Prompting early discussions around end of life care

The importance of palliative care is widely recognised by healthcare professionals, patients and members of the public, with a greater emphasis on the need for early introduction of palliative care. However, this often is difficult to achieve in practice.

Some healthcare professionals appear reluctant to discuss palliative care unless people are at the end of life, or experiencing intractable pain or other severe symptoms. Patients and carers are often fearful when palliative care is mentioned, exacerbated by anxiety, myths and misconceptions.

Adapted terminology

Some cancer centres have replaced the words ‘palliative care’ with ‘supportive care’, although the use of such semantics is currently debated and there is no current evidence that changing terminology improves patients’ perceptions.

The introduction of Advanced Care Planning (ACP) aims to facilitate communication at end of life, promoting early discussions with patients and carers to ascertain their concerns, needs and priorities. This also gives healthcare professionals a chance to discuss sensitive issues, such as the potential benefits of further treatment, resuscitation and their preferred place of death. Despite ACP training being considered essential in oncology, there continues to be a lack of focus on early discussions and palliative interventions, as you can read in our feature

'Improving patient care involves changing practice, which can be an uphill struggle for nurses to undertake single-handedly'

Improving patient care involves changing practice, which can be an uphill struggle for nurses to undertake single-handedly. Support in a multidisciplinary team can facilitate effective change, including changing people’s attitudes. I have witnessed dramatic improvements from a joint-working project between palliative care and breast medical oncology in my organisation, which resulted in early assessment of patients’ needs, fewer crisis admissions and greater community support.

The RCNi Nurse Awards showcase innovations in clinical practice. The Excellence in Cancer Research award recognises individual clinical research nurses, research teams or nurses who work on clinical trials for cancer to discover new ways to prevent, diagnose or treat the disease and improve patient outcomes. If your clinical research or initiative is innovative and benefits patients or nursing practice apply for the awards below.

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Carole Farrell is consultant editor of Cancer Nursing Practice