Oncology nurses' experiences with requests for assisted dying from terminally ill patients with cancer.
OBJECTIVE
To explore oncology nurses' experiences with receiving requests for assisted dying from terminally ill patients with cancer.


METHODS
Descriptive, naturalistic.


METHODS
RNs who identified themselves as direct care providers or clinical nurse specialist members of the Oncology Nursing Society.


METHODS
40 oncology nurses who responded to a randomized, sequential direct mailing submitted 48 stories for analysis.


METHODS
Anonymously submitted written stories analyzed using Denzin's process of interpretive interactionism.


METHODS
The experience of receiving a request for assisted dying.


RESULTS
Four main themes emerged from the thematic analysis: Control, Conflict, Covert Communication, and the Enduring Influence. Eleven subthemes included the Cry for Help, Hastening the Process, What if, Managing the Morphine, Countering With Palliative Care, Collision of Values, Sense of Distress, Dialogue Around the Request, Silent Knowing, the Unforgettable, and Reflections on Lessons Learned.


CONCLUSIONS
Experiences included a mixture of direct-patient and family requests for pain relief, anticipatory fear of future pain, desire to end life before unacceptable deterioration, family requests to hasten the dying trajectory, and others. Stories reflected the larger societal struggle with desires to control life, health, and the dying process.


CONCLUSIONS
Nurses should be prepared to respond to such requests in a compassionate and helpful way that is respectful of both the patient's and the nurse's personal values. Diversity of individual values and priorities may trigger some patients to seek assistance in controlling the timing and circumstances of death. Thus, continued study of nurse, patient, and family member experiences with this ethical dilemma is warranted.
Volker
D L
DL
School of Nursing, University of Texas in Austin, USA. dvolker@mail.nur.utexas.edu
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D003142:Communication; D003220:Conflict, Psychological; D003625:Data Collection; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D009723:Nurse-Patient Relations; D017236:Suicide, Assisted; D013727:Terminal Care; D014481:United States
D000701:Analgesics, Opioid; D009020:Morphine