Patients with advanced cancer should receive palliative care soon after diagnosis, according to the American Society of Clinical Oncology — but a recent study shows this is true for only half of veterans.1

Researchers analyzed care received by all veterans over 65 with cancer who died in 2012. Of these 11,896 individuals, 52% received palliative care. Of this group, many received it late in the disease’s progression instead of immediately after diagnosis.

The study found that 71% of patients received hospice care. However, Veterans Administration (VA) patients were less likely to receive hospice care for the minimum recommended three days compared with those in Medicare or in other contracted care paid for by VA. VA patients also first received hospice care a median of 14 days before death, compared with patients in VA-contracted care, who entered hospice a median of 28 days before death.

Sally Welsh, MSN, RN, NEA-BC, chief executive officer of the Pittsburgh-based Hospice and Palliative Nurses Association, says three primary components of palliative are the following:

  • to provide “person-centered” care that is based on the values and beliefs of the individual,
  • to utilize expert communication skills, especially related to advance care planning and goals of care, and
  • to promote comfort through the provision of expert pain and symptom management.

“The ethical principles of autonomy, beneficence, nonmaleficence, and veracity are all key ethical principles embedded in the provision of quality palliative care,” says Welsh.2

Welsh says ethicists can advocate for early palliative care by championing the integration of advance care planning and goals of care discussions for all patients.

“Ethicists can help promote care discussions that include the benefits and burdens of care and which encompass the values and beliefs of the patient,” says Welsh.


  1. Gidwani R, Joyce N, Kinosian B, et al. Gap between recommendations and practice of palliative care and hospice in cancer patients. Journal of Palliative Medicine 2016. Online ahead of print. doi:10.1089/jpm.2015.0514.
  2. Coyle, Nessa and Ferrell, Betty R. HPNA Palliative Nursing Manuals: Legal and Ethical Aspects of Care. Ed. Oxford University Press, New York. (2016).


  • Sally Welsh, MSN, RN, NEA-BC, Chief Executive Officer, Hospice and Palliative Nurses Association, Pittsburgh. Phone: (412) 787-9301. Fax: (412) 787-9305. Email: