Palliative and End of Life.
Palliative and End of Life.
Communicating with Patients and their Families about Palliative and End of Life: Comfort and Educational Needs of Staff RNs
Cheryl Moir, RN/CHPN [Care Coordinator], Home Care/Hospice, St. Luke’s Health System, 190 E. Bannock St., Boise, ID 83712
Renee Roberts, BSN RN [Clinical Nurse], Bone Marrow Transplant, University of Colorado Hospital, 12505 E. 16th St, Aurora, CO 80045
Kim Martz, PhD RN [Assistant Professor], Boise State University, 1910 University Drive, Boise, ID 83725
Judith Perry, MSN, ACHPN [Nurse Practitioner—Board Certified], and Home Care/Hospice, St. Luke’s Health System, 190 E. Bannock St., Boise, ID 83712
Laura J. Tivis, PhD, CCRP [Nursing Research Director] St. Luke’s Health System, 190 E. Bannock St., Boise, ID 83712
ORDER CUSTOM, PLAGIARISM-FREE PAPER
Abstract
Introduction—Effectively discussing palliative care with patients and families requires knowledge and skill. The purpose of this study was to determine perceived needs of inpatient
nurses for communicating with patients and families about palliative and end of life care.
Method—A non-experimental design was utilized. Sixty inpatient nurses completed the End of Life Professional Caregiver survey.
Results—Effects for years of experience and unit were found [F(9,131.57)=2.22, p=0.0246; Wilk’s Λ=0.709 and F(6,110)=2.49, p=0.0269]. For all three domains (Patient and Family-
Centered Communication, Cultural and Ethical Values, and Effective Care Delivery) years of
nursing experience was positively associated with comfort in communicating about end of life
care. Oncology nurses reported were most comfortable with regard to patient and family-centered
communication.
Discussion—The success and sustainability of this service is dependent on education for healthcare providers. Studies are needed to determine best ways to meet this educational
challenge.
Keywords
Palliative Care; End of Life Care; End of Life Professional Caregiver survey; Patient-Centered Communication
Direct correspondence to: Cheryl Moir RN/CHPN, St. Luke’s Health System, Hospice and Palliative Care, 190 E. Bannock St., Boise, ID 83712; moirc@slhs.org; Telephone: (208) 850-3498; FAX: (208) 381-2725.
Conflicts of Interest The authors have no conflicts of interest to report.
HHS Public Access Author manuscript Int J Palliat Nurs. Author manuscript; available in PMC 2016 March 01.
Published in final edited form as: Int J Palliat Nurs. 2015 March ; 21(3): 109–112. doi:10.12968/ijpn.2015.21.3.109.
A uthor M
anuscript A
uthor M anuscript
A uthor M
anuscript A
uthor M anuscript
Introduction
Our review of the literature and our own experiences led us to postulate that inpatient staff
nurses may not be prepared to provide optimal care to end of life (EOL) and palliative care
patients and their families (Chan and Webster, 2011; Patel, Gorawara-Bhat, Levine, and
Shega, 2012; Prem, Karvannan, Kumar et al., 2012; Agustinus, Wai Chi Chan, 2013).
Palliative care patients can continue to seek curative treatments while evaluating their goals
and care needs. End-of-life (EOL) care patients usually are no longer receiving aggressive
curative treatment; instead they are receiving comfort care only. In the US, the word
“hospice” is interchangeable or synonymous with EOL care. These patients usually die at
home or in the intensive care unit limiting the contact a regular staff nurse may have in
providing care to them. Nurses skilled and comfortable in communicating with patients and
families about EOL (hospice) and palliative care may improve the quality of life and patient
satisfaction in the hospital setting.
Some patients transition during a hospital stay from curative-based care to hospice care.
Whether the transition is made smoothly and gradually, depends on the kind of
communication and education patients receive from doctors, nurses, and other caregivers
while in the hospital (Adams, 2005; Beck, Tornquist, Brostrom and Edberg, 2012; Brummen
and Griffiths, 2013). Palliative care options should be provided in a way that helps patients
understand its goals and how it differs from end of life care. However, many people opt for
palliative care only when they are very close to the end of their lives (Raljmakers et al.,
2011; Wilson, Gott and Ingleton, 2011).
It seems reasonable to think that a lack of education and accompanying uneasiness among
clinical nurses in discussing palliative care with patients and their families may negatively
impact the transition from curative-based care to hospice care. The current research focused
on the role of the nurse during the transition in patients’ lives from curative to palliative
care. The study aim was to determine the perceived educational needs of inpatient staff
nurses in our facility when communicating with patients and families about palliative and
EOL care.
Study Design / Methodology
A non-experimental survey design was utilized to examine differences by the age of the
nurse, years of nursing experience, and the unit on which he/she worked.
To measure palliative and EOL educational needs among nurses (i.e., their current degree of
comfort in caring for this population) the End-of-Life Professional Caregiver Survey was
distributed to a convenience sample of clinical nurses working exclusively in telemetry,
oncology and critical care units (EPCS; Lazenby, Ercolano, Schulman-Green and McCorkle,
2012). Permission to use the EPCS was granted by the authors. The EPCS is a 28-item,
psychometrically valid scale developed to assess the palliative and EOL educational needs
of professionals and was validated in a large study encompassing doctors, nurses and social
workers (Lazenby et al., 2012). For each item, a Likert-style scale is presented where 1=Not
at All, and 5=Very Much. Items represent care-provider comfort with a variety of situations
related to palliative and EOL care (e.g., “I am comfortable helping families to accept a poor
Moir et al. Page 2
Int J Palliat Nurs. Author manuscript; available in PMC 2016 March 01.
A uthor M
anuscript A
uthor M anuscript
A uthor M
anuscript A
uthor M anuscript
prognosis”). Higher scores indicate greater skill or comfort. Three distinct factors were
identified by Lazenby et al. (2012): 1) Patient and Family-Centered Communication
(PFCC), 2) Cultural and Ethical Values (CEV), and 3) Effective Care Delivery (ECD). See
Lazenby et al (2012) for factor loading (p.429).
Data collection began following approval from the hospital Institutional Review Board
(IRB). Permission to distribute the survey was also acquired from individual unit managers
prior to distribution. Data was collected over a one month period. We had sixty participants
respond.
The survey was conducted at a 378 bed hospital in the intermountain region. Telemetry,
oncology, and critical care units were chosen for their patient populations; that is, patients
on these units were most often among those transitioning from curative based care to end of
life care. The three units employed a combined clinical nursing staff of approximately 215
(telemetry unit 90, oncology 35, and critical care 90). Recruitment emails were sent to 175
clinical nurses (identified from the 215 as having active email addresses) employed on the
designated units, requesting participation in the research project. In addition, recruitment
flyers were also posted on the selected units to inform nurses of the project and request
participation. Online and paper-and-pencil survey options were available. Both options were
anonymous. Paper and pencil surveys were made available on each unit. An investigator-
addressed envelope was attached to each paper survey for nurses to return the completed
instrument through interoffice mail to retain anonymity. The paper and pencil surveys was
kept in a locked office and shredded after data collection was complete. The online survey
was hosted by REDCap at the University of Washington, Institute of Translational Health
Sciences (https://www.iths.org/).
Data Analysis and Results
Sixty nurses participated. Based on the number of active email addresses within the three
units, this reflects a 34% participation rate. Data were analyzed using SAS 10.0. Descriptive
statistics and Chi-Square were used to analyze demographic information. PFCC, DEV and
ECD domain scores were calculated as described by Lazenby et al (2012). Mulitvariate
analysis of variance (MANOVA) was used to determine overall effects of age, unit, and
years of nursing experience across domain scores. Duncan’s Multiple Range Test was used
to conduct post-hoc domain comparisons as appropriate.
Sample distribution by unit was similar, with about 37% of respondents were from Critical
Care, about 26% from Oncology, and about 37% from Telemetry. The majority of
respondents were under 50 years of age: 41% were younger than 30, 43% were between 30
and 49, and only 16% were 50 or above. Participant age did not differ by work unit
[Likelihood Ratio Χ2 (6, N = 58) = 5.68, p = .46]. The majority of respondents had two to 10
years of nursing experience: 12% had less than two years, 33% had two to five year, 29%
had five to ten years of experience, and 27% had more than 10 years. Years of experience
did not differ by work unit [Likelihood Ratio Χ2 (6, N = 60) = 9.98, p = .13].
MANOVA revealed that there was an overall effect of experience and unit, but no effect of
age [Experience: F(9,131.57)=2.22, p=0.0246; Wilk’s Λ=0.709; Unit: F(6,110)=2.49,
Moir et al. Page 3
Int J Palliat Nurs. Author manuscript; available in PMC 2016 March 01.
A uthor M
anuscript A
uthor M anuscript
A uthor M
anuscript A
uthor M anuscript
Palliative and End of Life.