Facing End of Life
Coping with news that you are dying
Everyone copes in their own way. It is natural to experience a range of strong emotions and for these feelings to change often.
Hearing the news
Learning that you may not have long to live is shocking news. Even if you are aware that the cancer has spread, hearing that you are dying can be extremely upsetting.
We all know that death is a natural part of life and that it will happen to us all one day, but most of us hope that we won’t die anytime soon. Realising that death is close can be frightening and hard to believe. For some people, it may be a relief. You may have questions right away, or you might need time to absorb the news and come to terms with the expected outcome of your disease (prognosis).
How you might feel
You will probably have many strong emotions. After the initial shock, feelings of fear, denial, anger, despair, helplessness and anxiety are common. You may also worry about how your family and friends will cope – emotionally, physically, socially and financially. The news will mean that you can’t live the future you’d planned. It may mean leaving behind a partner, children, family, friends and pets.
You may find that your emotions change, sometimes from day to day or even from hour to hour. This is often part of the process of making sense of what is happening. How you respond to these feelings will vary. You may find it hard to think clearly. It’s natural to cry or feel completely overwhelmed; you don’t need to put on a brave face.
Some people compare these feelings to waves at the beach. The first waves may knock you off your feet, then your footing becomes a little stronger. But, at any time, a large wave can suddenly come back and knock you off your feet again. The waves of emotions may not hit in any particular order, but people often say that their fears are stronger when it’s quieter at night, and that they rarely share how they’re feeling with others.
You may be able to work out your own ways to cope with these feelings. Find someone you can talk to, perhaps a family member or friend. You could also consider seeking professional help through a palliative care specialist or nurse, general practitioner (GP), counsellor, psychologist, psychiatrist or spiritual adviser. Other
people nearing the end of life offer a unique perspective, so you may want to consider joining a support group.
There is no easy way to start this conversation, but you may find it helps to practise what you are going to say.
When you feel ready, decide who to tell and what you want to say. Think of answers to possible questions, but only respond if you feel comfortable. You don’t have to share every detail.
- Choose a quiet time and place.
- Accept that people may react in different ways. They may be uncomfortable and perhaps not know what to say. If they get upset, you may find yourself comforting them, even though you are the one dying. Another common reaction is denial – they may be convinced that a cure will be found or that the doctors are wrong.
- Call Cancer Council 13 11 20 if you need help telling people. They can help you find the words that feel right for you. Another option is to ask your doctor or nurse to help you share the news.
Do people who are dying need to be told?
Sometimes family members learn the cancer is terminal before the person who is dying. They may think the person is too young or too old to be told the truth. Some cultures may also think it’s best that the person is not told.
Usually people who are dying know what is happening. Trying to keep it a secret from them may mean they feel alone just when they most need support. Ask the person if they would want to know and follow their wishes. The health care team can help you with this conversation and also with an approach for complex situations, such as when the person dying has dementia.
Common questions about dying
Knowing that you have a short time to live raises many questions. Sometimes, you may not be sure if you want to know the answers. Below are some of the questions you may want to ask when you feel ready.
Some people want to know how long they have left to live. Others prefer not to know. It’s a very personal decision.
Knowing can help you prepare for and plan the time you have left. If you want to know, you can ask your doctor. They won’t be able to give you an exact answer. As everyone is different, a doctor can only give you an estimate (prognosis) based on what usually happens to people in your situation, but can’t say exactly what will happen to you.
Some doctors may sound very definite about how long you have left to live, but it is only ever an estimate. Other doctors may be hesitant in case they overestimate or underestimate the time. They will probably talk about the time in terms of days, days to weeks, weeks to months, or perhaps even longer.
It is likely to be very difficult if you are told that the time you have left to live will probably be short. Even if it is only a matter of weeks, having a sense of how much time might be left can give you a chance to focus on what you’d like to do. If you live longer than the estimated time, you may feel unsettled and like you’re waiting to die, or you might feel lucky to be living beyond that time. It may help to talk about how you’re feeling with your family, the palliative care team, your doctor or a counsellor.
Palliative care is person-centred care that helps people with a progressive, life-limiting illness to live as fully and as comfortably as possible. It’s sometimes called supportive care. The main goal is to help you maintain your quality of life by identifying and dealing with your physical, practical, emotional, cultural, social and spiritual needs. Palliative care also offers support to families and carers.
A team of health professionals, as well as volunteers and carers, work together to offer a range of palliative care services. The services will be tailored to your individual needs, and may include:
- relief of pain and other symptoms such as fatigue, nausea, vomiting, and shortness of breath
- resources such as equipment to aid care at home
- assistance for families to come together to talk about sensitive or complex issues
- links to other services such as home help and financial support
- support for emotional, cultural, social and spiritual concerns
- referrals to respite care services.
Your palliative care may be coordinated by your GP, a palliative care nurse or the specialist palliative care team in your area. Palliative care teams see people with the most complex needs, but they can also advise other health professionals on ways to manage symptoms. Palliative care can be provided in the home, in a hospital, in a palliative care unit or hospice, or in a residential aged care facility. Services vary, because palliative care is different in each state and territory.
Wherever you receive end-of-life care, the different health professionals in your palliative care team can offer a range of services to assist you. You may not need to see all of the people listed below, but understanding the different roles can help you work out what support is available and who to ask about particular issues. Your care may be coordinated by your GP, a community or hospital palliative care nurse, or the specialist palliative care team.
GP – continues to see you for day-to-day health care issues and may coordinate your palliative care specialist
palliative care nurse – may work in a community or hospital setting, can provide ongoing care and may coordinate your palliative care
community nurse – visits you at home to supervise medical care, assesses your needs for supportive care, and works with your GP
palliative care specialist (physician) – treats pain and other symptoms to maximise wellbeing and improve quality of life; usually works in collaboration with your GP or palliative care nurse
cancer specialists (oncologists and surgeons) – may refer you to the specialist palliative care team and continue to provide cancer treatment to help manage your symptoms
counsellor, psychologist – help you manage your emotional response to diagnosis and treatment
psychiatrist – specialises in the diagnosis and treatment of mental illness, can prescribe medicine and uses evidence-based strategies to manage emotional conditions
spiritual care practitioner (pastoral carer) – discusses any spiritual matters and helps you reflect on your life and search for meaning; if appropriate,
may arrange prayer services and other religious rituals
pharmacist – dispenses medicines and gives you advice about dosage and side effects
occupational therapist – assists in adapting your living and working environment; can suggest equipment, such as a hospital bed, wheelchair and bedside commode (toilet chair)
physiotherapist – helps with restoring movement and mobility, and preventing further injury
diversional therapist – offers recreational activities to improve your wellbeing
dietitian – recommends an eating plan and tries to use diet to assist with digestive issues, such as nausea or constipation
speech pathologist – helps with communication and swallowing problems
social worker – links you to support services and helps you with emotional, practical and financial issues; may also be called a welfare officer
volunteers – can help with home or personal care and transport, and also offer companionship
If your doctor has told you that the cancer cannot be cured, you may wonder whether there are any other therapies you could try. Complementary therapies tend to focus on the whole person, not just the cancer. They are used alongside conventional medical treatments, while alternative therapies are used in place of conventional treatments.
Many people use complementary therapies to help them feel better and cope with cancer and its treatment. This is also true for people who are dying with cancer. Complementary therapies may help you relax and reduce anxiety. They can also be useful in managing symptoms such as pain and nausea. Some people find gentle therapies, such as massage and aromatherapy, helpful. People who find it uncomfortable or painful to be touched may prefer meditation or visualisation.
Alternative therapies are often promoted as cancer cures, and family members, friends or even strangers may suggest you try them when you explain your prognosis. Unlike conventional medical treatments, alternative therapies have not been scientifically tested, so there is no proof they stop cancer growing or spreading. They can be very expensive and could interfere with other medicines.
If you are considering trying an alternative therapy, discuss this with your doctor first. Cancer Council does not recommend the use of alternative therapies as a treatment for cancer.
People often talk about wanting to have a “good death ”. What dying well means is different for each person, shaped by their attitudes, cultural background, spiritual beliefs and medical treatments.
Think about what dying well means to you. You might find it is important to:
- know that death is coming and have some understanding of what to expect
- have some control over pain relief and other symptoms
- be able to retain some control over where death occurs and how it happens
- maintain a sense of dignity
- have the opportunity to prepare for death
- reconcile damaged or broken relationships
- have the chance to say goodbye
- resolve regrets
- be able to have a say in end-of-life care and ensure your wishes are respected.
There are different ways to die well. Some people see staying at home as the key to dying well, but others feel more supported spending their last days in a hospital or palliative care unit. It is important that your family, friends and health care team understand what matters most to you. Open conversations and planning ahead for dying can also help family members and friends cope better with the grief and loss they may experience
(bereavement). They may feel a sense of peace knowing your preferences were respected.
If an illness is prolonged or causing uncomfortable symptoms, some people think about speeding things up. Euthanasia is the act of deliberately ending the life of a person with an incurable condition or illness. Voluntary assisted dying is when a person ends their own life with the help of a doctor.
At the time of last review of this section (2022), voluntary assisted dying is illegal in most Australian states and territories. In Victoria and Western Australia, voluntary assisted dying is legal only for people who meet all the strict conditions and follow certain steps. Visit health.vic.gov.au or health.wa.gov.au and search for “voluntary assisted dying”.
Voluntary assisted dying laws have been passed in Tasmania, South Australia and Queensland, and voluntary assisted dying will start between late 2022 and early 2023. The laws in other states and territories are under review. Visit end-of-life.qut.edu.au for updates.
Regardless of the law, some seriously ill people consider this path. Sometimes a person with cancer may decide they want their death hastened, but later decide that they don’t. They may have thought that way because they were feeling particularly ill, scared, or worried about the strain they were putting on others.
If this is how you feel, discuss your concerns with a doctor, counsellor or social worker. Sometimes these feelings are due to depression or a sense of helplessness, or because pain or other symptoms are not well controlled.
Pain and depression can almost always be treated, and help is generally available for other symptoms. It is important that you talk to your doctor or nurse about any physical or emotional symptoms that are causing you pain or distress, and find ways to make your final days more comfortable.
If you urgently need somebody to talk to because you are thinking about ending your life, call Lifeline on 13 11 14 for free, confidential telephone
counselling at any time.
It’s common to have misconceptions or fears about what the process of dying is like. Many people say they don’t fear death as much as the unknowns of dying. Having some idea of what to expect can make the process easier. Not being prepared for what might happen can be distressing for you as well as for your family and friends.
If you’ve been with a person who has died, this experience will influence how you feel about dying. It may have left you reassured, thoughtful, sad, angry or scared. You may have been disturbed by some of the physical changes that happened to the person. For example, perhaps it appeared they were having trouble breathing, or they seemed to be in pain or uncomfortable.
It will help to talk to your doctor or to the palliative care staff. They can explain the physical process of dying and reassure you that you will be cared for. You might not be aware of physical changes because you may be drowsy or unconscious.
Modern health care means that people should not die in pain or distress. If you have symptoms that are not well controlled, you can ask your doctor or the palliative care team to help.
For many, dying is a process that happens gradually. As the body slowly shuts down, energy levels vary and there are good days along with days when you can’t do much at all. Your appetite will reduce, and sips of water or a teaspoon of food here and there may be enough.
As death gets closer, it’s common to have little interest in talking and the outside world. You may find your attention withdraws from family and friends, and you may sleep more and more during the day.
Near the end, some people may require sedation for symptom management. Many people slip into unconsciousness before dying, although some remain alert almost until the end. Others may have periods of being awake, and then slip back into unconsciousness.
No-one knows how a dying person experiences the moment of death. Whatever happens, it is thought to be a peaceful moment.
This information is reviewed by
This information was last reviewed February 2020 by the following expert content reviewers: Dr Megan Ritchie, Staff Specialist Palliative Medicine, Palliative Care Service, Concord Repatriation General Hospital, NSW; Gabrielle Asprey, Cancer Support Consultant, Cancer Council NSW; Rosemary Cavanough, Consumer; Louise Durham, Nurse Practitioner, Metro South Palliative Care Service, QLD; Tracey Gardner, Senior Psychologist, Cancer Counselling Service, Cancer Council Queensland; Karen Hall, 13 11 20 Consultant, Cancer Council SA; Linda Nolte, Program Director, Advance Care Planning Australia, VIC; Rowena Robinson, Clinical Advisor, Palliative Care Australia, ACT; Helena Rodi, Program Manager, Advance Care Planning Australia, VIC.