Addressing patients' end-of-life needs: the role of the oncology nurse.

The purpose of this qualitative study was to explore oncology nurses’ experiences of requests for assisted dying from patients with cancer at the end stage of disease. Nurses who identified themselves as direct care providers or clinical nurse specialist members of the Oncology Nursing Society were asked to submit a written account or story of receiving a request for assistance in dying from a patient with advanced cancer with a limited life expectancy. Forty oncology nurses submitted 48 stories that were analyzed using Denzin’s process of interpretive interactionism. The majority of the participants were master’s prepared females with a mean age of 45 and a mean of 14 years in oncology. Four main themes and 11 subthemes emerged from the data analysis of the 48 stories. The first main theme was control. Subthemes for control were cry for help, hastening the process, what if, managing the morphine, and countering with palliative care. Patient and family requests often were attempts to control intense pain, suffering, and the dying process. Many nurses responded by offering palliative care or hospice referrals. The second main theme was conflict. Subthemes for conflict were a collision of values and sense of distress. Nurses described a sense of uncertainty and distress in receiving requests for assisted dying because of their conflict between meeting the patient and family needs and maintaining their professional values. The third main theme was covert communication. Subthemes for covert communication were the dialogue around the request and the silent knowing. Nurses described communication with family members regarding assisted dying as covert, perplexing, and complex. The fourth main theme was enduring influence. The subthemes for enduring influence were the unforgettable and reflections on lessons learned. Nurses described the lasting impact that requests for dying had on their personal and professional lives. Some expressed a change in values and felt they would be more comfortable in meeting patient and family requests for assisted dying in the future.