Abstract
Oncology and haematology patients with incurable malignancies have differing disease pathways and prognoses. In the literature, and on various patient-targeted information websites, palliative care services are recommended early in their journey to provide the holistic support engendered by the definition of palliative care. What was often unclear in the literature discussion exploring palliative care, was how, when, and by whom this care was perceived and provided: by specialist and/or hospice, or generalist care providers, including those within primary care. The majority of the literature highlighted the perception that palliative care pertained to end-of-life. Palliative care is introduced in both oncology and haematology, however haematological malignancies provided unique challenges to the integration of early palliative care.
The researcher is currently involved in the nursing care and support of haematology patients, and previously with oncology patients in a chemotherapy treatment setting. This was followed by a period of time within a hospital based palliative care advisory service. Consequently, the researcher is well attuned to the disease trajectories of these malignancies and the various palliative needs. It had become evident within these settings, that palliative needs were not always met in a timely way, and confusion was evident regarding the perceptions of healthcare providers as to the definition of early palliative care and who should provide this care.
This integrative review aimed to explore health care providers' perceptions and the application of early palliative care and the implications for both haematology and oncology patients with malignancy. During the literature review five themes were extracted, encompassing the variables of barriers and enablers to referral, geographical and organisational issues, the impact of relationships, and the need for targeted education. All five themes included the significant role of nurses in this growing area of care. Thematic analysis provided the means to cohesively draw together these findings which assisted in answering the integrative review question and providing implications for practice.
The resulting implications for practice are grounded in the conclusion that nurses play a pivotal role in understanding, undertaking and coordinating the core values of palliative care, while ongoing recommendations include targeted education for nurses and other health care providers. Education for patients assisted with the understanding that the holistic care provided by all stakeholders is the very foundation of palliative care philosophy, and early integration neither removes hope or indicates end-of-life. Such a goal could well be actioned by specialist nurses who are, or can be educated in, the care of haematology and oncology patients with incurable disease, to bridge the void which exists between diagnosis, and the intervention of specialist palliative care provision.