The study was reported as qualitative and to have been conducted by the 'Australian National Health and Medical Research Council' research study. It is stated as follows of the study: "The nursing insights indicate that an understanding of end-of-life care in hematology needs to be set in a trilogy of overlapping models (labeled functional, evolving, and refractory) that address the complexity of issues associated with professional and hospital culture." (McGrath, 2007)
Findings include the development of a working model focused on enabling the "integration of palliative care into adult hematology. The model is accredited the development of a new language for understanding and fostering the integration of palliative care and hematology." (McGrath, 2007)
One reason that palliative care is so important for hematology patients are necessary provisions of informed consent and other end-of-life issues. That is because many of these issues have to do with factors related to survival and its priority over quality of life for these patients. It is specifically stated: "Survival benefit is often the primary outcome measure in clinical research relating to palliative chemotherapy. This suggests a difference in perspective between palliative care clinicians, for whom "palliative" refers to improvement in quality of life, and those clinicians who focus on prolonging life. Emphasizing survival gain, however, might not be in conflict with the wishes of patients. Many patients with advanced cancer priorities survival over quality of life1and oncologists might "collude" with them in attempting to do something active about the disease." (Audrey, et al., 2008)
The primary reason for these considerations include that "
The offer of active treatment with palliative effects can support patients through a process of adjustment from the distress of diagnosis towards goals other than long-term survival. But if survival benefit is not discussed when treatment decisions are being made, there can be a considerable gap between patients' hopes and what can usually be achieved." (Audrey, et al., 2008) Continuous and ongoing care is also supported and reported in a study conducted by Maganto, Gonzalez and Moreno" (2004) who states that this concept is "not only applicable to the terminal stage. Such a simplification could generate inequities of therapy and discrimination. Historically, oncology services have been structured as networks dispensing chemotherapy and radiotherapy rather than services dedicated to the integrated care of the cancer patient. This situation has changed in a continuous and progressive manner over the past few years..." (Maganto, Gonzalez and Moreno, 2004)
Conclusion & Recommendations
This brief review has demonstrated that palliative care in the area of hematology and notes that the articles reviewed are recent in origin and serve to highlight concerns and considerations of haemotological palliative care. However, this study has been of a very brief nature and the proposal for research contained herein is an exploration and examination of the most recent palliative care issues in hematology.
Finlay, Ilora (2001) UK Strategies for Palliative Care. JR Soc Med 2001;94. Online available at: http://jrsm.rsmjournals.com/cgi/reprint/94/9/437.pdf
Audrey, Suzanne et al. (2008) What Oncologists Tell Patients About Survival Benefits of Palliative Chemotherapy and Implications for Informed Consent: Qualitative Study. BMJ 2008, 337:a752. Online available at: http://www.bmj.com/cgi/content/full/337/jul31_3/a752
McGrath, Pam D. (2007) Description of an Australian Model for End-of-Life Care in patients with Hematological Malignancies. Oncology Nursing Forum. Vol.43 No.1 2007. Online available at: http://ons.metapress.com/content/w1l1mx43646772k3/
Maganto, Vincente Valentin, Gonzalez, Maite Murillo and Moreno, Maria Valentin (2004) Continuous Care in the Cancer Patient: Palliative Care in the 21st Century. Clinical and Translational Oncology. Vol. 6 No. 7 October 2004.
C7 Palliative Care Services. (nd) Australian Government Health Publication -- corporate. Online available at: http://www.health.qld.gov.au/publications/corporate/CSCF/docs/cscfv2_c7.pdf