End of Life Care in Haematological Malignancies-proofread

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End of Life Care in Haematological Malignancies


Diagnosis of tumours does not only determine the period a patient might live but the way he or she will die. Patients with haematologic malignancies, such as multiple myeloma, lymphoma, and leukemia, usually receive palliative care or more intensive care at the life end, including admission to the ICU, chemotherapy, as well as life-support measure such as mechanical ventilation (Hui et al. 2014). Research from the University of Texas MD Anderson Cancer Center that contrasted the end of life care quality between solid tumors and advanced haematological malignancies presented significant differences (Kinahan et al. 2017). Specifically, in the past one month of life, haematologic malignancies patients are more likely to receive targeted therapy and chemotherapy contrasted with solid tumors patients (Cheng et al. 2015). Furthermore, from Kinahan et al. (2017) study, the researchers also revealed that the other primary difference between haematological malignancies and solid cancer is the diverse approach of specialist to palliative care. As contrasted to solid tumor treatment, in the past decades, haemato-oncology hardly entailed any palliative care. Thus the present tendency of embracing palliative care to people with haematologic malignancies is a new strategy (Hochman et al. 2018). Although, with surging evidence indicating the abundant merits of palliative care for people with haematological malignancies, the demand for palliative care services continues to rise dramatically (McCaughan et al. 2018). Some of the identified benefits associated with palliative care in individuals with haematologic malignancies include improvements in mood and quality of life, increased chances of survival, a decrease in symptom burden, as well as excellent caregiver outcomes (Cheng et al. 2015). However, people with haematologic malignancies are hardly receiving services of palliative care contrasted to individuals with solid cancer, regardless of the mounting evidence of various unfulfilled needs of palliative care in patients with haematologic malignancies (Cheng et al. 2105). Therefore, the aforementioned inconsistency shows a need for education to inform both patients and caregivers about the practice of PC, and extra efforts to receive services of palliative care to better meet haematologic patients’ needs.

Due to insufficient knowledge of the merits associated with PC in haematologic patients, the present essay will reveal the significance of palliative care among the population with haematological disorders. In other words, the purpose of the piece is to contribute towards the rigorous evaluation of effectiveness or benefits of PC for the care of the population with haematological cancer. The piece pinpoints the absence of palliative care amongst haemato-oncology patients and gives justification and relevance of the topic to a nursing student. The present paper also presents a critical analysis which explains the way the practice aspect affects the client group. Finally, the author presents a discussion of the outcomes for a band five nurse practice and also gives a conclusion which summarizes what is covered in the entire article.

2.0 An Identified Aspect of Haemato-Oncology Practice

In the present case, the modality of haemato-oncology practice which will be discussed is palliative care and the part it plays in the management of symptoms experienced by haematologic malignancy patients. The CAPC (Center-to-Advance-Palliative-Care) describes palliative care as therapeutic care for a population diagnosed with a terminal illness, such as haematologic malignancies (Capc.org. 2018). CAPC further explains that palliative care often aims to relieve patients from the stress and symptoms of a severe disorder, while the primary objective is to increase the life quality for the involved patient alongside with his or her family (Capc.org. 2018). Moreover, CAPC also defines palliative care as a multidisciplinary model for psychosocial support, symptom management, and helping patients with terminal ailments and their families in making treatment decisions (Capc.org. 2018). The palliative care emphasizes the patients’ well-being throughout their disease course despite their state of disorder. Therefore, PC does not focus on a specific illness stage, but instead it describes philosophy of care, which clarifies that palliative care can be offered in different settings, by a specialists such as physiotherapists, physicians, nurses, doctors, and other medical professionals who cooperate with family caregivers or members to offer extra support layer (Weissman and Meier, 2011).

Similarly, WHO (2016) perceives palliative care as a model which increases patients’ life quality experiencing the problem linked with severe illness, through suffering prevention and relief using early detection and impeccable evaluation as well as treatment of pain and other disorders. However, both CAPC and WHO descriptions differ with medical vernacular, where palliative care is usually utilized to explain terminal and late-stage care, as the one offered by hospice agencies (Hochman et al. 2018). More accurately, palliative care entails more than merely hospice care, although it is perceived as one of palliative care types, and is also the popular category of end-life-care offered in the US (WHO, 2016). Therefore, the present essay will utilize palliative care as a necessary constituent of concern for people with haematologic malignancies from the diagnosis time.

Palliative care applies to all kinds of patients despite their age in a severe disorder and can be offered together with treatment (Hui et al. 2014). One of the primary reasons for choosing PC practice in the haemato-oncology is to examine the unwillingness of the oncologists to adopt services of palliative care to treat individuals diagnosed with blood tumor, such as myeloma, leukemia, and lymphoma (Hui et al. 2015). Palliative care provides immense help to patients with blood-related tumor, although it is not fully actualized or utilised for far-reaching benefits to the patients with severe disorders (Hui et al. 2014). The present essay also reveals barriers which limit the full use of palliative care in treating haematologic malignancy amongst patients.

Rationale and Relevance of the Selected Aspect

The primary motive for selecting “end of life care in haematological malignancies” as the topic in the present article is that despite the increasing evidence depicting the merits of  PC in improving care quality, its effectiveness or benefits in a blood tumour lacks proper establishment (Hui et al. 2015). People with haematologic malignancies have strong PC needs, such as high symptom burden, yet, they rarely contrasted with solid tumours’ population get specialist PC services and more likely to get intensive care at the end-of-life (LeBlanc et al. 2016). Specifically, people with blood cancer are less often going to demand palliative care services, rarely have appointments with the physiotherapists, high possibility of dying while in ICU, and high chances to get chemotherapy in the last thirty days of their life (Cheng et al. 2015). Therefore, the above findings highlight unmet palliative carer needs amongst the haematologic malignancy patients, probably, due to few knowledge of its benefits.

The other motive that has driven the author in the present essay to choose the topic mentioned above is the late recommendations or approvals to services of palliative care due to the negative attitude among caregivers and patients (Hui et al. 2015). The reason for the delayed referrals is inadequate clinician experience and understanding of palliative care. Despite, several studies demonstrating that early exposure to services of PC for a population with haematological malignancies improves life quality, surges care satisfaction and lessens depression disorders, referrals to PC are delayed in the disease trajectory (Romano et al. 2017). Furthermore, despite the increasing awareness of the variations as mentioned above, infrequent utilization of palliative care by population with haematologic disorders is poorly understood. Past studies suggest that unwillingness or perceptions of the oncologists, patients, and caregivers toward palliative care play a significant role in referrals (LeBlanc et al. 2015). However, presently, there has been scant research examining if attitudes vary among haematologic malignancies’ patients, oncologists, and caregivers. Thus, the recent essay will hypothesize that different oncologists, patients, and caregivers hold varying perceptions, hence depicting the relevance of the current paper in the hospital settings. By presenting the merits of the PC among the people diagnosed with the severe illness in the recent piece, hospital managers and nursing educators will be able to support bedside oncology nurses in offering palliative care to a population with haematologic malignancies (Stern and Parks, 2016).

Moreover, nurses can utilize the information acquired from the present piece to cooperate with a multidisciplinary team to improve and change palliative care for a population with blood tumours and their caregivers. Additionally, the present paper will also have some relevance to the nursing students in various colleges who are anticipated to knowledgeably address the challenge of haematological malignancy treatment in the future. As future nurses, the expectation is that students will proficiently help patients to overcome symptoms related to severe disorders, such as haematological malignancy.

Lastly, the psychosocial and symptom needs of patients with a haematological tumour are increasingly acknowledged, hence the need to develop and expand palliative care programs in cancer settings (Hochman et al. 2018). Traditionally, the purview of palliative care programs involved home hospice care, intensive care units, and inpatient consultations (Stern and Parks, 2016). However, with growing importance placed on timely symptom’s management and advance care planning, there has been an increasing interest in involvements in the ambulatory care setting.

Critical Analysis How a Chosen Aspect of Practice Impacts Client Group

Several studies demonstrate that palliative care improves psychosocial and physical symptoms, bereavement outcomes, the well-being of a family caregiver, and satisfaction of patient, physician, and family (Casarett et al. 2008; Nilsson et al. 2009; Temel et al. 2010).  Also, a study conducted by LeBlanc, Roeland and El-Jawahri (2017) indicated that use of palliative care in treating patients with hematopoietic stem cell transplantation, such as Leukemia reported substantial improvement in the life quality of both patients and their caregivers in the long-term effects. The authors also demonstrated that patients who are administered to palliative care in regards to the transplant procedure equally depicted a decrease in anxiety and depression, where patients’ relief extended for more than three weeks. These objectives are attained when palliative care teams frequently meet with haematologic malignancies’ victims and their caregivers to establish realistic and appropriate goals as well as plan for safe transit from hospitals to other settings that are more supportive (LeBlanc, Roeland and El-Jawahri, 2017). Communication in regards to goals and prognosis of patients by palliative care team with expertise and team lead to well-informed decisions, care plan clarity, and reliable follow-through (Connor, 2017). Such dialogs with family members of the patients lead to a lighter family burden and increase family satisfaction and improve bereavement outcomes (Connor, 2017). However, contrary to broadly held benefits of palliative care, many research has also indicated that PC is linked with a substantial life prolongation for populations with haematological malignancies (Bakitas et al. 2015; Temel et al. 2010). Conjectures demonstrating the prospect that specialized PC might extend life include a decrease in depression, symptom-burden reduction, and improved caregivers support, as well as prevention of the hospitalization hazards and high-risk medical-involvements (Connor, 2017).

Furthermore, the analysis of the efficacy of PC started in 1980 with the National Hospice Study, where the influence of hospice care on life quality was compared to non-hospice terminal care (Connor, 2017). The results of the study demonstrated that despite the fact haematologic tumour patients were more likely to die at home, life quality was similar for palliative and non-hospice care (Connor, 2017). Moreover, another hospice care study published in 1984 indicated that there was no difference between conventional and palliative care for symptom control, but significant satisfaction among the caregivers and patients in the hospice group (Kelley and Morrison, 2015). Currently, scant research has been done to show the effectiveness or the benefits of end-of-life care amongst the haematologic malignancy patients. However, the palliative care practice has the prospective of changing the physical and psychological symptom burdens facing the population with haematologic malignancy (Kelley and Morrison, 2015). It is broadly anticipated that improved research and study in regards to palliative care delivery who give patients with blood malignancies equal benefits with the solid tumor patients. Palliative care amongst the population with haematologic malignancies would raise their mood, improve the quality-of-life, and also manage their symptom burden.

Furthermore, a randomized study done by Manitta et al. (2011) demonstrates that involving family caregivers during the delivery of palliative care results in positive impact, where it influences them to respond with ease to the patient. Manitta et al. (2011) also revealed that with palliative care, family members were more understanding, as well as depicted reduced depression and stress burden. Thus, it is apparent that delivery of palliative care to haematologic patients indicates positive impacts on the patient and their family caregivers. Manitta et al. (2011) further showed that adverse effects, such as shortened chances of survival and reduced quality-of-life, can be generated by the palliative care service if the treatment therapy and regimen are extensively rigorous. Additionally, a study by El-Jawahri et al. (2016), conducted on the population with haematologic malignancies reported that a reduction amplified depression, the decline in the life quality, and a high burden due to symptoms for the people hospitalized for stem cell transplantation process.

Also, as per the study done by JAMA (Journal-of-the-American-Medical-Association) indicates that family caregivers of the haematologic malignancies demonstrated the ability to control the stress and stress associated with the patient. JAMA also went ahead and took another study to examine if palliative care has the potential of improving life quality of haematological malignancies’ patient in a period of two weeks. The outcomes depicted the positive impact of the palliative care to the patients since the patients reported reduced anxiety, stress, and depression. In contrast to the control group utilized in the study, haematological malignancy patients showed fewer PSTDs in three months. Therefore, from the above analysis, it is apparent palliative care has a more positive impact on the haematologicsl malignancy patients than adverse effects.

Moreover, a study conducted by Dahlin, Gallagher, and Temel (2011) reported that early palliative care reduces depression and improves life quality. Possible explanations for these impacts of the palliative care to haematologic malignancy patients is that; first, PC provides psychosocial care and therefore may directly lessen psychological distress at the end-of-life. Second, intensive concerns during the end-of-life might generate adequately high mental suffering levels when cancer treatment yields more damage than benefits. Although results reported in Dahlin, Gallagher, and Temel (2011) study strongly advocate that palliative care has beneficial influences, it had several limitations. The research involved only participants with metastatic-non-small cell-lung-cancer; thus the results are not adequate for generalizability to all tumour patients (Dahlin, Gallagher, and Temel, 2011). Also, the research was done at only one hospital which had already a well-experienced team of palliative care and a combined link with the section of oncology. Furthermore, the study sample was relatively homogenous, thus limiting the study’s potential to generalize these results to patients from different walks of life (Dahlin, Gallagher, and Temel, 2011).

Discussion of the Implications for Professional Practice

Palliative care for patients with blood cancer has vast inferences for my professional practice as a junior band 5 nurse. In hospital settings, oncology nurses are often found at the patient’s bedside, offering chances to start dialogs which allow patients to think about their perceptions on good life quality, their physical state, and their beliefs, preferences, and values about life-extending interventions (Dahlin, Gallagher, and Temel, 2011). Most oncology nurses offer palliative care at the diagnosis time, at recurrence, at treatment time, and at the disease progression news (Isenberg, Aslakson, and Smith, 2017). Nurses provide comfort and support at these stages, especially after challenging dialog with oncology doctors (Dahlin, Gallagher, and Temel, 2011). Skillful delivery and careful timing of PC are significant to strengthen and nurture the relationship between a patient and a nurse.

In hospital settings, oncology nurses also have a potential of endorsing early palliative care initiation and the positive part it plays to treating team and the blood malignancies’ patients, which can be achieved with integration with conversations on other features of comprehensive cancer care (Isenberg, Aslakson, and Smith, 2017). For instances, nurses may provide haematological malignancy patients, and their caregivers access to oncologists who focus on symptom and pain management as well as psychosocial support to increase life quality (Dahlin, Gallagher, and Temel, 2011). Oncology nurses are also in a better place to increase trust and acceptance of PC practice among haematologic malignancy patients and can introduce specialist directly to the victims and their family members (Dahlin, Gallagher, and Temel, 2011). Oncology nurses can identify patients stressed by treatment of haematologic cancer and require PC to assist them to finish therapy. For patients that are left with little or no treatment options, nurses should discuss the possibilities and benefits for palliative care (Sealey et al. 2015).

To summarize, palliative care practice has professional implications to my professional training as a junior nurse since oncology nurses act as the passionate supporters to patients, especially blood malignancy patients, and are often anticipated to demonstrate therapeutic skills of communication (Glajchen and Goehring, 2017). Nurses are the major guidance counsellors to patients, where they also them with well-informed advice to help them reduce suffering and symptoms (Sealey et al. 2015). Nurses also play a role of an educator where they offer patients together with their caregiver’s guidelines on the health state as well as control of prevalent health problems (Sealey et al. 2015). Zealous performance of the role of the nurse results in a positive mood shift to the patients irrespective of the stress and pain they are experiencing due to a medical condition (Wilson, Avalos, and Dowling, 2016).


In conclusion, although the palliative care has proved to be an essential aspect of people with haematological malignancies, it has not yet gained full acceptance among the caregivers and patients. The essay shows how the efforts to provide improved care-planning among the haematologic patients has been met with resistance. Moreover, the goal of the present piece was to demonstrate that palliative care has beneficial effects on patients with haematological malignancies. Thus, some of the benefits shown in the present piece include improved life quality, abridged depression and stress, less intensive end-of-life care, and prolonged life. With the current evidence in the recent article, nursing students need to gain confidence and embrace palliative care to their patients, both at present and in the future.  Thus, to aid nurses to offer advanced care to patients with blood malignancies, they should make efforts to understand the merits of incorporating the practice of PC into oncology care. The paper also suggests that nursing student in palliative care education receipt can utilize their learning in practice to offer psychosocial support to blood malignancies’ patients and their caregivers approaching the end-of-life.







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