Why earlier palliative care conversations matter in oncology nursing
One patient I still think about came in frequently for supportive care visits. Technically, the appointments were straightforward. She was there for things like IV fluids or symptom management. But her visits were rarely simple. She had questions about labs, treatment side effects, fatigue, and what different changes in her body meant. Over time, our conversations expanded beyond the immediate medical task in front of us.
She talked about how much harder everyday life had become. She tired easily. Walking longer distances became difficult. She was losing independence in ways that frightened her. Eventually, we began talking about mobility aids. She did not want a walker or wheelchair. To her, they represented loss.
I remember trying to reframe the conversation. I told her that using a walker did not mean she had stopped living fully. If being outdoors mattered to her, then the goal was not preserving the image of how she used to move through the world. The goal was helping her continue participating in the parts of life she still loved. A wheelchair might allow her to stay outside longer. A walker might help her conserve energy for the moments that mattered most.
Looking back, I realize many of those conversations were already palliative conversations long before the term itself ever entered the room. In many ways, palliative care is about helping patients continue being themselves even as illness changes what daily life looks like.
She ended up passing sooner than I expected.
That is part of why these conversations matter earlier than many people realize. Palliative care is often misunderstood as something reserved for the final stages of life, when treatment options have been exhausted. But one of the most remarkable findings in oncology over the last decade is that early palliative care not only improves quality of life and reduces depression, but in some cases may even extend survival. A landmark study published in the New England Journal of Medicine found that patients with metastatic non–small cell lung cancer who received early palliative care lived nearly three months longer than those receiving standard oncology care alone.
There is often an unspoken assumption that prioritizing comfort means sacrificing time, as though quality of life and length of life exist in opposition to one another. But some of the strongest palliative care data suggest otherwise. The experiences many nurses witness at the chairside suggest the same thing: support, symptom management, and clearer communication may help patients live more fully and sometimes even longer.
Even knowing this, I still sometimes find palliative care conversations difficult to begin. Not because I question their value, but because I know how often the word itself is misunderstood. I have found myself anticipating fear before I even explain what palliative care actually is. In my experience, once patients understand that palliative care is an added layer of support rather than a reflection of lost hope or limited time, many are receptive to it and continue follow-up visits because they find them genuinely helpful.
Too often, these conversations happen later than they could—or do not happen at all. I do not think this comes from a lack of compassion. Oncology clinicians spend enormous energy trying to preserve hope and move patients toward the next treatment, the next option, the next possibility. But sometimes patients also need help navigating the reality of how illness is affecting daily life now, not just what the next scan or therapy might show.
Palliative care helps create space for those conversations. It supports symptom management, emotional well-being, family communication, and decision-making. It helps patients adapt without feeling abandoned. And for families, it can reduce the fear and second-guessing that often accompany serious illness.
Even in my own family, palliative and hospice support became some of the most meaningful parts of my father’s care. He had advanced Parkinson’s disease and stage IV melanoma. Despite having a daughter who was an oncology nurse—and even though he would have qualified for that support much earlier in his illness—these services were only in place for a relatively short period of time near the end of his life. I remain deeply grateful for the support we eventually received, because it helped shift our focus away from constantly second-guessing our decisions and worrying whether we were advocating enough, and back toward spending meaningful time together.
As oncology nurses, we are often the clinicians patients speak to most honestly. We hear about the fatigue that is becoming unmanageable, the loss of independence, the fear of burdening loved ones, and the quiet grief that comes with a changing body and changing life. In many ways, we already practice the principles of palliative care every day at the chairside. The challenge is learning to name these conversations earlier, more comfortably, and without allowing the discomfort surrounding the term itself to delay support that could meaningfully improve how patients live.
Courtney Desy, BSN, RN, OCN, is an oncology infusion nurse. She cares for adults receiving chemotherapy and immunotherapy and is the founder of the Stronger Than Chemo Foundation, a nonprofit focused on improving patient education and support during cancer care. Her last post on AJN Off the Charts was “Nurses Know Safety Can’t Depend on Assumptions.”
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