Online Exclusive Article

Oncology Nurses' Personal Understandings About Palliative Care

Margaret M. Mahon

William J. McAuley

palliative care
ONF 2010, 37(3), E141-E150. DOI: 10.1188/10.ONF.E141-E150

Purpose/Objectives: To examine how oncology nurses define palliative care, views about who should and should not receive palliative care, and beliefs about palliative care decision making, including who should be involved and how decisions should be managed.

Design: Qualitative interviews and analysis.

Setting: Preferred location of each respondent.

Sample: 12 nurses representing different aspects of oncology nursing.

Methods: An interview guide was employed to ensure that specific topics were covered. Interviews were transcribed verbatim. Qualitative analysis consisted of independent, multiple reviews of the transcripts to share initial findings and identify, refine, and reach consensus on major themes and subthemes.

Main Research Variables: Nurses' definitions of palliative care, views about who should and should not receive palliative care, and beliefs about palliative care decision making.

Findings: Nurses' perceptions of palliative care focused on symptom management. Most did not distinguish between palliative care and hospice and believed that only patients who were near the end of life should receive palliative care. They viewed their role in decisions regarding palliative care to be limited and indirect.

Conclusions: Although oncology nurses should be at the cutting edge with regard to palliative care, these nurses' personal understandings could serve to limit care for many patients with cancer who could benefit from it.

Implications for Nursing: Education and clinical experience embedded in a continuous quality-improvement model are needed to ensure sustained change that will overcome the multiple, interwoven barriers to providing appropriate palliative care.

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    American Association of Colleges of Nursing. (2004). Peaceful death: Recommended competencies and curricular guidelines for end-of-life nursing care. Retrieved from
    American Cancer Society. (2009). Cancer facts and figures, 2009. Atlanta, GA: American Cancer Society.
    Bruce, S. (2006). Palliative care: Helping patients live longer and better with cancer. ONS News, 21(5), 1, 4, 6.
    Campbell, M. L., & Guzman, J. A. (2003). Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest, 123, 266-271.
    Campbell, M. L., & Guzman, J. A. (2004). A proactive approach to improve end-of-life care in a medical ICU for patients with terminal dementia. Critical Care Medicine, 32, 1839-1843.
    Coyne, P., Paice, J. A., Ferrell, B. R., Malloy, P., Virani, R., & Fennimore, L. A. (2007). Oncology End-of-Life Nursing Education Consortium training program: Improving palliative care in cancer. Oncology Nursing Forum, 34, 801-807. doi: 10.1188/07.ONF.801-807
    de Veer, A. J., Francke, A. L., & Poortvliet, E. P. (2008). Nurses' involvement in end-of-life decisions. Cancer Nursing, 31, 222-228. doi: 10.1097/01.NCC.0000305724.83271.f9
    Doyle, D., Hanks, G., Cherny, N. I., & Calman, K. (2005). Oxford textbook of palliative medicine (3rd ed.). London, England: Oxford University Press.
    Dudgeon, D. J., Knott, C., Eichholz, M., Gerlach, J. L., Chapman, C., Viola, R., … Bartfay, E. (2008). Palliative care integration project (PCIP) quality improvement strategy evaluation. Journal of Pain and Symptom Management, 35, 573-582. doi: 10.1016/j.jpainsymman.2007.07.013
    Ferrell, B., Grant, M., & Virani, R. (2001). Nurses urged to address improved end-of-life care in textbooks. Oncology Nursing Forum, 28, 1349.
    Ferrell, B., & Virani, R. (2008). National guidelines for palliative care: A roadmap for oncology nurses. Oncology, 22(2, Suppl., Nurse Ed.), 28-34.
    Ferrell, B., Virani, R., Smith, S., & Juarez, G. (2003). The role of oncology nursing to ensure quality care for cancer survivors: A report commissioned by the National Cancer Policy Board and Institute of Medicine [Online Exclusive]. Oncology Nursing Forum, 30, E1-E11. doi: 10.1188/03.ONF. E1-E11
    Foley, K. M., & Gelband, H. (2001). Improving palliative care for cancer. Washington, DC: National Academy Press.
    Hodgson, N. A., & Lehning, A. J. (2008). Palliative care in nursing homes: A comparison of high- and low-level providers. International Journal of Palliative Nursing, 14, 38-44.
    Joishy, S. K. (1999). Palliative medicine secrets. Philadelphia, PA: Hanley and Belfus.
    Kirchhoff, K. T., Beckstrand, R. L., & Anumandla, P. R. (2003). Analysis of end-of-life content in critical care nursing textbooks. Journal of Professional Nursing, 19, 372-381.
    Mahon, M. M., & Sorrell, J. M. (2008). Palliative care for people with Alzheimer's disease. Nursing Philosophy, 9, 110-120. doi: 10.1111/j.1466-769X.2008.00344.x
    McCall, K., & Johnson, B. (2007). Treatment options in end-of-life care: The role of palliative chemotherapy. International Journal of Palliative Nursing, 13, 486-488.
    Morita, T., Akechi, T., Ikenaga, M., Kohara, H., Mukaiyama, T., Nakaho, T., … Uchitomi, Y. (2005). Late referrals to specialized palliative care services in Japan. Journal of Clinical Oncology, 23, 2637-2644. doi: 10.1200/JCO.2005.12.107
    National Consensus Project for Quality Palliative Care. (2009). National Consensus Project for Quality Palliative Care (2nd ed.). Pittsburgh, PA: Author.
    National Quality Forum. (2006). A national framework and preferred practices for palliative and hospice care quality. Washington, DC: Author.
    Oncology Nursing Society & Association of Oncology Social Work. (2007). Oncology Nursing Society and Association of Oncology Social Work joint position on palliative and end-of-life care. Oncology Nursing Forum, 32, 1097-1098.
    Paice, J. A., Ferrell, B. R., Coyle, N., Coyne, P., & Callaway, M. (2008). Global efforts to improve palliative care: The International End-of-Life Nursing Education Consortium Training Programme. Journal of Advanced Nursing, 61, 173-180. doi: 10.1111/j.1365-2648.2007.04475.x
    Pavlish, C., & Ceronsky, L. (2007). Oncology nurses' perceptions about palliative care. Oncology Nursing Forum, 34, 793-800. doi: 10.1188/07.ONF.793-800
    Reinke, L. F., Engelberg, R. A., Shannon, S. E., Wenrich, M. D., Vig, E. K., Back, A. L., & Curtis, J. R. (2008). Transitions regarding palliative and end-of-life care in severe chronic obstructive pulmonary disease or advanced cancer: Themes identified by patients, families, and clinicians. Journal of Palliative Medicine, 11, 601-609. doi: 10.1089/jpm.2007.0236
    Rubin, H. J., & Rubin, I. S. (1995). Qualitative interviewing: The art of hearing data. Thousand Oaks, CA: Sage Publications.
    Sesterhenn, A. M., Folz, B. J., Bieker, M., Teymoortash, A., & Werner, J. A. (2008). End-of-life care for terminal head and neck cancer patients. Cancer Nursing, 31, E40-E46. doi: 10.1097/01.NCC.0000305709.37530.a7
    Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: Sage Publications.
    Strumpf, N. E. (2004). Minimum data set trigger guide for palliative care. Retrieved from
    Strumpf, N. E., Tuch, H., Stillman, D., Parrish P., & Morrison, N. (2004). Implementing palliative care in the nursing home. Annals of Long Term Care: Clinical Care and Aging, 12(11), 35-41.
    Sulmasy, D. P., He, M. K., McAuley, R., & Ury, W. A. (2008). Beliefs and attitudes of nurses and physicians about do not resuscitate orders and who should speak to patients and families about them. Critical Care Medicine, 36, 1817-1822. doi: 10.1097/CCM.0b013e31817c79fe
    von Gunten, C. (2002). Secondary and tertiary palliative care in U. S. hospitals. JAMA, 287, 875-881.
    von Gunten, C. F., Ferris, F. D., Portenoy, R. K., & Glajchen, M. (Eds.). (2001). How to establish a palliative care program. New York, NY: Center for Palliative Studies and the Department of Pain Medicine and Palliative Care.
    Watson, M. S., Lucas, C. F., Hoy, A. M., & Back, I. N. (Eds.). (2005). Oxford handbook of palliative care. Oxford, England: Oxford University Press.
    Willard, C., & Luker, K. (2005). Supportive care in the cancer setting: Rhetoric or reality? Palliative Medicine, 19, 328-333.
    World Health Organization. (2007). Cancer control: Knowledge into action, WHO guide for effective programmes. Geneva, Switzerland: WHO.