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J Clin Nurs. 2018 Jul 3. doi: 10.1111/jocn.14603. [Epub ahead of print]

"Operating in the dark": Nurses' attempts to help patients and families manage the transition from oncology to comfort care.

Author information

1
Department of Communication, Wake Forest University, Department of Social Sciences & Health Policy, Wake Forest University School of Medicine.
2
Sr. Director Bioethics, Spiritual Care and Healing Arts, Novant Health.
3
Gynecologic Oncology, Forsyth Medical Center, Novant Health.
4
Director of Spiritual Care, Novant Health.
5
Palliative Care, Novant Health.
6
Advance Care Planning, Novant Health.
7
Integrative Arts, Novant Health.
8
Department of Communication, University of Kentucky.

Abstract

AIMS & OBJECTIVES:

To (1) investigate challenges nurses face when providing care for oncology patients transitioning from curative to palliative care and (2) identify educational and support opportunities for nurses.

BACKGROUND:

Communicating with oncology patients/families transitioning from curative treatments to care focused on comfort can be problematic due to a variety of factors. Research suggests discrepancies exist between physicians' perspectives on patient probable length of life and patients' beliefs. These disconnects can deepen suffering. Oncology and palliative care nurses are well positioned to facilitate this transition. However, they receive little formal instruction regarding these complex scenarios beyond what occurs through on-the-job training.

METHODS:

Twenty-eight nurses in oncology (n = 14) and palliative care (n = 14) settings participated. The constant comparative method was used to analyze the data.

RESULTS:

Four themes emerged that characterize oncology and palliative care nurses' experiences: (1) coping with interprofessional communication errors during the transition, (2) responding to patient/family reactions to miscommunication about the goals of care, (3) navigating emotional connection to patients, and (4) adapting to sociocultural factors that influence information exchange.

CONCLUSIONS:

This study supports previous research regarding challenges related to patient reactions, family relationships, and emotional burden during end-of-life care. However, it adds to the literature by a providing a more in-depth explication of interprofessional and patient-physician communication barriers that negatively impact patient care.

RELEVANCE TO CLINICAL PRACTICE:

Misunderstandings between patient, physician, and nurses can deepen patient suffering and complicate nurses' efforts to support patients. Nurses reported a problematic power dynamic that impedes their ability to facilitate communication between patient and physician or to offer insights that could enhance patient care. Medical education and continuing education initiatives are needed to build understanding across professional roles and specialties and to improve comfort discussing worsening prognosis and end-of-life issues. This article is protected by copyright. All rights reserved.

KEYWORDS:

Communication; End of life; Nursing; Oncology; Palliative

PMID:
29968315
DOI:
10.1111/jocn.14603

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