Running head: MISCONCEPTIONS OF PALLIATIVE CARE… 1

Problem Based Research Paper: Misconceptions of Palliative Care

Delaware Technical Community College
NUR 340 Nursing Research
Amanda Smith
4/21/2018
MISCONCEPTIONS OF PALLIATIVE CARE… 2

Abstract
Palliative care has been my topic focus throughout the nursing research course. Through

research, I have opened my awareness to what palliative care is, how other healthcare

professionals view the topic, and how palliative care is practiced. Notably, there are

misconceptions among healthcare professionals and even patients who could benefit from it.

This paper addresses the misconceptions of palliative care and the detrimental effect that can

have on those who could benefit. This paper uses numerous research sources found from online

databases. The end of the paper discusses recommendations toward resolving the problems

surrounding the administration of palliative care and the research to back it up.
MISCONCEPTIONS OF PALLIATIVE CARE… 3

Misconceptions of Palliative Care

Introduction
Palliative care is a relatively new approach for medical practice. This type of care is

described as improving the quality of life of patients who have a serious or life-threatening

illness. Palliative care is a way to address the person as a whole, including spiritual, physical,

psychological, and social problems, as well as any caregiver needs (National Cancer Institute,

2017). The goal of palliative care is to prevent or treat the symptoms and side effects of the

disease and its treatment. Patients can get palliative care in the hospital, an outpatient clinic,

home, or in a long-term care facility (National Cancer Institute, 2017). Specialist palliative care

also includes: symptom identification and management; psychological, spiritual, and logistical

support; assistance with treatment decision-making and setting care goals; and complex care

coordination (Kavalieratos, et.al, 2014).

Problem

There are many misconceptions about palliative care, and that is a problem for the

healthcare community as a whole. In a blog post, a neonatologist who is also a palliative care

physician broke down what they believe to be the most common misconceptions surrounding

palliative care. Those misconceptions were 1) [palliative care] only offers comfort measures, 2)

[palliative care] only helps the patient, and 3) [palliative care] only addresses end-of-life care

(Cortezzo, 2017). Other misunderstandings along the same lines are that palliative care is

synonymous with hospice care, palliative care patients can no longer receive aggressive or

curative treatments, and a palliative care team is not necessary (Montelongo, 2016).
MISCONCEPTIONS OF PALLIATIVE CARE… 4

Research

American Heart Association

Research conducted by the American Heart Association concluded that palliative care

referrals for heart failure patients may be suboptimal due to limited provider knowledge and

misperceptions of palliative care as a service reserved for those near death (Kavalieratos, et.al,

2014). The research determined that heart failure patients receive palliative care less often than

cancer patients, and that underuse by the provider may be to blame. More than half of surveyed

cardiologists were found to not discuss palliative care with elderly advanced heart failure

patients (Kavalieratos, 2014). This literature study used semi-structured interviews to gain

information from the sample. The sample was stratified and included physicians, nurse

practitioners, and physicians assistants who were practicing in North Carolina and had cared for

three or greater heart failure patients in the past six months (Kavalieratos, 2014). One initially

selecting a sample the study allowed chain referral so that those in the sample could refer another

qualifying candidate who may provide information. The survey questionnaire had domains of

interest that sample questions stemmed from, and one interviewer conducted all the interviews

either in person or by phone (Kavalieratos, 2014). This study appears fairly well structured.

Some problems to be identified could be all the participants were practicing in North Carolina

and the chain referral could lead to biased data based on who was referred.

National Cancer Institute

Another palliative care study was conducted in a rural National Cancer Institute

designated hospital in New Hampshire, which included a VA medical center in Vermont

(Bakitas, Lyons, & Hegel, et.al, 2009). The study was a randomized controlled trial conducted
MISCONCEPTIONS OF PALLIATIVE CARE… 5

from November 2003 through May of 2008 and included 322 patients with advanced cancer

(Bakitas, et.al, 2009). The objective of the study was to determine the effect of a nursing-led

intervention on quality of life, symptom intensity, mood, and resource use in patients with

advanced cancer (Bakitas, et.al, 2009). A multicomponent, psychoeducational intervention was

conducted by advanced practice nurses and was used to evaluate until patient death or study

completion. The evaluation was used initially four times a week and then consisted of monthly

follow up sessions (Bakitas, et.al, 2009). The study determined that compared with patients who

were receiving usual oncology care, patients receiving a nurse-led, palliative care focused

intervention that addressed physical, psychological, and care coordination provided concurrently

with oncology care had greater scores for quality of life and mood, but did not have symptom

improvement or less days spent in the ICU or emergency room (Bakitas, et.al, 2009). This

suggests that nurse-led palliative care helped with some problems cancer patients encountered,

but not all. It would be interesting to see how the researchers evaluated the statements that

suggested they had a better quality of life and mood. Symptoms improvement may have some

subjectivity as well, but the length of stay in the ICU and ER would be objective information.

End Stage Renal Disease

A study done about the benefit of palliative care for end stage renal disease patients

highlighted the need for these patients to receive that type of care, and the barriers to obtaining it.

The End-Stage Renal Disease Workgroup examined the care that those patients were receiving

and determined that there is an urgent need to incorporate palliative care into those patients care

(Jablonski, 2008). The barriers identified in the study to getting palliative care was 1) palliative

care equals hospice care, 2) a chronic illness alone does not qualify a patient for palliative care

services, 3) patients with ESRD live longer and are not considered appropriate candidates, 4)
MISCONCEPTIONS OF PALLIATIVE CARE… 6

patients with ESRD are not appropriate because they continue to seek treatment, and 5) palliative

care is best offered through hospice (Jablonski, 2008). These statements were reviewed and

contradicted by using statements by the World Health Organization. Recommendation for

nurses, physicians, and dialysis staff to understand the benefits of palliative care for these

patients was included. The study was based on literature review and surveying. The study

appeared to include numerous aspects of palliative care and ESRD patients, the study should

have more greatly went into detail about the cohorts used for the study.

Children

Palliative care in children may be a particularly difficult topic because of the parent’s

potential difficulty to accept a need for palliative care at all. The study was designed to explore

barriers to palliative care experienced by pediatric health care providers. A study questionnaire

given to nurses and physicians involved in pediatric care determined that there were four

recurring barriers to palliative care for children (Davies, et.al, 2008). One of the barriers the

questionnaire identified was the reluctance of parents to accept palliative care for their children

because of problems with communication and insufficient education in pain and palliative care

(Davies, et.al, 2008). After the study was completed, the authors decided that improved staff

education about communication skills and palliative care for children may overcome these

barriers (Davies, et.al, 2008). The study surveyed nurses and physicians at an academic

children’s hospital. The article was not specific to what children’s hospital was used for the

study. Upon evaluating this study, there are flaws based on negating information about what

hospital was used and what region this study may have originated from. The study did say a

questionnaire was used to survey 81 physicians and 117 nurses (Davies, et.al, 2008).
MISCONCEPTIONS OF PALLIATIVE CARE… 7

Recommendations and Conclusion

Further research of palliative care, and making the research available and accessible to

physicians’ and patients is a good goal to achieve in order to change the mindset of those

populations about this type of care. A research study that was directed towards education in

medical schools about palliative care discovered good and bad conclusions. The admirable

conclusion was that most medical educators in the United States perceive the teaching of

palliative care competencies as important, and the students find it valuable and effective

(Horowitz, Gramling, & Quill, 2013). The poor conclusion was that there is not an organization

that sets standards for the teaching of palliative care competencies. The only palliative care

related mandate for schooling is set by the Liaison Committee on Medical Education direct that

end-of-life be included in medical school curriculum. However, this does not even directly

include palliative care. The findings in the schools indicate that medical school education on

palliative care varies from two hours of classroom time to weeks of clinical orientation with

hospice-centered themes (Horowitz, Gramling, & Quill, 2013). This directly influences the

knowledge about palliative care that new practitioners come out of medical school with. The

study recommends that palliative care competencies should be defined and integrated into each

year of medical school curriculum (Horowitz, Gramling, & Quill, 2013). This recommendation

would be a very good way to enhance the knowledge of medical practitioners about palliative

care and what the true meaning of it is. Nursing schools should administer the same teaching for

palliative care, many times nurses are who patients initially ask about palliative care services and

it is the nurse’s job to be educated about those services. All hospitals should have teaching

committees that are able to educate patients about palliative care services. This teaching should
MISCONCEPTIONS OF PALLIATIVE CARE… 8

not be confined to patients simply experiencing terminal illnesses, but to all patients

experiencing symptoms that could be helped by palliative care services.

 MISCONCEPTIONS OF PALLIATIVE CARE… 9

References

Bakitas, M., Lyons, K.D., Hegel, M.T., et.al. (2009, August 19). Effects of a Palliative Care Intervention

on Clinical Outcomes in Patients With Advanced Cancer The Project ENABLE II Randomized

Controlled Trial. JAMA.2009;302(7):741–749. doi:10.1001/jama.2009.1198

Cortezzo, D. (2017, Oct 17). Cincinnati Children’s. Three common misconceptions about palliative

care. Retrieved from https://blog.cincinnatichildrens.org/rare-and-complex-con

Davies, B., Sehring, S., Partridge, J., Cooper, B., Hughes, A., Philp, J., Amidi-Nouri, A., & Kramer, R.

(2008, February). American Academy of Pediatrics. Barriers to palliative care for children:

perceptions of pediatric health care providers. Retrieved from

http://pediatrics.aappublications.org/content/121/2/282

Horowitz, R., Gramling, R., & Quill, T. (2013, December 11). Wiley Online Library. Palliative care

education in united states medical schools. Retrieved from

https://onlinelibrary.wiley.com/doi/full/10.1111/medu.12292 DOI: 10.1111/medu.12292.

Jablonski, A. (2008, May 1). Palliative care: misconceptions that limit access for patients with chronic

renal disease. Retrieved from

http://web.a.ebscohost.com.libproxy.dtcc.edu/ehost/pdfviewer/pdfviewer?vid=5&sid=74861a15-

c244-4ed1-9ff6-590c717ada40%40sessionmgr4010

Kavalieratos, D., Mitchell, E., Carey, T., Dev, S., Biddle, A., Reeve, B., Amy P., Weinberger, M.,

Weinberger, A. (2014, January 2). Journal of the American Heart Association. “Not the grim

reaper service:” an assessment of provider knowledge, attitudes, and perceptions regarding

palliative care referral barriers in heart failure. DOI: 10.1161/JAHA.113.000544.

 MISCONCEPTIONS OF PALLIATIVE CARE… 10

Montellongo, S. (2016, February). National Association of Catholic Chaplains. Three common myths

about palliative care. Retrieved from https://www.nacc.org/vision/2016-jan-feb/three-common-

myths-about-palliative-care-by-sedona-montelongo/

National Cancer Institute. (2017, October 20). Palliative care in cancer. Retrieved from

https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet#q1