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Strategies Used by Outpatient Oncology Nurses to Introduce Early Palliative Care: A Qualitative Study
Shan Mohammed1, Nadia Swami, Ashley Pope
1Author Affiliations: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto (Dr Mohammed); Department of Supportive Care and Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network (Mss Swami and Pope, Drs Rodin and Zimmermann); and Division of Palliative Medicine (Dr Zimmermann), Division of Medical Oncology (Dr Zimmermann), and Department of Psychiatry (Dr Rodin), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Background:
Although early palliative care is linked to improved health-related quality of life, satisfaction with care, and symptom management, the clinical strategies that nurses use to actively initiate this care are unknown.
Objectives:
The aims of this study were to conceptualize the clinical strategies that outpatient oncology nurses use to introduce early palliative care and to determine how these strategies align with the framework of practice.
Methods:
A constructivist-informed grounded theory study was conducted in a tertiary cancer care center in Toronto, Canada. Twenty nurses (6 staff nurses, 10 nurse practitioners, and 4 advanced practice nurses) from multiple outpatient oncology clinics (ie, breast, pancreatic, hematology) completed semistructured interviews. Analysis occurred concurrently with data collection and used constant comparison until theoretical saturation was reached.
Results:
The overarching core category, pulling it all together , outlines the strategies used by oncology nurses to support timely palliative care referral, drawing on the coordinating, collaborating, relational, and advocacy dimensions of practice. The core category incorporated 3 subcategories: (1) catalyzing and facilitating synergy among disciplines and settings , (2) promoting and considering palliative care within patients' personal narratives , and (3) widening the focus from disease-focused treatment to living well with cancer .
Conclusion:
Outpatient oncology nurses enact unique clinical strategies, which are aligned with the nursing framework and reflected multiple dimensions of practice, to introduce early palliative care.
Implications For Practice:
Our findings have clinical, educational, and policy implications for fostering the conditions in which nurses are supported to maximize their full potential in the introduction of early palliative care.
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