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‘Fighting talk’ about cancer can do more harm than good

The desire to put on a brave face can rob patients of the chance to discuss end of life care

The desire to put on a brave face can rob patients of the chance to discuss end of life care


Picture: iStock

Fight, battle, beat. Just a few words that many people use about cancer when going through treatment.

But how helpful is this kind of 'fighting talk' for nurses and other healthcare professionals when it comes to supporting people who are approaching the end of their life? And does it serve the people who need to think and talk about dying?

For some, the effort required to remain upbeat about a terminal illness is too much

Treating cancer as an enemy that you have the power to overcome can help some people to channel negative feelings and regain a sense of control over their lives.

But for others, the effort required to remain upbeat about a terminal illness is too much. At a time when gruelling treatment has left you feeling physically weak, bottling up your emotions and putting on a brave face can be exhausting.

Reluctant to talk about death

As a district nurse, I cared for lots of people who were approaching the end of their lives but were reluctant to talk about death. Some felt that talking about it meant they had somehow ‘given up’ on life, or they worried about upsetting their relatives.

A recent report by Macmillan Cancer Support, Missed Opportunities, shows that such concerns are common. Almost 2,000 people with cancer answered a survey question about death and dying: a quarter (25%) said they had not shared their thoughts or feelings about death or dying due to seeing themselves as a ‘fighter’; more than one in four people (28%) felt guilty if they could not stay positive about their disease.

Initiating sensitive conversations about death and dying is one of the most difficult parts of our job as nurses, particularly when you want to reassure the person that you are doing all you can to support and care for them. How will they react? Is this person mentally ready to talk about dying? Will this be upsetting for them and their family?

By having those difficult conversations, you can often make people feel more in control of their future life and what will happen to them

Yet the rewards could not be greater. By encouraging people to think about and share how and where they would like to be cared for in their final days, you are setting the wheels in motion to help ensure that person’s dying wishes can be respected.

By having those difficult conversations, you can often make people feel more in control of their future life and what will happen to them. Discussing choices and making plans while going through treatment can be deeply reassuring and provide a sense of hope. This enables people to focus on their remaining life and the things that are important to them.

The best possible care at the end of life

There are, of course, also wider benefits to the health service of advance care planning. When we know where someone would like to die, that person is almost twice as likely to die in the place of their choosing , and have fewer emergency admissions at the end of their life.

Macmillan Cancer Support is urging governments across the UK to honour their commitments to ensuring advance care planning is used as an important component of person-centred care.

Initiating difficult conversations with the people you care for, and helping them to plan ahead for their final days, can help ensure they receive the best care possible as they approach the end of their life.


Adrienne Betteley is specialist advisor for end of life care at Macmillan Cancer Support

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