Early integrated palliative care in the acute care setting: impact on patients and nurses' roles and responsibilities

The early integration of palliative care (PC) into the trajectory of patients diagnosed with a life-limiting disease in the acute care setting may improve quality of care and lessen patients’ distress. The SENS structure (Symptoms, End-of-life decisions including advance care planning, Network and Support of caregivers) provides a structure for PC conversations with patients. Some patients found the PC conversations based on the SENS structure hard because of being confronted with the finiteness of their lives. Others were relieved to talk about their fears and expectations. Nurses can play an important role in early integrated PC and advance care planning. If trained appropriately they can have the responsibility to facilitate early integration of PC and advocate for patients’ wishes. An analysis showed that patients at the end of life in the acute care setting, who receive additional specialized PC services, require overall more nursing care time for direct and indirect care compared to patients receiving usual care alone.