Cancer Patient Perceptions of Nurse Abandonment at End of Life

Abstract

Purpose: The purpose of this qualitative descriptive study was to explore cancer patient perceptions of oncology nurse abandonment near end of life (EOL). Background: The EOL period represents a challenging time for cancer patients as they face significant physical and emotional losses, including the loss of their oncology healthcare team during EOL handoffs in care. The loss of the physician-patient relationship, as well as alterations in this relationship, has led to cancer patient perceptions of physician abandonment. Feelings of abandonment can have negative implications for quality EOL cancer care, such as serving as a deterrent to enrollment in palliative care programs, potentially inhibiting advanced care planning discussions, and causing shock and distress. There has been no known research exploring cancer patient perceptions of nurse abandonment near EOL. Theory: Bowlby’s attachment theory and Peplau’s theory of interpersonal relations in nursing provide a foundation for this research. A new tentative model for understanding the complex oncology nurse-patient relationships near EOL is also proposed. Methods: Qualitative descriptive methodology was employed with data collection consisting of semi-structured interviews and written field notes. A total of nine participants with advanced cancer were enrolled in and completed the study. Data analysis occurred through qualitative content analysis. Results: The overarching theme woven throughout the narratives was “Good Communication Fosters Nurse-Patient Relationships.” Three additional themes emerged from this main theme: 1) “Valuing the Professional Relationship;” 2) “Embracing the Personal Relationship;” and 3) “An Unimaginable Termination” Patients with advanced cancer near EOL experienced feelings of safety, security, and comfort from the professional and personal aspects of their relationships with their oncology nurses. They did not perceive being abandoned by their oncology nurses, nor did they anticipate being abandoned in the future. Discussion: Perceptions of abandonment near EOL may be mitigated through good communication techniques that are representative of patient-centered communication. Fostering strong nurse-patient relationships by promoting professional closeness as well as feelings of personal closeness through mutual sharing should be considered. Strategies for remaining connected with patients even after face-to-face visits have ceased should also be incorporated into the nursing care of patients with advanced cancer.