Episode 440: Reframing Death in Terminal Cancer Care

"Patients often fear that when the treatment stops, the caring will stop as well. It is so important to remind the patients we're serving that we're not stopping the care. We're just changing our focus and prioritizing things differently. We're still treating pain, we're managing symptoms, and we're helping them achieve the goals that matter most to them. The care doesn't go away. In many ways, it becomes even more personalized and supportive," ONS member Julia Proshwitz, BSN, RN, OCN®, NPD–BC, clinical educator of inpatient and outpatient oncology services, infusion, and vascular access at Corewell Health in Saint Joseph, MI, told Madeline Johnston, MSN, RN, OCN®, oncology clinical specialist at ONS, during a conversation about reframing death in terminal cancer care.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by November 6, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to caring for people with terminal cancer.

• Complete this evaluation for free NCPD.
• ONS Podcast™ episodes:
  • Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care
  • Episode 257: Redefining the Bell: The Ethics of Hope for Oncology Nurses and Patients
  • Episode 251: Palliative Care Programs for Patients With Cancer
  • Episode 135: ELNEC Has Trained More Than One Million Nurses in End-of-Life Care
• ONS Voice articles:
  • By Fulfilling 49 Patient Wishes, One Unit Improves Both EOL Care and Healthcare Workers' Well-Being
  • Communication Is Essential to End-of-Life Choices
  • End-of-Life Care Helps Patients Pursue Purpose in the Presence of Pain
  • When the Story Ends, Cancer Does Not Win: Reframing Death in Terminal Cancer Care
  • Writing Condolence Cards Supports Nurses as Well as Deceased Patients' Families
• Clinical Journal of Oncology Nursing articles:
  • Clinical Oncology Nurse Best Practices: Palliative Care and End-of-Life Conversations
  • Elevating End-of-Life Care: Implementing General Inpatient Hospice Services on a Medical Oncology Unit
  • Enhancing Nurses' Comfort and Capability With End-of-Life Care for Patients With Cancer
  • Promoting End-of-Life Care and Healthcare Worker Well-Being: Implementing the 3 Wishes Project in an Oncology Intensive Care Unit
• Oncology Nursing Forum article: Exploring Information Needs of Patients With Cancer and Family Caregivers: A Descriptive and Network Analysis of End-of-Life Inquiries
• ONS Huddle Card: Palliative and Hospice Care
• Being Mortal by Atul Gawande
• Center to Advance Palliative Care: Palliative Care in Cancer Care
• End-of-Life Nursing Education Consortium: Resources

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

"Cancer isn't always something that people can overcome and it's not always with determination alone. There are many patients who can do everything right. They've showed up with incredible courage, they've never missed a treatment, and their cancer still progresses. When we only talk about cancer as a battle, we risk creating this idea that people win or lose based on effort, and that's just not how cancer works. Personally, I prefer following the patient's lead. If they see themselves as a fighter, I'll meet them there. And if they see it differently, that's okay too. ... If we look at cancer care as a tally mark of wins and losses, we lose the person and the experience. And it really should be about them." TS 2:06

"A lot of times, patients will ask nurses those difficult questions—the ones they don't want to ask anyone else. And sometimes it's because they trust us. Sometimes it's because the person sitting beside them after everyone else leaves the room has just given them that space to feel like they are having a private moment. And sometimes it's just because they feel vulnerable and really want to dig into that piece of discovery for their journey. As nurses, we're able to help translate some of those complex medical terms, but we're also there to listen. And sometimes listening is the most important thing we can do. There is truly so much power that can be discovered in silence and just being present with someone." TS 5:27

"I've learned that some of the most important questions have nothing to do with clinical jargon or medicine at all. Asking, 'What's most important to you right now?' 'What are you hoping for today or in the near future?' or 'What does a good day look like for you?'... Those questions can tell us so much more. It's like opening a book to their present story. This is a huge chapter in their life, and we really want to understand those components. ... That vulnerable nature of being able to just completely be a person with them and not just a clinician, is a huge part of how we can arrive for the patients we care for." TS 11:53

"I've found that at the end of life, most patients aren't talking about test results, scans, lab values, and the treatment they received. They're talking about those relationships and memories, finding forgiveness and joy, the legacy they're leaving behind, and really understanding the meaning of their life, their journey, how people have impacted them, and how they've impacted others. Cancer may always be part of their story, but it never has to be their whole story." TS 18:02

"Our goal is not simply to help people live longer. Our goal is to help people live well in oncology. ... I have learned over and over again that a person's life is not defined by their diagnosis, and it's certainly not defined by whether their cancer was cured. … As healthcare professionals, we may not always be able to change the outcome, but we can always influence the experience. We can help patients feel heard, respected, comforted, and valued. At the end of the day, I believe end-of-life care is really about honoring the person in front of us. When we do that well, we're not just caring for a patient. We're helping to preserve dignity, meaning, and humanity during one of life's most profound transitions. A successful cancer journey isn't always measured by survival. Sometimes it's measured by how well we help someone to live, love, and find meaning all the way to the end." TS 25:18