Advanced practice nurse-led early palliative care: a novel model for improved access to care

Sep 24, 2026

Uploaded by Jake

Early palliative care benefits in advanced cancers are well established, yet access remains limited and uptake is low. Barriers include provider attitudes, absence of a standardized referral approach, policy misalignment that constrains resources, and insufficient palliative care expertise. The article describes the development and implementation of an early palliative care initiative at CancerCare Manitoba, detailing planning, processes, teams, and interventions to support others delivering similar care. It discusses barriers, facilitators, and mitigation strategies, concluding that the model improved access with pre/post implementation data reported in a future publication.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Rationale for early palliative care in advanced cancer

Barriers and low uptake

Rationale for a nurse-led initiative

Methods/Initiative Description

Clinical Nurse Specialist scope and model purpose

Ethical considerations

Supportive Care in Cancer (2025) 33:168 [https://doi.org/10.1007/s00520-025-09193-3](https://doi.org/10.1007/s00520-025-09193-3) Advanced practice nurse‑led early palliative care: a novel model for improved access to care Stephanie Lelond1,2 · Christina A. Kim1,3,4 Received: 25 April 2024 / Accepted: 21 January 2025 / Published online: 10 February 2025 © The Author(s) 2025 Abstract Background Although the benefits of early palliative care have been established in advanced cancers, there remains a lack of access to and poor uptake of these services. Barriers include healthcare provider attitudes, lack of standardized referral approach, misaligned policy limited resources, and lack of palliative care expertise. Purpose In consideration of these barriers, a description of the development and implementation of an early palliative care initiative at CancerCare Manitoba in Canada is presented. Explanations of innovative planning, processes, teams, and interventions are offered to facilitate insight for those intending to offer early palliative care. Discussion Barriers and facilitators to integrating a nurse-led early palliative care initiative are discussed. Considerations to mitigate common barriers encountered and leveraging existing resources are offered. Conclusions This information may be beneficial to those working to facilitate access to palliative care in oncology for patients with advanced cancers. This model has been successful at our institution with pre and post implementation data presented in an upcoming publication. Keywords Early palliative care · Model of care · Palliative oncology · Integrated palliative care · Nurse-led care · Advanced cancer · Clinical Nurse Specialist Introduction Cancer prevalence is expected to increase with many of these cancers being of an advanced and incurable stage [1, 2] . During post COVID-19, many healthcare systems are struggling with human resources and health service reductions, and subsequent backlogs have led to a delay in the diagnosis and treatment of cancers [3, 4] . Advanced cancers have been disproportionately affected, with 69% of patients with metastatic cancer reporting that their appointments had been cancelled, postponed, or rescheduled, compared * Stephanie Lelond Slelond2@cancercare.mb.ca 1 CancerCare Manitoba, Winnipeg, MB, Canada 2 College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada 3 Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada 4 Section of Medical Oncology and Haematology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada to only 50% of patients with earlier-stage cancers [5] . Waiting longer to be seen and receive care may be especially challenging for those with advanced cancers [6], particularly for those dealing with a heavy symptom burden and rapid disease progression [7–9] . An early palliative care (EPC) intervention for those with advanced cancers can facilitate timely access to diagnostics to guide discussions around prognosis, treatment options, and goals of care. Palliative care is a multidisciplinary approach to care, with a focus on patient and family-centred care and quality of life for those diagnosed with a life-limiting illness [10], however, is typically only accessed in the final days or weeks of life in Canada [11], after treatment options have been exhausted [12] . Randomized studies have shown that earlier introduction of palliative care, EPC, improves the quality of life and symptom burden, reduces health care costs, and can improve overall survival [13–17]. The American Society of Clinical Oncology clinical practice guidelines recommend that for patients with advanced cancer, referral for specialist palliative care services should occur within 8 weeks of diagnosis and should be provided alongside standard oncologic care [18] . However, several barriers exist to a

FAQs

What barriers limit early palliative care access in advanced cancers?

Barriers include healthcare provider attitudes, lack of standardized referral approaches, policy-related limits on resources, and insufficient palliative care expertise.

What is the purpose of the initiative described in the article?

The article presents how CancerCare Manitoba developed and implemented an early palliative care initiative, explaining planning, processes, teams, and interventions to guide others.

How does the nurse-led model aim to improve access to palliative care?

It uses a Clinical Nurse Specialist-led approach to provide early palliative care and address common barriers to integration, leveraging existing resources.

Sep 24, 2026

Uploaded by Jake