“When we meet people for the first time, we get to know them on a level much deeper than what is in their medical chart or the data in the computer,” said Harri Brackett, RN, MS, CNS, ACHPN, a palliative care clinical nurse specialist at University of Colorado Hospital in Denver.

She discovers where they grew up, how they met their spouses, and what makes them tick. “Getting them to tell you about who they are, and about what legacy they are leaving behind, is extremely important and fulfilling – not only to the patient, but to us as clinicians,” she said.

For advanced cancer patients, a new study shows that a nurse-led palliative care intervention along with standard oncology treatment results in improved quality of life and mood. The study appeared in the Aug. 19 issue of Journal of the American Medical Association (JAMA).

“Comprehensive cancer care must incorporate more than state-of-the-art disease-modifying treatment,” the authors wrote. An interdisciplinary approach addresses physical, psychological, social, spiritual and existential concerns for patients and families.

The researchers, of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., noted that those views are shared by the Institute of Medicine, the National Consensus Project for Quality Palliative Care, as well as related advisory panels and oncology societies.

“This study clearly shows the impact of palliative care nursing on quality of life, on mood, coping, family and preparation for future death,” said Pamela S. Davies, MS, ARNP, of the Palliative and Supportive Care Service at the Seattle Cancer Care Alliance.

But there was limited effect on symptom intensity and use of resources. The intervention had no bearing on the length of stays in the hospital and intensive care unit, the number of emergency department visits or anticancer treatment.

These findings were not surprising to Davies. “In my own practice, new patients typically have very high symptom burden scores,” she said, citing pain, fatigue, anxiety, low appetite and constipation as examples.

A good nurse at the bedside can help elevate a patient’s mood and minimize symptoms’ impact on slowing someone down. “Every day is better than it would have been if they didn’t have this nursing care,” said Patrick Coyne, MSN, APRN, FAAN, clinical director of the Thomas Palliative Care Program at Virginia Commonwealth University’s Massey Cancer Center in Richmond.

Coyne has followed some patients for years from the day of diagnosis. “It’s almost for us a journey together,” he said. “I’m constantly trying to keep the patient and family informed about what’s going on, what to expect, and how we can help.”

Being an active listener is just as essential. “The dying patient usually has a lot to verbalize,” said Jeannette Garcia-Slanker, MSN, ARNP, advanced practice director in the Courtelis Center for Psychosocial Oncology at the University of Miami’s Sylvester Comprehensive Cancer Center.

Patients may be scared of dying, yet feel uncomfortable voicing those fears to family members. “It is also important for nurses to continually assess the patients for pain and anxiety before expecting patients to pay attention to new information or try new coping skills,” Garcia-Slanker said.

Another dimension to palliative care is discovering what brings hope to a patient. “We’re here to transition hope to something that is possible,” said Brackett, the clinical nurse specialist at University of Colorado Hospital.

“If there is no hope for cure, there is hope for pain control. If there is no hope for more curative treatments, there is hope for going home or for being with family or more a peaceful death. There is always hope.”