Clinical problem
The common concept surrounding palliative care is that it is afforded to patients within inpatient care units and hospice care by specialty palliative care nurses. This has meant that palliative care is only confined to those patients within these settings and thus limiting the accessibility of these services for outpatients populations with chronic or caner illnesses. Patients in need of palliative care usually have physical and psychological problems that require early and constant monitoring and intervention which can only be afforded through palliative care (Zimmermann et al., 2014). While these patients do not seek to cure their illnesses, their primary objective of seeking care is to prolong life but at the same time ensure that they live a quality life even within the limiting health factors. Palliative care has a similar objective and that includes the education for patients as well as guided training to cope with the various issues that the particular illness imposes on them (Greer, Jackson, Meier & Temel, 2013).
One of the key aspects of appropriate caring for cancer and chronic illness patients is the early integration of palliative care aspects in their care plan. However, the inpatient and hospice care units are only designed to accommodate patients who cannot sustain a quality life in the absence of professional clinical care. This then implies that patients in who have had recent diagnosis for these illnesses or those who are in their early days of diagnosis of an illness cannot access palliative care to support them and help begin appropriate coping mechanism at an early stage (Greer, Jackson, Meier & Temel, 2013). It becomes a challenge for patients in their early stages of an illness as they are only expected to seek or access palliative care in the later stages when the illness has significantly progressed. In essence it limits the benefits of palliative care (Hui, Kim, Roquemore, Dev, Chisholm & Bruera, 2014). There is enough evidence to suggest that palliative care when offered alongside curative care has enormous benefits if afforded at an early stage. In fact, it stands out that when palliative care is afforded alongside curative care form an early stage, the self-efficacy of the patient is improved significantly so that they can easily cope with the implications of the illness in the later stages (Zimmermann et al., 2014).
Significance and purpose
This forms the basis on which the integration of palliative within outpatient care settings becomes a necessity especially in an era when chronic illnesses are becoming a pandemic to the society. The patients and families will benefit from learning about their illness and thus develop innate measures to cope if only they access these services at an early age and stage. On the other hand, this will help eliminate the need for hospice care even in the latter stages and thus minimize the burden of high patient populations within hospice and inpatient units even in stages when the patient and family can manage the condition (Greer, Jackson, Meier & Temel, 2013). The purpose of this research is thus pegged on answering the question “For patients in early stages of cancer and chronic illnesses, does the integration of palliative care in oncology care within outpatient units as compared to standard oncology care improve self-efficacy and the quality of life in the latter stages of the illness?”
In answering this question, the objective is to expound on the notion that palliative care is only afforded to patients in end-of-life care; a perception that has actually led to the marginalization of palliative care (Partridge et al., 2014). Palliative care has to be viewed as a process in which the patient and their families can initiate early coping mechanism and evolve with the progress of the illness so that they are not confined to a situation where the latter stages of the illness become a burden to the patient and the family care givers (Tappen, 2011). The patient has to be assured that the latter stages of the illness will not have a significant, uncontrolled role in determining their quality of life and self-efficacy. Self-efficacy is built on a deep understanding of the illness and an actual desire to develop tailored coping mechanisms which is possible when early patient education ifs afforded; palliative care is designed to support this aspect (Melnyk & Fineout-Overholt, 2015).
References
Greer, J. A., Jackson, V. A., Meier, D. E., & Temel, J. S. (2013). Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA: a cancer journal for clinicians, 63(5), 349-363.
Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., & Bruera, E. (2014). Impact of timing and setting of palliative care referral on quality of end‐of‐life care in cancer patients. Cancer, 120(11), 1743-1749.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. My work setting: Hospice
Partridge, A. H., Seah, D. S., King, T., Leighl, N. B., Hauke, R., Wollins, D. S., & Von Roenn, J. H. (2014). Developing a service model that integrates palliative care throughout cancer care: the time is now. Journal of Clinical Oncology, 32(29), 3330-3336.
Tappen, R. M. (2011). Advanced nursing research: From theory to practice. Sudbury, MA: Jones & Bartlett Learning.
Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., & Donner, A. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet,383(9930), 1721-1730.
