Prognostication in Advanced Cancer: Nurses' Perceptions of the Dying Process

Nancy Dendaas

ONF 2002, 29(3), 493-499. DOI: 10.1188/02.ONF.493-499

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.

Jump to a section


    Adams, P.J., & Nichols, B.S. (1996). An exploration of the nursing diagnosis terminal syndrome. Nursing Diagnosis, 7, 135--140.

    Addington-Hall, J.M., MacDonald, L.D., & Anderson, H.R. (1990). Can the Spitzer quality-of-life index help to reduce prognostic uncertainty in terminal cancer? British Journal of Cancer, 62, 695--699.

    Angell, M. (1985). Disease as a reflection of the psyche. New England Journal of Medicine, 312, 1570--1572.

    Bruera, E., Miller, M.J., Kuehn, N., MacEachern, T., & Hanson, J. (1992). Estimate of survival of patients admitted to a palliative care unit: A prospective study. Journal of Pain and Symptom Management, 7, 82--86.

    Buchan, J.E. (1995). Nurses' estimation of patients' prognoses in the last days of life. International Journal of Palliative Nursing, 1, 12--16.

    den Daas, N. (1995). Estimating length of survival in end-stage cancer: A review of the literature. Journal of Pain and Symptom Management, 10, 548--555.

    Evans, C., & McCarthy, M. (1985). Prognostic uncertainty in terminal care: Can the Karnofsky index help? Lancet, 1, 1204--1206.

    Forster, L.E., & Lynn, J. (1988). Predicting lifespan for applicants to inpatient hospice. Archives of Internal Medicine, 148, 2540--2543.

    Forster, L.E., & Lynn, J. (1989). The use of physiologic measures and demographic variables to predict longevity among inpatient hospice applicants. American Journal of Hospice Care, 6(2), 31--34.

    Furman, J., & McNabb, D. (1997). The dying time: Practical wisdom for the dying and their caregivers. New York: Bell Tower.

    Hampe, S.O. (1975). Needs of the grieving spouse in a hospital setting. Nursing Research, 24, 113--119.

    Heyse-Moore, L.H., & Johnson-Bell, V.E. (1987). Can doctors accurately predict the life expectancies of patients with terminal cancer? Palliative Medicine, 1, 165--166.

    Hull, M.M. (1989). Family needs and supportive nursing behaviors during terminal cancer: A review. Oncology Nursing Forum, 16, 787--792.

    Irwin, B.L., & Meier, J.R. (1973). Supportive measures for relatives of the fatally ill. In M. Batey and Western Interstate Commission for Higher Education (Eds.), Communicating nursing research: Collaboration and competition (6th ed., pp. 119--128). Boulder, CO: Western Interstate Commission for Higher Education.

    Krippendorff, K. (1980). Content analysis: An introduction to its methodology. Newberry Park, CA: Sage.

    Leonard, K.M., Enzle, S.S., McTavish, J., Cumming, C.E., & Cumming, D.C. (1995). Prolonged cancer death: A family affair. Cancer Nursing, 18, 222--227.

    Lewandowski, W., & Jones, S. (1988). The family with cancer: Nursing interventions throughout the course of living with cancer. Cancer Nursing, 11, 313--321.

    MacDonald, N. (1993). Priorities in education and research in palliative care. Palliative Medicine, 7(Suppl. 1), 65--76.

    Maltoni, M., Nanni, O., Derni, S., Innocenti, M.P., Fabbri, L., Riva, N., et al. (1994). Clinical prediction of survival is more accurate than the Karnofsky performance status in estimating life span of terminally ill cancer patients. European Journal of Cancer,30A, 764--766.

    Maltoni, M., Nanni, O., Pirovano, M., Scarpi, E., Indelli, M., Martini, C., et al. (1999). Successful validation of the palliative prognostic score in terminally ill cancer patients. Journal of Pain and Symptom Management, 17, 240--247.

    McCusker, J. (1984). The terminal period of cancer: Definition and descriptive epidemiology. Journal of Chronic Disease, 37, 377--385.

    Molter, N.C. (1979). Needs of relatives of critically ill patients: A descriptive study. Heart and Lung, 8, 332--339.

    Mor, V., Laliberte, L., Morris, J.N., & Wiemann, M. (1984). The Karnofsky performance status scale: An examination of its reliability and validity in a research setting. Cancer, 53, 2002--2007.

    Oxenham, D., & Cornbleet, M.A. (1998). Accuracy of prediction of survival by different professional groups in hospice. Palliative Medicine, 12, 117--118.

    Parkes, C.M. (1972). Accuracy of predictions of survival in later stages of cancer. BMJ, 2(5804), 29--31.

    Reuben, D., Mor, V., & Hiris, J. (1988). Clinical symptoms and length of survival in patients with terminal cancer. Archives of Internal Medicine, 148, 1586--1591.

    Rodgers, B.L., & Knafl, K.A. (1993). Concept development in nursing: Foundations, techniques, and applications. Philadelphia: Saunders.

    Rosenthal, M.A., Gebski, V.J., Kefford, R.F., & Stuart-Harris, R.C. (1993). Prediction of life expectancy in hospice patients: Identification of novel prognostic factors. Palliative Medicine, 7, 199--204.

    Schonwetter, R.S., Teasdale, T.A., & Storey, P. (1989). The terminal cancer syndrome. Archives of Internal Medicine, 149, 965--966.

    Schonwetter, R.S., Teasdale, T.A., Storey, P., & Lucchi, R.J. (1990). Estimation of survival time in terminal cancer patients: An impedance to hospice admissions? Hospice Journal, 6(4), 65--79.

    Ventafridda, V., Ripamonti, C., Tamburini, M., Cassileth, R.B., & DeConno, F. (1990). Unendurable symptoms as prognostic indicators of impending death in terminal cancer patients. European Journal of Cancer, 26, 1000--1001.

    Wright, K., & Dyck, S. (1984). Expressed concerns of adult cancer patients' family members. Cancer Nursing, 7, 371--374.

    Yates, J.W., Chalmer, B., & McKegney, F.P. (1980). Evaluation of patients with advanced cancer using the Karnofsky performance status scale: An examination of its reliability and validity in a research setting. Cancer, 45, 2220--2224.