Ethical issues in caring for the patient with advanced cancer.

The patient in the advanced stages of cancer presents many challenges for the nurse caregiver. To care for the patient effectively as the end of life approaches requires a shift in focus from cure or treatment of the disease to the management of the associated symptoms. This is the primary goal of palliative care, a unique approach to meeting the needs of this vulnerable patient group. The clinical issues that are common in the care of the patient with advanced cancer may raise specific ethical concerns for the nurse. Managing the symptoms with the goal of palliative care in mind will help to frame these concerns more clearly. Communicating with patients and families on an ongoing basis in a clear and sensitive manner will help to ensure that patients' decisions are known and respected. Nurses need to be prepared to assist in these difficult situations. A nursing ethics group is one method that has been found to be effective in developing nurses' expertise in this area.