The U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (2008) 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. 32204).
This definition demonstrates palliative care as a multidisciplinary approach that may 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. However, confusion between these two terms can limit access to these important services. Palliative care is a philosophy of care and an organized, highly structured system for delivering care (National Consensus Project, 2013) focused on providing relief from the symptoms and stress of a serious illness (Center to Advance Palliative Care, n.d.). 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). The value of palliative care in improving quality of life has been supported through clinical research, including its potential to increase life expectancy (Bakitas et al., 2009; Ferrell, et al., 2015; Temel et al., 2010). In its landmark report Dying in America, the Institutes of Medicine (2014) noted that “palliative care is associated with a higher quality of life, including better understanding and communication, access to home care, emotional and spiritual support, well-being and dignity, care at time of death, and lighter symptom burden. Some evidence suggests that, on average, palliative care and hospice patients may live longer than similarly ill patients who do not receive such care” (p. 2).
Oncology nurses are critical participants in the delivery of palliative care. The Oncology Nursing Society’s (2014, 2015a, 2015b) 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, a significant amount of content is allocated to palliative care on all of the certification examinations developed by the Oncology Nursing Certification Corporation (2014). All oncology nursing certification examinations include content on the physical and psychosocial aspects of palliative care in addition to addressing ethical and legal aspects.
Approved by the ONS Board of Directors, November 2014. Reviewed January 2015, January 2016.
Bakitas, M., Lyons, K.D., Hegel, M.T., Balan, S., Brokaw, F.C., Seville, J., . . . Ahles, T.A. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. JAMA, 302, 741–749. doi: 10.1001/jama.2009.1198
Center to Advance Palliative Care. (n.d.) About palliative care. Retrieved from https://www.capc.org/about/palliative-care
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
Ferrell, B., Sun, V., Hurria, A., Cristea, M., Raz, D.J., Kim, J.Y., . . . Koczywas, M. (2015). Interdisciplinary palliative care for patients with lung cancer. Journal of Pain and Symptom Management, 50, 758–767.
Institute of Medicine. (2014). Dying in America: Improving quality and honoring individual preferences near the end of life: Key findings and recommendations. http://iom.nationalacademies.org/~/media/Files/Report%20Files/2014/EOL/Key%20Findings%20and%20Recommendations.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. (2014). OCN® test blueprint. Retrieved from https://www.oncc.org/files/ocn_blueprint.pdf
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
Temel, J.S., Greer, J.A., Muzikansky, A., Gallagher, E.R., Admane, S., . . . Lynch, T.J. (2010). Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine, 363, 733–742. doi:10.1056/NEJMoa1000678