Models of care for persons with progressive cancer.

A need exists for a living-dying model that encompasses hospice care and alternative programs of care for the terminally ill. The existing medical and rehabilitative models are focused in directions that do not allow implementation of continuity of care directed toward supporting patients during the plateaus of their illnesses. Today, society has evolved to value the patient as a consumer of health care who can participate through making informed choices among the rich alternatives of care available. Yet the knowledge and technology base of health care delivery today increases at such a rapid rate that it almost seems out of control. This paradox makes it difficult for the patient-consumer to have access to information necessary for involvement in informed decision making. Greater numbers of consumers of health care are active in assuming responsibility for maintaining wellness. At the same time, they are seeking health care programs outside the medical model, as well as within the medical model. The "high-tech" atmosphere has been tempered with an emphasis on humanism, perhaps as a response to the infusion of machinery into our lives. As health care costs have escalated, concern has mounted that health care costs be contained, and that the poor and the elderly not be further curtailed in access to health care resources. There is tremendous potential among nurses for leadership in the creation of services that support quality of life for cancer patients and families. Nurses, as a collective, must be willing to engage in the politics of negotiation for reallocation of health care resources toward person-centered services and to establish a power base for influencing these decisions at the local, state, and national level of government and within various organizations offering health care services. As person-centered services are established, nurses must also move toward formalizing emergent practices into standards of care. Consumers deserve the protection of practice standards that are developed and sanctioned by the profession. It is also critical to test practice, both as it emerges, and after it has been formalized into standards. Nurses must continue to question the tenets of their practice. For example, what are the outcome effects of monitoring and supporting patients during the chronic phase of the living-dying interval? Is either the severity or the number of problems in the terminal phase reduced by these interventions? Changes in the provision of health services in this past decade have been extensive and broadly based.(ABSTRACT TRUNCATED AT 400 WORDS)