Nurses & Palliative Care
Your Role in Providing
Better End-of-Life Patient
Outcomes
Why is this important?
Because you’re all about to be real nurses, and
not just playing one on TV…
Why aren’t doctors talking to their
patients about palliative care?
Palliative care is – in a way – the acknowledgement
of failure on the part of medicine.
Are patients even interested in
palliative care?
A 2011 study in Taiwan tracked and surveyed
314 palliative patients and their physicians. They
asked questions regarding two very basic endof-life issues:
1. Truth telling regarding the disease process.
2. The patient’s desire for supportive care.
Huang, H-L., Cheng, S-Y., Yao, C-A., Hu, W-Y., Chen, C-Y., Chiu, T-Y. (2015). Truth telling and treatment strategies in end-of-life care in physician-led accountable care
organizations: Discrepancies between patients’ preferences and physicians’ perceptions. Medicine, 94(16), e657.
Are patients even interested in
palliative care?
94% of patients wanted to be fully informed regarding their disease
prognosis
98% of patients wanted to know the truth regarding their terminal
status
80% of physicians were willing to tell the truth about the patient’s
prognosis or terminal status
90% of patients wished to be given the option for supportive care
instead of life-prolonging treatments, but only 16% of physicians
offered these treatments or even considered them important.
Huang, H-L., Cheng, S-Y., Yao, C-A., Hu, W-Y., Chen, C-Y., Chiu, T-Y. (2015). Truth telling and treatment strategies in end-of-life care in physician-led accountable care
organizations: Discrepancies between patients’ preferences and physicians’ perceptions. Medicine, 94(16), e657.
What is causing this disparity?
Disparities in palliative care come down to
deficiencies in medical education.
The American Hospital Association’s Physician Leadership Forum
harshly criticized their own education system, citing a lack of any
education in palliative/end-of-life care1.
Conversely, a core competency of independently practicing
Nurse Practitioners includes “…anticipatory guidance,
counseling, disease management, palliative, and end-of-life
care”2.
1. Combes, J.R. & Arespacochaga, E. (2012). Lifelong learning physician competency development. American Hospital Association’s Physician Leadership Forum, Chicago, IL.
2. Thomas, A., Crabtree, M.K., Delaney, K.R., Dumas, M.A., Kleinpell, R., Logsdon, M.C., Marfell, J. & Nativio, D.G. (2014). Nurse practitioner core competencies content. The National Organization
of Nurse Practitioner Faculties. Retrieved May 12, 2015, Retrieved from http://c.ymcdn.com/sites/nonpf.site-ym.com/resource/resmgr/Competencies/NPCoreCompsContentFinalNov20.pdf
How are deficiencies in medical
education affecting patients?
In a 2002 Canadian study, 134 physicians were asked to rate their
competency and their opinions on the importance of issues
within the scope of palliative care:
 Pain
 Symptom control
 Bereavement
Barnabe, C. & Kirk, P. (2002). A needs assessment for southern Manitoba physicians for palliative care education. Journal of Palliative Care, 18(3), 175-84.
How are deficiencies in medical
education affecting patients?
In a 2014 American study, 280 medical interns, residents,
fellows, attendings, and specialists in five New York hospitals
responded to an anonymous survey regarding their approach to
palliative care:
 The results suggested that these physicians largely felt
uncomfortable and even fearful of having end-of-life
discussions with their patients and families.
 Over 50% admitted to relegating the role to other providers!
Litauska, A., et al. (2014). Do residents need end-of-life care training? Palliative & Supportive Care, 12(3), 195-201.
How do Nurse Practitioners improve
palliative patient outcomes?
Higher self-care assessments and improved
symptom management
Higher quality of life scores
Higher education scores (patients have a better
understanding of their condition)
Higher overall psycho-social behavioral outcomes
Positive feelings towards discussions on Advanced
Directives
Shorter lengths of stay in the hospital (with higher
profits for the hospital)*
Fewer ED visits
Lower patient costs