Patient control and end-of-life care part I: the advanced practice nurse perspective.
OBJECTIVE
To explore understanding of preferences of adult patients with cancer for control in the context of end-of-life care and to explore strategies that oncology advanced practice nurses (APNs) use to assist patients in achieving personal control at the end of life.


METHODS
Descriptive, naturalistic using Denzin's model of interpretive interactionism.


METHODS
A variety of settings throughout the state of Texas.


METHODS
9 oncology APNs.


METHODS
Participants were recruited via a mailed invitation to APN members of the Oncology Nursing Society who resided in Texas. Interviews were recorded on audiotape and analyzed via Denzin's interpretive process of data analysis.


METHODS
Patient control.


RESULTS
APNs' descriptions of patient preferences for control at the end of life included engagement with living, turning the corner, comfort and dignity, and control over the dying process. APN roles included presenting bad news in a context of choices, managing physical care and emotional needs, and facilitating care services and systems.


CONCLUSIONS
Patient desire for control manifests in a wide variety of actions and desires to live fully and remain actively involved in personal decision making in the context of an advanced cancer diagnosis. APNs play a pivotal role in determining and facilitating patient preferences for control.


CONCLUSIONS
Academic programs to prepare oncology APNs must include attention to communication skills, clinical care needs, and care management strategies for the end-of-life continuum of care. APNs may need to increase efforts to dispel patient and family misperceptions about value and timing of palliative care and hospice services.
Volker
Deborah L
DL
Austin School of Nursing, University of Texas, Austin, TX, USA. dvolker@mail.nur.utexas.edu
Kahn
David
D
Penticuff
Joy H
JH
D000328:Adult; D001293:Attitude to Death; D003657:Decision Making; D005260:Female; D017051:Hospice Care; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology* / Q000628:therapy; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology*; D009859:Oncology Nursing / Q000193:education*; D010361:Patients / Q000523:psychology; D026684:Personal Autonomy; D012297:Right to Die; D013727:Terminal Care; D014342:Truth Disclosure