Interview With Palliative Care Director Dr. James Tulsky

TheONC’s community editor Stephanie Wiseman sat down with Dr. James Tulsky, Director of the Duke Center for Palliative Care at Duke University, to discuss steps that oncology nurses can take to help patients with end-of-life care.

End-of-life care is a gradual process, and Dr. Tulsky recommends that practitioners proceed in a stepwise fashion by implementing the “ask-tell-ask” model:

• Ask your patient if he understands the nature of his existing illness. This will allow your patient to verbalize his thoughts on where he stands regarding prognosis and treatment.
• Ask your patient about how he views his future and what worries him the most. A patient may soon realize that he only has a life expectancy of three months rather than two years and will require financial and personal planning sooner than expected.

Dr. Tulsky also stresses the importance of the caregiver. Oftentimes, caregivers assume a role that they were not expecting, or they do not understand the disease process, disease progression, or what the basic needs will be for the patient. This is why it is important for caregivers to be involved in all conversation between the patient and the cancer and/or palliative care team.

While caregivers strive to take care of the patient as best they can, the stress may become overwhelming. Sometimes, caregivers may not feel as though they are doing enough to help support the patient. Tulsky says it’s important for the oncology nurse and other members of the cancer team to always praise caregivers by telling them what an extraordinary job they are doing. In turn, this may be just the positive push they need to provide ongoing support during such a difficult time.