End-of-Life Conversations: ‘When They Open the Door, You Have to Go In’

Oncology nurses have a unique relationship with patients that allows for difficult but essential end-of-life conversations, says expert Patricia Jakel, MN, RN, AOCN.

Jakel, one of the editors in chief of Oncology Nursing News, emphasized that following up with patients and ascertaining what answers and support they need comes with the close bonds that oncology nurses form with patients with cancer.

When a patient initiates a conversation to discuss the realities of end-of-life care and plans, Jakel added, it is part of the nurse’s role to engage in these discussions and find ways to provide empathetic care.

While these conversations can often be emotional, Jakel stressed the importance of putting in effort to have those conversations, even when difficult, and recognizing that patients place their trust in oncology nurses.

Transcript

We play an important role. We’re the person that establishes trust. So nurses are always in your intimate space, taking care of you, starting your IV, accessing your port, doing your dressing change, sitting by your bedside to talk about the side effects of chemotherapy.

I think there’s a level of intimacy that other health care workers don’t seem to establish—and I’ve even seen it with the [medical assistants] and the care partners in the hospital, because they’re really taking care of you—so I think there is…that bond that happens.

We play a really important role. And sometimes patients ask us difficult questions, and we have to be prepared for it. I remember a lovely young patient I had, she had 2 little girls, and she was very sick. And things weren’t going well for her in the hospital, and she just—she looked up at me and she said, “Am I dying today?”

And I thought, “She’s opening the door. She needs to have this conversation.” And I said, “It’s not going to be today, but I think it’s going to be soon.”

And she kind of chuckled, because her sister was at the bedside, and she said to her sister, “I need my makeup done. I want my makeup on today, if today’s not the day.” And that took us to a whole conversation about what dying would look like for her.

So when a patient opens the door, don’t be afraid. And I had a nursing student one time that had the conversation with this young gentleman who had sarcoma, and the nursing student was in with the conversation, and the doctor left, and she was there, and the patient goes, “Well, what do you think? I’m dying.”

And she goes, “I don’t know.” And she ran out of the room, and she came into my office crying, and she said, “I didn’t do that right.”

And I said, “Let’s go back. Let’s have a conversation with him.” And we did go back, had the conversation, all 3 of us ended up crying.

But when they open the door, you have to go in. And if you don’t feel comfortable at that moment, please, please go back and have that conversation. It’s really important.

This transcript has been edited for clarity and conciseness.