Advanced cancer patients often have to face the fact that there are no effective treatments available as cancer cells in the later stages will spread to other organs, and eventually lead to death. This may lead to psychological distress, anxiety, fear and even anger.

Oncology nurses will encounter multiple ethical dilemmas that may later impair their ability to provide quality end-of-life care. Here are some of the dilemmas and the possible means of managing them.

Telling patients the truth & being alert for communication cues


Cancer prognosis-related communication amongst nurses, patients and family is the real challenge. The ethical dilemmas most frequently reported by oncology staff nurses were feelings of uncertainty in relation to truth-telling, conflicting obligations and futility.

For novice nurses who landed their first duty in oncology wards, pressure begins to rise once there is a need to explain the prognosis spontaneously to patients, or when the physicians are asked to relay the health condition and medical information in front of patients and relatives.

Healthcare providers need to discuss with the medical officers on what needs to be told to patients and their relatives, so that nurses are subsequently able to relay the information accurately. Nurses especially need to be attentive and sharp to identify the patients’ signs that will allow nurses to begin the discussion on their illness. These are usually ideal situations that allow one to start to communicate, such as when patients clearly understand and acknowledge that their cancer cells are spreading and failing treatments.

False hope & conflicting obligations


Nurses are placed in a difficult situation when healthcare providers escape from discussing the end-of-life issues with patients and their families. Giving patients false hope concerning the treatments and cancer prognosis also prevent nurses from revealing the necessary information regarding the illness.

Ethical dilemmas of nurses’ conflicting obligations take place when nurses have to withhold information confidentiality, and patients’ rights. Nurses sometimes experience problematic situations where families do not want the patient to know his or her prognosis.

In these circumstances, the nurse may feel conflicted over the right course of action. In one case, a nurse described that “several months ago we [they] continued to give daily chemo injections to a woman in her late 80s who was barely coherent. Her daughter did not want to stop treatment.”

Advocating for patients amid futile treatments


The treatment options for some elderly patients may be aggressive and non-responsive. Undergoing these treatments may even reduce one’s quality of life.

Therefore, these treatments may seem futile as patients no longer respond to available therapies. There is also a possibility that they will not benefit the patient.

Compared with other care settings, the oncology site is the best clinical area for nurses to become an excellent patient advocator. As the core of frontline providers, patients always rely on nurses’ capabilities as their advocates by individually communicating with physicians about their prognoses and treatment plans.

It is important to realise the prognosis-related issues related to cancer patients. Nurses need to be well-prepared with cancer-related knowledge, specifically on cancer stages, therapies available, side effects of each treatment, current technologies, news and trends in oncology. This will make the nurse more comfortable and be able to discuss prognosis-related information with patients.

However, in any given situation, nurses should always prioritise individualisation of care. Additionally, every situation is different, therefore, nurses need to assess and evaluate the patients’ readiness to know the prognosis. When the timing is right, the care plan can be done individually.

The importance of discussions pertaining to disease status and future options should be emphasised by all medical professionals, particularly nurses who work in acute settings such as oncology wards. MIMS

Read more:
8 ethical dilemmas that healthcare professionals face
A nurse’s vital responsibilities when dealing with terminally ill patients
Patient honesty: How it can be improved

Sources:
Felea, M.G. et al., (2014). Expressing distress in patients with advanced cancer. SEA - Practical Application of Science. 11 (3). Retrieved from http://sea.bxb.ro/Article/SEA_5_43.pdf
http://www.medscape.com/viewarticle/780057_1