Wait and see With this approach, nurses would mention the concept then wait and see how willing patients were to hear about the benefits of early palliative care. They then took a step back if they saw that the patient was not ready after all, but would go forward with the idea if the patient wanted to hear more about the process. Many felt that patients were less threatened by nurses than by physicians, since oncologists concentrated on achieving a cure, whereas nurses were more involved with supporting the patient, which fits in with the concept of palliative care.

Build trust, then discuss Using this approach, the nurse often found an appropriate space in the close nurse-patient relationship to build trust, discuss early palliative care and how it could help, and to address the stigma associated with it. The strength of the nurse doing this is that the patient perceived the nurse as less threatening than the oncologist, and more engaged with the patient’s emotional issues and day-to-day concerns.

The researchers felt that early palliative care for patients and their families could be made more accessible if all nurses received training in the theory of palliative care. They could then participate more fully in making referrals within the limitations of their practice roles.

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The Canadian group also recommended creating a nonhierarchical, interprofessional

practice model in oncology that would be collaborative and enable a joint approach among nurses and oncologists toward introducing early palliative care. 1


1. Mohammad S, Savage P, Kevork N, Swami N, Rodin G, Zimmermann C. “I’m going to push this door open. You can close it”: a qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care [published online October 29, 2019]. Palliat Med. doi: 10.1177/0269216319883980