Palliative care in hematological oncology: boundaries between cure and care

Boundaries Between Care and Cure: An Insight Into Palliation in Haematological Oncology Setting

The objective of the research proposed herein this document is one in which palliation will be explored and the notion of cure and care in the Hematological oncology setting will be examined.

The questions that will be at focus in the proposed research are those as follows:

(1) How important is palliative care in the field of hematological oncology?

(2) What are newly discovered considerations for palliative care in the hematological ontological setting?

(3) What steps does this field of study need to take in order to ensure optimal hematological oncology care?

The methodology to be utilized in the proposed research is one of a qualitative nature that will involve a review of the literature in this area of study and specifically British related literature on care and cure on the haemotological setting.

Significance of Study

The significance of the study proposed in this research proposal is the information and knowledge that will be added to the existing base of knowledge through the synthesis of information already existing in this area of study.

Organization of the Study

The study proposed herein this document will include an introductory chapter which will be chapter one of the study which has been proposed. Chapter two will be a review of the literature and Chapter three will report findings, conclusions and recommendations.

Literature Review

The work of Ilora Finlay (2001) entitled: "UK Strategies for Palliative Care" states that palliative and support care "differ in philosophy from curative strategies in focusing primarily on the consequences of a disease rather than on its cause or specific cure." (Finlay, 2004) Therefore, the approaches utilized are "necessarily holistic, pragmatic and multidisciplinary and there is almost no philosophical distinction between palliation and support." (Finlay, 2004)

Palliative care was once viewed as being only for those who are dying however, palliative care is stated to be many times needed "from the time of diagnosis." (Finlay, 2004) In fact, there is stated to be evidence that "the cost-efficacy of palliative care far outweighs attempts at disease cure, in terms of quality of life for the individual and family" and this is stated to be the reason that emphasis has changed in the UK towards "services working in parallel with other specialties earlier in the disease." (Finlay, 2004)

In a report published in Scotland Calman-Hine states that there is an existing need for "multiprofessional specialist palliative care teams" and specifically states as follows:

"Palliative care should not be associated exclusively with terminal care. Many patients need it early in the course of their disease, sometimes from the time of diagnosis. The palliative care team should integrate in a seamless way with all cancer treatment services to provide the best possible quality of life for the patient and their family. The palliative care services should work in close collaborations at the Cancer Centre and be involved in region audit and developing integrated operational policies and protocols." (Calman-Hine cited in Finlay, 2004)

The healthcare needs of people are widely varied in the area of palliative care and include the following stated needs:

(1) Affirms life and regards dying as a normal process;

(2) Aims to neither hasten nor postpone death;

(3) Aims to enhance quality of life and positively influence the course of the illness;

(4) Gives the patient a central role in decision making;

(5) Provides relief from pain and other distressing symptoms;

(6) Integrates the psychological, emotional, spiritual and social aspects of care for the patient, the family and close carers;

(7) Offers a support system to help patients live as actively as possible until death;

(8) Recognizes need for support of the family and carers after the patient's death;

(9) recognizes need for support of the family and carers after the patient's death;

(10) Uses a team approach to address the needs of patients and their families, including prevention of suffering (where able) and bereavement follow-up;

(11) Can be applied early in the course of illness in conjunction with other therapies that are intended to prolong life (such as systemic therapy, radiation therapy or surgery) (World Health Organization 2002; National Health Priority Action Council 2004; cited in Queensland Health Clinical Services Capability Framework, 2005)

The work of McGrath (2007) entitled: "Description of an Australian Model for End-of-Life Care in Patients With Hematologic Malignancies" presents an end-of-life care model that was derived from the experiential knowledge of nursing staff in what was a longitudinal study over the course of two-year time.

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.