Research Article| Volume 69, ISSUE 6, P961-968, November 2021

Download started.


American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access

Published:October 25, 2021DOI:


      The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Nursing Outlook
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • African Palliative Care Association
        Standards for providing quality palliative care across Africa.
        2011 (Retrieved from)
        • Ahmed E.
        • Cleary J.
        • DeLima L.
        • Mattfeld E.
        • Pettus K.
        • Radbruch L.
        • Rajagopal M.R.
        Global availability of internationally controlled medicines – Briefing Note.
        Global Palliative Care and Covid-19 Series. 2020; (Retrieved from)
      1. American Nurses Association & Hospice & Palliative Nurses Association. (2017). Call for action: Nurses lead and transform palliative care.Retrieved from

        • Arya A.
        • Buchman S.
        • Gagnon B.
        • Downar J.
        Pandemic palliative care: beyond ventilators and saving lives.
        CMAJ. 2020; 192: E400-E404
        • Cerni J.
        • Rhee J.
        • Hosseinzadeh H.
        End-of-life cancer care resource utilisation in rural versus urban settings: A systematic review.
        International Journal of Environmental Research and Public Health. 2020; 17: 4955
        • Ciruzzi S.
        • Comoretto N.
        • Hain R.
        • Jennings B.
        • Pettus K.
        • Radwany D.
        • Schwartz L.
        Bio-ethical principles, Practices, and recommendations relevant to the COVID-19 pandemic – Briefing Note.
        Global Palliative Care and Covid-19 Series. 2020; (Retrieved from)
        • Clark D.
        • Baur N.
        • Clelland D.
        • Garralda E.
        • López-Fidalgo J.
        • Connor S.
        • Centeno C.
        Mapping levels of palliative care development in 198 countries: The situation in 2017.
        Journal of Pain and Symptom Management. 2020; 59: 794-807.e4
        • Connor S.R.
        • Downing J.
        • Marston J.
        Estimating the global need for palliative care for children: A cross-sectional analysis.
        Journal of Pain and Symptom Management. 2017; 53: 171-177
        • Connor S.R.
        Global atlas of palliative care.
        2nd ed. 2020 (Retrieved from)
        • Dahlin C.
        • Coyne P.J.
        • Ferrell B.R
        Advanced practice palliative nursing.
        Oxford University Press, New York, NY2016
        • Daniels A.
        • Downing J.
        Increasing access to children's palliative care education through e-learning: a review of the ICPCN experience.
        International Journal of Palliative Nursing. 2018; 24: 351-358
      2. Downing J., Ben Gal, Y., Daniels, A., Kiwanuka, R., Lin, M., Ling, J., …Yaters, P. (2020). “Leaving no one behind”: Valuing and strengthening palliative nursing in the time of COVID-19 – Briefing Note. Global Palliative Care and Covid-19 Series. Retrieved from

        • Downing J.
        • Leng M.
        • Grant L.
        Implementing a palliative care nurse leadership fellowship program in Uganda.
        Oncology Nursing Forum. 2016; 43: 395-398
        • Elbaum A.
        Black lives in a pandemic: Implications of systemic injustice for end-of-life care.
        The Hastings Center Report. 2020; 50: 58-60
        • Elk R.
        • Emanuel L.
        • Hauser J.
        • Bakitas M.
        • Levkoff S.
        Developing and testing the feasibility of a culturally based tele-palliative care consult based on the cultural values and preferences of southern, rural African American and white community members: A program by and for the community.
        Health Equity. 2020; 4: 52-83
        • Emanuel L.
        • Solomon S.
        • Fitchett G.
        • Chochinov H.
        • Handzo G.
        • Schoppee T.
        • Wilkie D.
        Fostering existential maturity to manage terror in a pandemic.
        Journal of Palliative Medicine. 2020; (Advance online publication)
        • Ferrell B.R.
        • Coyle N.
        The nature of suffering and the goals of nursing.
        Oxford University Press, New York, NY2008
        • Ferrell B.R.
        • Handzo G.
        • Picchi T.
        • Puchalski C.
        • Rosa W.E.
        The urgency of spiritual care: COVID-19 and the critical need for whole-person palliation.
        Journal of Pain and Symptom Management. 2020; S0885-3924 (Advance online publication): 30578-30579
        • Ferrell B.R.
        • Paice J.A
        Oxford textbook of palliative nursing.
        5th ed. Oxford University Press, New York, NY2019
        • Harding R.
        • Ciruzzi M.S.
        • Downing J.
        • Hunt J.
        • Morris C.
        • Rosa W.
        Palliative care for LGBT+ people in the time of COVID-19 – Briefing Note.
        Global Palliative Care and Covid-19 Series. 2020; (Retrieved from)
        • Harrop E.
        • Mann M.
        • Semedo L.
        • Chao D.
        • Selman L.E.
        • Byrne A.
        What elements of a systems' approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19.
        Palliative Medicine. 2020; 34: 1165-1181
        • Hawkins-Taylor C.
        • Mollman S.
        • Walstrom B.
        • Kerkvliet J.
        • Minton M.
        • Anderson D.
        • Berke C.
        Perceptions of palliative care: Voices From rural South Dakota.
        The American Journal of Hospice & Palliative Care. 2020; (Advance online publication)
        • Helton G.
        • Wolfe J.
        • Snaman J.M.
        Definitely mixed feelings: The effect of COVID-19 on bereavement in parents of children who died from cancer.
        Journal of Pain and Symptom Management. 2020; S0885-3924 (Advance online publication): 30722-30723
        • Horesh D.
        • Brown A.D.
        Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities.
        Psychological Trauma. 2020; 12: 331-335
        • Indian Directorate General of Health Services, Ministry of Health & Family Welfare
        Proposal of strategies for palliative care in India.
        2012 (expert group report). Retrieved from
      3. International Council of Nurses (ICN). (2020a). Nurses: A voice to lead: Nursing the world to health.Retrieved from

        • International Council of Nurses (ICN)
        ICN position statement: Nurses’ role in providing care to dying patients and their families.
        2012 (Retrieved from)
        • International Council of Nurses (ICN)
        The ICN Code of ethics for nurses.
        2012 (Rev. 2012). Retrieved from)
        • International Council of Nurses (ICN)
        ICN position statement: Nurses and human rights.
        2011 (Retrieved from)
        • Kidd J.
        • Black S.
        • Blundell R.
        • Peni T.
        Cultural health literacy: the experiences of Māori in palliative care.
        Global Health Promotion. 2018; 25: 15-23
        • Knaul F.M.
        • Farmer P.E.
        • Krakauer E.L.
        • De Lima L.
        • Bhadelia A.
        • Jiang K.
        • Rajagopal M.R.
        • Lancet Commission on Palliative Care and Pain Relief Study Group
        Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report.
        Lancet. 2018; 391: 1391-1454
        • Li Z.
        • Ge J.
        • Yang M.
        • Feng J.
        • Qiao M.
        • Jiang R.
        • Yang C.
        Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control.
        Brain, Behavior, and Immunity. 2020; 88: 916-919
        • Malloy P.
        • Davis A.
        Nursing education.
        in: Ferrell B.R. Paice J.A. Oxford textbook of palliative nursing. 5th ed. Oxford University Press, New York, NY2019: 844-854
        • Malloy P.
        • Ferrell B.
        • Virani R.
        • Mazanec P.
        Promoting palliative care internationally: building leaders to promote education, practice, and advocacy.
        Journal of Pain and Symptom Management. 2018; 55: S140-S145
        • Morris S.E.
        • Moment A.
        • Thomas J.D.
        Caring for bereaved family members during the COVID-19 pandemic: before and after the death of a patient.
        Journal of Pain and Symptom Management. 2020; 60: e70-e74
        • Noordman J.
        • van Vliet L.
        • Kaunang M.
        • van den Muijsenbergh M.
        • Boland G.
        • van Dulmen S.
        Towards appropriate information provision for and decision-making with patients with limited health literacy in hospital-based palliative care in Western countries: a scoping review into available communication strategies and tools for healthcare providers.
        BMC Palliative Care. 2019; 18: 37
        • Pettus K.
        • Cleary J.F.
        • de Lima L.
        • Ahmed E.
        • Radbruch L.
        Availability of internationally controlled essential medicines in the COVID-19 pandemic.
        Journal of Pain and Symptom Management. 2020; 60: e48-e51
        • Pettus K.
        • De Lima L.
        • Chambaere K.
        • Chassagne A.
        • Mutch M.
        • Riegler E.
        • Rajagopal M.R.
        Vulnerable populations in Covid-19: Palliative care for detainees in custodial settings – Briefing Notes.
        Global Palliative Care and Covid-19 Series. 2020; (Retrieved from)
        • Puchalski C.
        • Bauer R.
        • Ferrell B.
        • Abu-Shamsieh K.
        • Chan N.
        • Delgado-Guay M.
        • Vandenhoeck A.
        Interprofessional spiritual care in the time of COVID-19 – Briefing Note.
        Global Palliative Care and Covid-19 Series. 2020; (Retrieved from)
        • Radbruch L.
        • De Lima L.
        • Knaul F.
        • Wenk R.
        • Ali Z.
        • Bhatnaghar S.
        • Pastrana T.
        Redefining palliative care-a new consensus-based definition.
        Journal of Pain and Symptom Management. 2020; S0885-3924 (Advance online publication): 30247
        • Radbruch L.
        • Knaul F.M.
        • de Lima L.
        • de Joncheere C.
        • Bhadelia A.
        The key role of palliative care in response to the COVID-19 tsunami of suffering.
        Lancet. 2020; 395: 1467-1469
        • National Coalition for Hospice and Palliative Care
        Richmond VA Clinical practice guidelines for quality palliative care. 4th ed. National Coalition for Hospice and Palliative Care, 2018
        • Roodbeen R.
        • Vreke A.
        • Boland G.
        • Rademakers J.
        • van den Muijsenbergh M.
        • Noordman J.
        • van Dulmen S.
        Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers and suggestions for improvement reported by hospital-based palliative care providers.
        PloS One. 2020; 15e0234926
        • Rosa W.E.
        • Gray T.F.
        • Chow K.
        • Davidson P.M.
        • Dionne-Odom J.N.
        • Karanja V.
        • Meghani S.H.
        Recommendations to leverage the palliative nursing role during COVID-19 and future public health crises.
        Journal of Hospice and Palliative Nursing. 2020; 22: 260-269
        • Rosa W.E.
        • Pettus K.I.
        • De Lima L.
        • Silvers A.
        • Sinclair S.
        • Radbruch L.
        Top ten tips palliative clinicians should know about evidence-based advocacy.
        Journal of Palliative Medicine. 2021; (Advance online publication)
        • Rosa W.E.
        • Hannaway C.J.
        • McArdle C.
        • McManus M.F.
        • Alharahsheh S.T.
        • Marmot M.
        Nurses for health equity: Guidelines for tackling the social determinants of Health.
        World Innovation Summit for Health, Qatar, UAE2021 (Retrieved from)
        • Rosa W.E.
        • Krakauer E.L.
        • Farmer P.E.
        • Karanja V.
        • Davis S.
        • Crisp N.
        • Rajagopal M.R.
        The global nursing workforce: realising universal palliative care.
        The Lancet Global Health. 2020; 8: e327-e328
        • Rosa W.E.
        • Schlak A.E.
        • Rushton C.H.
        A blueprint for leadership during COVID-19.
        Nursing Management. 2020; 51: 28-34
        • Rushton C.H.
        Moral resilience: Transforming moral suffering in healthcare.
        Oxford University Press, New York, NY2018
        • American Nurses Association (ANA)
        Silver Spring Code of ethics for nurses with interpretive statements. 2nd ed., MD2015
        • Skinner E.
        • Colclough A.
        • Downing J.
        • Harding R.
        • Luyirika E.
        • Palat G.
        • Rosa W.
        Palliative care for those experiencing homelessness in the time of COVID-19 – Briefing Note.
        Global Palliative Care and Covid-19 Series. 2020; (Retrieved from)
        • Sleeman K.E.
        • de Brito M.
        • Etkind S.
        • Nkhoma K.
        • Guo P.
        • Higginson I.J.
        • Gomes B.
        • Harding R.
        The escalating global burden of serious SHS: projections to 2060 by world regions, age groups, and health conditions.
        The Lancet Global Health. 2019; 7: e883-e892
        • United Nations (UN)
        Political declaration of the high-level meeting on universal health coverage.
        Universal health coverage: moving together to build a healthier world. 2019; (Retrieved from)
        • United Nations (UN)
        Transforming our world: The 2030 agenda for sustainable development.
        2015 (Retrieved from)
        • United Nations Office of the High Commissioner for Human Rights
        International covenant on economic, social and cultural rights.
        1966 (Retrieved from)
        • Wallace C.L.
        • Wladkowski S.P.
        • Gibson A.
        • White P.
        Grief during the COVID-19 pandemic: Considerations for palliative care providers.
        Journal of Pain and Symptom Management. 2020; 60: e70-e76
        • World Health Organization (WHO)
        State of the world's nursing 2020: investing in education, jobs and leadership.
        2020 (Retrieved from)
      4. World Health Organization (WHO). (2020b). Palliative care: key facts. Retrieved from

        • World Health Organization (WHO)
        Strengthening of palliative care as a component of integrated treatment within the continuum of care.
        2014 (Retrieved from)
        • World Health Organization (WHO)
        Integrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers, and managers.
        2018 (Retrieved from)
        • World Health Organization (WHO)
        Integrating palliative care and symptom relief into paediatrics: a WHO guide for health care planners, implementers and managers.
        2018 (Retrieved from)