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Current practices in advance care planning: implications for oncology nurses
Abigail Cohen1, Anita Nirenberg
1Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. cohena2@mskcc.org
Clinical Journal of Oncology Nursing
|September 29, 2011
Summary
Advance care planning (ACP) discussions are infrequent for cancer patients, leading to unestablished advance directives (ADs) and poor end-of-life (EOL) outcomes. Early palliative care and EOL discussions improve patient health outcomes.
Area of Science:
- Oncology
- Palliative Care
- Healthcare Policy
Background:
- Advance care planning (ACP) discussions are notably absent between cancer patients and physicians.
- Many patients with cancer lack advance directives (ADs), particularly nearing the end of life (EOL).
- Limited EOL discussions and aggressive EOL care correlate with adverse patient outcomes.
Purpose of the Study:
- To review current practices of ACP and AD use among cancer patients in the U.S.
- To identify the role of healthcare providers in ACP and AD establishment.
- To offer recommendations for nurses and nurse practitioners in facilitating ACP.
Main Methods:
- Systematic review of peer-reviewed research and professional reports.
- Literature search focused on U.S. studies published between 2002 and 2011.
- Synthesis of findings on ACP practices and AD utilization in cancer care.
Main Results:
- A significant gap exists in EOL discussions and ACP for cancer patients.
- Patients receiving early palliative care and engaging in EOL discussions experience better health outcomes.
- Nurses and nurse practitioners are pivotal in assisting patients with ACP and ADs.
Conclusions:
- Nurses and nurse practitioners are well-positioned to enhance ACP and AD completion for cancer patients.
- Continued education and training are essential for healthcare providers in ACP.
- Further research is needed to define and support the nurse practitioner's role in ACP.
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