The following article features coverage from the 2017 ONA Navigation Summit in Austin, Texas. Click here to read more of Oncology Nurse Advisor‘s conference coverage. 

Nurse navigators are well-suited to provide effective palliative and supportive care that improves quality of life for both the patient and the family, a presentation at the 2017 Oncology Nurse Advisor Navigation Summit has shown.

Palliative care, as it pertains to patients with cancer, is defined as patient/family-centered care that optimizes quality of life through anticipation, prevention, and treatment of suffering. Palliative care throughout the continuum of care addresses physical, intellectual, emotional, social, and spiritual needs and facilitates patient autonomy, access to information, and choice.

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In this oral presentation, Bonnie Freeman, DNP, RN, ANP, CT, ACHPN, discussed the best practice strategies for palliative care that improves quality of life for patients with cancer during treatment, post treatment, and at the end of life.

By virtue of their education and skill set, nurse navigators are as suited to helm the palliative care team as palliative care nurse practitioners (PCNPs). Clinically, the skill set for nurse navigators and PCNPs match; however, some differences exist in education and requirements. Their role in the continuum of care differs only in that nurse navigators are tasked with orienting patients to the cancer system in addition to nursing tasks involving emotional/educational support, advocacy, patient referrals, and to collaborate with other health care providers.

The role of advocacy involves insuring patient/family goals are set; promoting communication between the patient, the family, and the health care team; and taking an active role in managing symptoms. The most significant issues of patients with cancer are pain management, it’s rarely just physical; constipation, the only adverse effect of opioid use that the body does not build a tolerance to over time; nausea and vomiting, consider the receptor site (cortex, vestibular, chemotherapy trigger, peripheral pathways) when determining cause and optimal treatment; anxiety and depression, these symptoms often do not have a clear psychosocial trigger; and end of life care, most common symptoms patients need help with are nausea/vomiting, delirium, dyspnea, and pain.

The CARES tool is a very effective tool for managing patient and family needs at the end of life, said Dr Freeman. CARES is an acronym for an organized educational guide that addresses the most common symptom needs of the dying:

• Comfort Pain management is essential; there is no maximum dose of opioids for pain control. Patients are more likely to die of their disease than from opioids. Evaluate the need for vital signs, labs, vital signs, IV fluids, and tube feeding. Explain to the family the difference between the normal dying process and suffering.

  • Airway Use of a fan can reduce shortness of breath. Explain to the family agonal breathing vs suffering; supplemental oxygen is more for the family than the patient. Control the death rattle.

  • Restlessness and delirium Allow the patient and family to address possible unfinished business, say good-bye and give permission to stop fighting. Educate the family that the patient is not aware of behavior, and to be peacefully confused is possible.

  • Emotional and spiritual support Your humanity is needed the most. The family becomes the focus: be sure they are getting rest and taking breaks; provide coffee, water, etc; and continue to be available to answer questions.

  • Self-care Be realistic. You are not all-knowing or all-powerful; accept that a power greater than yourself will ultimately decide the fate of the patient, but you should find comfort in knowing that you did your very best.

But the most compassionate action a nurse navigator can take is to actively listen and give honest and open responses that show genuine caring, noted Dr Freeman. Navigators may serve as a therapeutic presence that helps patients and families avoid a sense of abandonment.

Effective palliative care improves quality of life for patients and their families. Navigators should be pro-active and anticipate patient and family needs, request palliative care consults, and celebrate the person — they are not their disease. “We cannot change the fact a patient will become terminally ill or die, but we have everything to say about the journey,” concluded Dr Freeman. “We can make a difference for our patients.”

Read more of Oncology Nurse Advisor‘s coverage of the 2017 ONA Navigation Summit by visiting the conference page.


1. Freeman B. The navigator’s role in integrating palliative and supportive care. Oral presentation at: 2017 Oncology Nurse Advisor Navigation Summit; June 15-17, 2017; Austin, TX.