largest health professionals group but also rate poorly on health indicators. If we improve our health, we can be role models for our family, friends, patients, and community. ONS is supporting the ANA challenge, and I hope you have seen the weekly ONS tips that will help in this challenge.
What Is ONS’s Stance on Handling Chemotherapy While Pregnant, Breastfeeding, or Trying to Conceive?
One of the questions that ONS commonly receives in the clinical inbox (firstname.lastname@example.org) is whether nurses who are pregnant, breastfeeding, or trying to conceive can safely administer or handle chemotherapy and other hazardous drugs.