Nurses' Role in Providing Comprehensive Communication, Prognostication, and Palliative Care During the COVID-19 Pandemic

Abstract

This article presents the case of a mother of young children who has terminal stage IV cancer with whom providers had not discussed goals of care and prognostication. Communications about prognostication and goals of care are commonly initiated by physicians. Adolescents and young and middle-age adults with complex chronic or terminal illness often are not provided with timely, clear, complete information or palliative care support. Early palliative care for chronically ill patients facilitates discussions of prognostication and goals of care, in addition to providing symptom management. Such discussions do not diminish hope but rather allow patients to adjust hope to attain an optimal quality of life. Nurses can become active, confident advocates for patients with terminal illness of any age, and they are well positioned to assess patients and engage in goals of care and end-of-life conversations. It is especially important that palliative care nurses promote and maintain these early and comprehensive discussions during the COVID-19 pandemic because this population is at a high risk of complications from the coronavirus.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels

“…In addition to the generalist skills discussed previously (e.g., symptom management, advance care planning), nurses' communication training across global settings must be enhanced to ensure they are able to elicit patients' and families' goals, values, and preferences while considering health literacy and language sensitivity and adequately addressing ethical challenges (Ferrell, Buller, et al, 2020;Koch & Mantzouris, 2020;Moir et al, 2015; National Academies of Sciences, Engineering, and Medicine, 2016). Nurses must respond sensitively to patients' and families' cultural and spiritual needs, providing respectful care that is reflective of the community being served (Fang et al, 2016).…”

Palliative care delivery changes during COVID-19 and enduring implications in oncology nursing: a rapid review

“…Findings in this domain comprised a renewed emphasis on advance care planning (ACP) and targeted communication about goals-of-care to facilitate healthcare decision-making. Proactive ACP conversations became a clinical imperative in providing surrogate decision-makers and the healthcare team the anticipatory guidance needed to inform decision-making in the event of patient incapacity [ 9 ▪ , 41 ▪ ], and nurses were central in helping patients articulate values/preferences in advance [ 12 , 42 ]. However, these conversations were met with new challenges during the pandemic – ethical concerns surfaced over the shortened timeframe to conduct ACP, the lack of continuity of inpatient healthcare providers to facilitate ACP, and the inability to perform conversations in person [ 42 ].…”

Improved Serious Illness Communication May Help Mitigate Racial Disparities in Care Among Black Americans with COVID-19

“…One way to increase serious illness communication during the COVID-19 pandemic is to involve all clinicians in inpatient and outpatient care goal discussions and advance care planning. 40 By using serious illness communication tools tailored around the needs of persons at risk for poor COVID-19 outcomes, clinicians in primary and specialty care can lead these discussions across settings-including at home and in long-term care, nursing homes, dialysis centers, and other nonacute places of care before patients become severely ill. [40][41][42] Engaging Black Americans and other racial/ethnic minorities in a tailored community-based communication intervention-for example, at churches or social service organizations where mistrust of healthcare systems may not be as strong a barrier-may increase prevalence of these discussions in minority communities before patients are hospitalized. [43][44][45][46] These discussions can also be conducted via telehealth technology, a platform patients and clinicians have rapidly adopted during the pandemic.…”