Chapter 2: Integrating a Palliative Approach 15 In hospice and palliative care communities, the under- standing grew that people dying from any life-​ limiting ill- ness could benefit from hospice and palliative care. At the 2006 International Congress on Care of the Ter- minally Ill, a nephrologist, respirologist, neurologist, and cardiologist each spoke about the struggle to address the needs of the dying people for whom they care. The message of these professionals was clear: people with non-​ cancer diagnoses experience a significant symptom burden in the dying process and have psychosocial needs; hospice and palliative care programs are needed to serve people who have a non-​ cancer diagnosis! A More Responsive Model of Hospice and Palliative Care Figure 1c represents a more responsive approach to ad- dress the needs of people who can benefit from acute life-​ prolonging treatments while also receiving palliative care support. This model builds on the strengths of the model shown in Figure 1b. Responding to the needs of the person from the time of diagnosis is referred to as “moving upstream” or “front loading” (Coyle, 2015). As the person moves closer to death, disease-​ modifying treatments usually decrease and the focus on hospice and palliative care increases. In both the United States and Canada, more and more people with non-​ cancer diagnoses are served by hospice and palliative care programs. In Canada, “hospice palliative care” programs provide pal- liative consultations, access to benefits, and hospice ser- vices all in one service. In such programs, the person may be involved in “hospice palliative care” for much longer than six months. In the United States, people can register for hospice six months before death. However, physicians tend to over- estimate the prognosis and delay discussing death, re- sulting in people being admitted to hospice programs only days or weeks before death. In Figure 1c, the wavy line representing bereavement sup- port illustrates that the need for it may not decrease in a steady decline but instead may fluctuate in the months or years following a death. In the United States, palliative care is still funded separately from hospice care. Depending on the health care plan and the resources available at each hospital, people can access palliative care consultants or specialists early in the disease process. However, they may not be able to access palliative care services after registering for hospice services. Improving Quality of Life with Hospice and Palliative Care In a landmark study published in 2010, people who re- ceived palliative care in addition to oncological treatment reported better quality of life and improved mood states, and as a group experienced a longer survival rate (Temel et al., 2010). This study confirmed that hospice and palliative care does improve quality of life for people who are dying. Another study of 160 people found that early, multidisci- plinary hospice care was associated with better pain re- lief and quality of life, reduced costs, and less aggressive care at the end of life, as well as less psychiatric morbidity (Diamond et al., 2016). These studies support the essential role of hospice and palliative care in ensuring that dying people have better quality of life, fewer symptoms, and greater satisfaction with their care. According to the CHPCA, dying people who received hospice and palliative care also had fewer emergency room visits and fewer hospitalizations than people who did not receive such care (CHPCA, 2013; Coyle, 2015). Ethics Touchstone Provision 7 The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, profes- sional standards development, and the genera- tion of both nursing and health policy. Code of Ethics for Nurses (ANA, 2015a) How can nursing students advance the nurs- ing profession? How do the nurses that you work with help to generate nursing and health policies?