Prognostication in advance cancer: nurses' perceptions of the dying process.

PURPOSE/

OBJECTIVES

To determine how experienced nurses describe the dying process of patients with advanced cancer.

SAMPLE/

SETTING

Fifteen nurses, experienced in the care of patients with advanced cancer, employed by a midsize midwestern hospice or academic inpatient oncology unit.

METHODS

Individual interviews using structured and semi-structured questions. Responses were content-analyzed using Krippendorff's techniques.

MAIN RESEARCH VARIABLE: Dying process in cancer.

FINDINGS: Nurses view the dying process as a weeks-to-months-long, multidimensional process that encompasses physical, psychosocial, and spiritual/existential domains. Impending death is recognized and monitored. Common clinical signs include declining interest in life, increased weakness, somnolence, and changes in respiratory, circulatory, and cognitive status.

CONCLUSIONS

Active (or acute) dying processes are recognized and monitored by nurses; the complexities and patterns of the phenomenon remain unarticulated.

IMPLICATIONS FOR NURSING: Future research could explore both empirical and contextual aspects of acute dying processes. Nurses are in a position to develop useful knowledge about acute dying processes in cancer.