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Oncology Nurses’ Narratives About Ethical Dilemmas and Prognosis-Related Communication in Advanced Cancer Patients

McLennon, Susan M. PhD, RN; Uhrich, Margaret BSN, RN; Lasiter, Sue PhD, RN; Chamness, Amy R. BA; Helft, Paul R. MD

doi: 10.1097/NCC.0b013e31825f4dc8

Background: Oncology nurses routinely encounter ethical dilemmas when caring for advanced cancer patients, particularly concerning prognosis-related communications. Nurses experience uncertainty and barriers to providing quality end-of-life care; thus, more information is needed about recognizing and managing these dilemmas and to clarify their role in these situations.

Objective: The purposes of this study were to (1) describe the frequency and types of ethical dilemmas experienced by oncology nurses caring for advanced cancer patients and (2) to summarize their written comments about prognosis-related communications.

Methods: This was a content analysis of narrative comments provided by 137 oncology nurses who completed a mailed national survey of members of the Oncology Nursing Society.

Results: The most frequently reported ethical dilemmas encompassed uncertainties and barriers to truth telling, familial and cultural conflict, and futility. Physician-nurse teams were considered optimal for delivering prognosis-related information. Nurses offered strategies for facilitating these communications. They also expressed the need for more education about how to engage in prognosis-related discussions and for better methods for relaying this information among team members to avoid “working in the dark.”

Conclusions: Oncology nurses routinely experience ethical dilemmas, and there is a need for clarification of their role in these circumstances. Healthcare providers would benefit from interdisciplinary education about prognosis-related discussions. Attention to managing familial conflict and understanding cultural variations associated with illness, death, and dying is also needed.

Implications for Practice: Findings reveal new information about ethical dilemmas encountered by nurses and strategies for improving end-of-life communications with advanced cancer patients.

Author Affiliations: Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health (Dr McLennon, Ms Uhrich, Ms Chamness, and Dr Helft), School of Nursing, Indiana University (Drs McLennon and Lasiter), and School of Medicine, Indiana University (Dr Helft), Indianapolis.

This research was supported, in part, by the Walther Cancer Foundation, Inc, Indianapolis, Indiana (Dr McLennon, Dr Helft); the Richard M. Fairbanks Foundation (Ms Chamness, Ms Uhrich, Dr Helft), Indianapolis, Indiana; and the Methodist Health Foundation (Ms Chamness, Ms Uhrich, Dr Helft), Indianapolis, Indiana.

The authors have no conflicts of interest to disclose.

Correspondence: Susan M. McLennon, PhD, RN, Charles Warren Fairbanks Center for Medical Ethics, 1800 N Capitol Ave, Suite E130, Indianapolis, IN 46202 (

Accepted for publication May 9, 2012.

© 2013 Lippincott Williams & Wilkins, Inc.