Regardless of their demographic characteristics or specific cancer diagnoses, adult cancer patients referred for outpatient palliative care at least three months before they died made 29% fewer ED visits, had 33% fewer hospital admissions, and were 14% less likely to die in the hospital than those receiving inpatient palliative care less than three months before death. These are results from a retrospective study of data from the last 30 days of 366 deceased Houston-area residents' lives; all patients were either University of Texas MD Anderson Cancer Center inpatients or clients of the institution's outpatient supportive care center.
The authors suggest that their findings-and the fact that most oncology care is delivered in ambulatory settings-support increased availability of outpatient palliative care services. Among other study limitations, they noted their inability to "capture other factors that may influence the quality of end-of-life care," such as referring oncologists' likelihood of discussing end-of-life care goals. There was no mention of nurses as facilitators of such discussions, despite the fact that nurses often spend the most time with patients at the end of their lives and are more in tune with their needs. This makes nurses uniquely qualified to play that role, but in many cases, they feel ill equipped to do so.
"Nurses cannot practice what they don't know," says Pam Malloy, director and coinvestigator of the End-of-Life Nursing Education Consortium (ELNEC) project from the American Association of Colleges of Nursing. "So education in communicating with seriously ill patients and their families about end-of-life care is essential." She says the association has partnered with City of Hope, a cancer center based in Duarte, California, for 15 years to address this problem by offering nurses opportunities to practice communication skills relevant to end-of-life care.-Sibyl Shalo Wilmont, BSN, RN
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