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Advocacy, an important component of nursing professional practice, is pivotal to ensuring that nurses' experience and insight influence public policy. Understanding how to become engaged and receive training to inform that process can support nurses' professional development. Such engagement ensures that nurses' unique insights inform the policies that affect patient care and professional practice in oncology and beyond.

President Barack Obama announced the launch of the National Institutes of Health Precision Medicine Initiative® (PMI) in January 2015. Precision medicine includes the concept of individualized or personalized medicine at a more exact level through advances in science and technology, such as genetics and genomics sequencing. Although many disease processes will be investigated through the precision medicine lens for greater understanding and improved treatment responses, oncology research and translation to practice is leading the initiative's debut, referred to as the near-term focus.

Objectives: To provide foundational knowledge about approaches to ethical decision-making that arise as part of palliative care of cancer patients and their families., Data Source: Journal articles, research reports, state and federal regulations, professional codes of ethics and state of the science papers., Conclusion: More and more, cancer deaths occur after a long progressive illness, requiring ongoing goals of care discussion and a focus on joint decision-making. No matter how diverse the community or how advanced the healthcare setting, the needs, preferences, and values of the patient and family will continue to be at the core of palliative care., Implications for Nursing Practice: The increasingly complex healthcare environment makes it essential that nurses have an understanding of medical ethics and relevant federal and state laws so that this knowledge can be applied to the many issues arising in palliative and end-of-life care.

Objectives: Access to legal advocacy is an essential tool to help cancer patients and survivors through the continuum of care. This article examines delivery models that can seamlessly integrate into patient navigation programs., Data Sources: Technical reports, books, journal articles, and Web sites., Conclusion: Psychosocial obstacles are common barriers of low-income individuals facing a cancer diagnosis. Legal solutions can help to minimize these obstacles, yet patients rarely have access to these services. Training patient navigators to appropriately screen for legal issues and collaborate with attorneys can be used to help prevent, rather than just react to, legal issues by addressing them as a part of a treatment plan., Implications for Nursing Practice: Attorneys working with patient navigators, particularly nurse navigators, can impact oncology nursing practice by providing an innovative collaboration that is consistent with emerging trends in patient-centered treatment., (Copyright © 2013. Published by Elsevier Inc.)

Genetic advancements have presented numerous discrimination predicaments to individuals, the healthcare community, and legislators at state and federal levels. Oncology nurses should be knowledgeable about the Genetic Information Nondiscrimination Act of 2008 (GINA) and its applications to clinical practice. GINA is the first federal law passed to protect U.S. citizens with inherited disorders from being treated unfairly because of their genetic makeup. Understanding the legislation known as GINA, including how it modifies existing federal laws governing health insurance coverage and employment discrimination, can assist oncology nurses in providing important education and advocating for patients and their extended families. Federal agencies that govern and enforce GINA's provisions are identified. Case situations are included to demonstrate how to apply information concerning GINA to patients with cancer and their families who are considering or have already completed genetic testing. Privacy of genetic information is a timely issue but difficult to understand; therefore, provisions of GINA should be addressed and evaluated carefully.

The experience of receiving patient requests for assistance in prematurely ending life can represent both an ethical and legal dilemma for nurses in the United States. Similarly, the study of nurses' involvement with such a sensitive topic also poses risks to the study participants, the researcher, and the nursing profession's covenant with society. The purpose of this article is to explore methodological issues and approaches associated with studying an ethically and legally sensitive issue, and to describe application of these approaches to a study of oncology nurses' experiences with receiving requests for assisted dying from terminally ill patients with cancer.

Objectives: To examine the role and responsibilities of the nurse as a fact witness and an expert witness in legal proceedings, and provide practical instruction regarding testifying in either capacity., Data Sources: Federal rules, legal literature, and nursing articles., Conclusions: The nursing professional can serve the health care profession and the justice system by participating in the legal process., Implications for Nursing Practice: By participating in the legal process, nurses define and uphold the appropriate standard of care, and in so doing, preserve quality health care.

Objectives: To identify and summarize the legal and ethical issues found in the multiple settings in which oncology nurses practice., Data Sources: Lexis, Medline, Westlaw, federal and state laws, government documents, and nursing and medical textbooks., Conclusions: Oncology nurses face many legal and ethical dilemmas when delivering care. The best defense against litigation is to be knowledgeable about the specific issues found in each setting, the impact these issues have on practice, and requisite risk reduction practices., Implications for Nursing Practice: With the advent of new technology, changing state and federal laws, and new court decisions, the ethical and legal issues nurses will encounter when taking care of cancer patients will not remain the same. Continuing education will be essential if nurses are to remain current, lower their legal liability, and deliver quality care.

Objectives: To identify the legal and ethical issues involved in the detection/monitoring of cancer., Data Sources: Westlaw, Lexis, Medline, and legal and nursing literature., Conclusions: The introduction of genetic predisposition to cancer has increased the legal and ethical issues associated with the detection of cancer., Implications for Nursing Practice: The expanding role of nurses has opened up many exciting new roles in the area of early detection of cancer including genetic counseling. Along with the new opportunities comes increased legal liability and ethical controversies that oncology nurses must be aware of.

Objectives: To provide an introduction to the legal concepts that are involved in negligence suits involving oncology nurses., Data Sources: Medline, Lexis, Westlaw, legal literature and texts., Conclusions: To avoid liability and guard against negligence or malpractice suits, the oncology nurse must be aware of the legal responsibilities of each aspect of the nursing role., Implications for Nursing Practice: Protecting yourself against medical malpractice begins by understanding terms and concepts that are essential in instituting legal action against the nurse and incorporating the appropriate risk reduction practices into daily practice.

Objective: To prepare the oncology nurse, under the Patient Self-Determination Act, to analyze and discuss legal and ethical issues that may arise in the clinical area when end-of-life decisions are made., Data Sources: Nursing textbooks, scholarly articles, court cases, and internet publications., Conclusions: The dying patient has the right to die with dignity, respect, and the right treatment choices., Implications for Nursing Practice: Nurses need to understand how to implement the Patient Self-Determination Act regarding living wills, do not resuscitate orders, euthanasia, and whether or not to use feeding tubes.

Objective: To review the ethical principles of autonomy, nonmaleficence, beneficence, and justice to assist in understanding nursing's ethical obligation to patients and families in the practice of pain management., Data Sources: Position papers, government guidelines, and nursing and legal literature., Conclusion: Cancer pain management has been an issue in nursing and medical practice for more than a quarter of a century. Today we have numerous organisations that focus exclusively on the issue of pain and yet the oncology patient continues to have inadequate pain control., Implications for Nursing Practice: With the acknowledgement that we have the technical skills and the physiological knowledge to reduce pain, yet it is not being done, health care professionals have begun to explore the ethics behind pain.

Objectives: To identify the documentation and communication requirements an oncology nurse should follow to avoid negligence or malpractice suits., Data Sources: Lexis, Medline, Westlaw, nursing and medical literature, and nursing legtal texts., Conclusions: Effective communication and documentation is an essential part of an oncology nurses' role and will reduce the risk of liability., Implications for Nursing Practice: The old adage "not documented, not done" applies more today than ever before. Continuous, meticulous documentation and communication are essential for quality care as well as reduction of liability in every setting the oncology nurse practices.

Little is currently known about the context, nature, or frequency of nurses' responses to patient requests for help in dying. Only two empirical studies have surveyed American nurses about their actual responses to such requests. In one of those studies, 441 New England oncology nurses described how often patients ask them for help in ending their lives and also indicated how often they participated in assisted suicide and patient-requested euthanasia. One hundred and ten of those 441 nurses wrote comments on their returned questionnaires. This article describes the content analysis of those comments. Those oncology nurses who wrote have much to say about caring for patients at the end of life., (Copyright 2001 by W.B. Saunders Company)

A significant number of patients with cancer use or seriously consider using unconventional treatments. When patients or their families seek or use unproven treatment methods, the oncology nurse may face complex professional, legal, and ethical issues. This article addresses the possible reasons why patients and families may choose unconventional treatments. Oncology nurses are challenged to become aware of their many and varied nursing responsibilities. These responsibilities are examined in light of applicable codes and nursing practice standards, the clinical situation, and the values that are unique to each patient and family. Guidelines are offered for the oncology nurse to assist patients and families in choosing among treatment options.

In the current social and legal climate, nurses are increasingly subject to litigation charging professional negligence. A higher professional standing for nursing and a larger role in the decision-making aspects of health care have helped to effect this revolution. There are inherent risks in providing health care that are intensified by the rapid growth in medical technology and complex treatment. Claims brought against nurses have been categorized in studies, and primary causes of patient injury in the healthcare facility are also identified. Using these and other data, areas within cancer nursing that predispose to the risk of increased liability can be anticipated. Issues that are unique to the acute care, ambulatory, or homecare setting in oncology are described. Risk management is a mechanism that addresses the prevention and control of financial loss resulting from claims of negligence. Using risk management concepts, strategies are developed to help the cancer nurse recognize intrinsic dangers and reduce the potential for liability.