Is It Time to Rethink the Bell Ringing Ceremony in Cancer Care?

Two nurse leaders are spearheading efforts to make the traditional bell-ringing ceremony in cancer care an occasion that celebrates all patients.

Lindsey Zinck, PhD, RN, OCN, NEA-BC, who is the Chief Nursing Office at Abramson Cancer Center and Melania Zisa, RN, BSN, OCN, who is an infusion supervisor at Penn Presbyterian Medical Center in Cherry Hill, have both helped launch an initiative to redefine the bell and what it means for patients.

“Everyone is on their own disease journey,” Zinck and Zisa said in a presentation on their experience during the Oncology Nursing Society (ONS) Bridge. “All patients should have the opportunity to ring loud and proud.”

Why the bell?

As the nurses explained in the presentation, The University of Texas MD Anderson Cancer Center is credited with having begun the bell ringing tradition. U.S. Navy Rear Admiral Irve Le Moyne, who was undergoing treatment for his head and neck cancer, installed a brass bell in the Radiation Treatment Center, with the following words:

The tradition began in the radiation setting. However, over time, many people have begun to assume that the tradition began in the infusion areas, as it spread quickly to the infusion setting and has received a large amount of attention in this setting. According to Zisa, it is now almost more popular in infusion suites because of social media, word of mouth among family/friends.

What is the problem?

Unfortunately, the bell can be distressing for some patients. Consider, for example, individuals who will be on maintenance therapy for life, or those who stop active treatment and progress onto end-of-life treatment or hospice care. These patients will never get to ring the bell in the traditional sense that other patients will. For some of these individuals, public bell ringing can serve as a reminder of that reality.

Many institutions have opted to forego traditional bell ringing ceremonies to show sensitivity for these patients. However, some individuals really look forward to their bell ringing, and according to Zinck and Zisa, these individuals should have the opportunity to celebrate the conclusion of their treatment in a symbolic way.

“From the moment many patients start infusion treatments, they are planning their own bell ringing ceremony and deciding which family and friends they should have there,” Zisa said.

Potential Answers

Melania Zisa, RN, BSN, OCN

Therefore, the pair sought to redefine the bell ringing ceremony at their organization. The initiative was nurse-led. In the flagship campus, in Philadelphia, nurses hung bells in all the infusion floors, accompanied by new reasons for bell ringing, such as starting a new treatment, finishing a first round of treatment, or to sound the joy of an improved scan.

Lindsey Zinck, PhD, RN, OCN, NEA-BC

Zinck shared that prior to this initiative, their organization was not sure if they would be able to continue to use the bells since the ceremonies had become controversial. Many of their bells were gifts from former patients, so finding a way to continue to use them has been important to the staff.

The Cherry Hill satellite infusion center is much smaller. Here, their single brass bell has been relocated outside of the infusion suite next to a mural called the “Wall of Hope,” which is covered in a painting of trees, ribbons, flowers, and the word “HOPE.”

The examples encourage patients to ring when they have a good scan or good lab result, when they have ended chemotherapy, and when they are about to start or change a regimen. Most importantly, while patients can still ring to mark the end of their treatment, they are now encouraged to ring the bell at any point along their disease journey.

“Organizations for not need to all together eliminate bell ringing ceremonies, as all types of patients can benefit from these ceremonies,” Zinck concluded. “Organizations should consider unique efforts to redefine the bell to promote inclusivity and sensitivity to patients.”

Reference

Zinck L, Zisa M. Re-defining The Bell: Recognizing Milestone. Presented at: Oncology Nursing Society Bridge. September 13-15, 2022; virtual.