In an article published in the Journal of Clinical Oncology, the authors provide a review of relevant research with regard to end-of-life care for cancer patients, and they identify the ways that hospice care assists patients with advanced cancer and their loved ones who become caregivers. Ways in which hospice care can improve are also highlighted.
Priorities for Cancer Patients at the End-of-Life
The researchers observe that several studies have sought to explore the priorities of patients with advanced cancer and that of their caregiver for end-of-life care. Some of the most commonly indicated priorities were related to the following:
- Pain and symptom management
- Feeling well enough to spend time with loved ones
- Dealing with matters of business and legacy that had yet to be taken care of
As a result, the researchers state that “hospice care services have grown rapidly to support families and communities to care for people at home (including in skilled nursing facilities) through excellence in physical symptom control, psychological support, spiritual care, and support for caregivers.”
Mitigating the Burden of Symptoms
According to the research, hospice care allows for improvement of symptom management in issues that are commonly expected at the end-of-life. Symptom mitigation for advanced cancer patients nearing the end-of-life often involves addressing one or more of the following common symptoms:
The inability to feel pain was identified by the article as commonly the priority for patients and their loved ones over any other symptom. The evidence suggests that hospice care offers superior pain management to patients. Furthermore, it is noted that another priority symptom, delirium, which includes changes in cognitive function, illusions from hallucinating, and disruptions of sleep and wake cycles, can be treated with excellent nursing care. Nurses can treat reversible causes, assist in orienting the patient, and provide appropriate hydration and nourishment.
Optimal Integration within End-of-Life Care
The researchers encourage practitioners to explain the prognosis of rapidly declining advanced cancer patients with them, and refer them to hospice services. Optimal end-of-life care for cancer patients, as noted by the article includes:
- Every Health Professional Having Competency in Core End-of-Life Care Skills: This consists of identifying the end-of-life status, understanding the key tenets of symptom management and interdisciplinary care, conducting patient-centered, effective communication and shared decision-making, executing excellent clinical skills in thorough bedside evaluation, and engaging with empathy and compassion.
- Care from a Team-Based Approach: The article explains that patients tend to be more likely to express their concerns and disclose information about more issues when an interdisciplinary team is providing care and since the patient-identified needs are extensive at the end-of-life, multiple health clinicians working collectively is essential to accomplish the most optimal outcomes for the patient.
- Collaboration and Communication Between Hospice and Other Care Providers: Most advanced cancer patients either change locations for care or are admitted to a hospital near the end-of-life, and therefore, effective communication between all involved providers is imperative. Despite consistently improving electronic medical records, the challenge still persists for all clinical teams to be aware of the communication that each care provider has with the patient and their family.
Support for Caregivers
A key aspect of hospice care is the support provided to caregivers, and although research on the topic is limited, evidence suggests that the most effective support for caregivers results in:
- Need for information and education being better met
- Decreased rates of depression
- Improved ability to move forward with their own life after the death of their loved one
In conclusion, the authors state, “Hospice provides patients with the potential for a better quality of life, improved symptom control, and more time away from inpatient care.” Furthermore, since most of the care for advanced cancer patients becomes the responsibility of caregivers, any additional support provided to them while acting in the caregiver role will likely be of significant advantage.
Currow, D. C., Agar, M. R., & Phillips, J. L. (2020). Role of hospice care at the end of life for people with cancer. Journal of Clinical Oncology, 38(9), 937-943. https://doi.org/10.1200/JCO.18.02235.