In a conversation with CancerNetwork®, Kelley A. Rone, DNP, RN, AGNP-c, focused on end-of-life discussions, the multifaceted nature of these conversations with patients, and the importance of addressing a range of physical and emotional needs.
Rone, an advanced practice nurse in gastrointestinal (GI) cancer at the Mayo Clinic in Phoenix, Arizona, noted that one of the most challenging aspects of end-of-life care is managing patient fatigue. The fatigue can be related due to the disease itself or the adverse effects of treatment. She delved into ways on how to optimize energy levels, including dietary modifications, activity pacing, and medication adjustments.
Pain management is another crucial component of end-of-life care. Rone emphasized the importance of early and open communication with patients about pain management options. This communication includes discussing the potential need for stronger medications such as opioids while addressing concerns about addiction and misuse.
She concluded that by addressing these key areas, it may be possible to provide comprehensive and compassionate end-of-life care for patients with cancer.
Transcript:
[Pain or symptom management strategies] depend on what [the patient’s] symptom is. One of the most difficult things to manage is fatigue. A lot of our patients are just tired. We talk a lot about how patients need to eat enough. A lot of our patients have a lot of nausea or pain when they eat, so they don’t eat enough. We work around how to get in more calories and how to group their activities. If they are more energetic in the morning, [they should] do the things they need to do in the morning so they can rest in the afternoon. A lot of our patients have pain, and a lot of people are very concerned about becoming addicted to opioid pain medications.
We start the education about pain management early in the process. We ease patients into the fact that they are probably going to need something stronger than acetaminophen [Tylenol] at some point in time, and you have to make it okay. There’s a lot of things in the news about the opioid crisis, and you have to explain to [patients] that this is the result of people prescribing things inappropriately, and that for a patient with cancer—someone who has a tumor somewhere in their abdomen or in their leg that is causing them pain and won’t go away—they are going to need something that’s a little bit stronger. We start educating people about that early on.
You know the patients who are going to need more pain medicine; some of our patients go through their entire cancer journey without having any pain. You have to prompt that. A lot of the patients that I see have a lot of GI issues. I see a lot of people who have pancreas cancer, and those patients will develop gastric outlet obstructions, so those patients will often have to get something like a venting G-tube. You have to educate, educate, and educate patients about the things that might happen to them. You don’t lay it all out for them all at one time. A lot of people will start asking questions: “What’s going to happen at the end? What’s going to be the thing that that takes my life?” You can’t predict that, but you can lay out some scenarios for patients.
A lot of times, I will tell my patients, “You may not know….what makes you decide to stop treatment, but you will know when it happens.” You just have to prepare people. You also have to make it okay that some of these things need to be managed.
