Dealing with a terminal diagnosis Clatterbridge Centre for Oncology When someone is given a terminal diagnosis it doesn’t mean that nothing more can be done, but the aim of treatment changes and becomes focussed on reducing their symptoms.

In this article

Managing pain Talking about the diagnosis

Getting affairs in order Support

Not all terminally ill patients have pain but if they do, it’s generally well-controlled with painkillers, and these can be adjusted as needed. Other options for controlling pain include:

• Radiotherapy
• Nerve blocks
• Acupuncture
• Hypnotherapy
• Relaxation techniques

Nausea and vomiting can be very troublesome in terminal illness and may be caused by the cancer or as a side-effect of medicines like morphine. It's important that the doctor knows about it, as this can often be well-controlled by changing or adjusting medicines. Eating small meals more often can also help.

Talking to family and friends about the diagnosis is often difficult and can be very distressing for them and the patient. Often they don't know what to say or how to react but if it can be talked about openly and honestly, it can be a comfort. It's important to understand that everyone will react differently and some will seem unsympathetic or deny the truth. This doesn't mean that they don't care - it's often their way of coping.

It's best to be honest with children even if it's painful. How much they need to be told will depend on their age, and it's often better to talk to them with other relatives around so they feel supported. Sometimes people with terminal cancer don't want to talk or see anyone and their wishes should be respected.

Often when confronted with a terminal diagnosis the patient may find comfort in getting their affairs in order - they see it as looking after their loved ones. This may include making a will, making arrangements for children, making memory boxes for children and planning the funeral.

Generally, people who have been given a terminal diagnosis are at home. The GP is the doctor who will look after them, helped by a number of others, including:

• District nurses
• Macmillan nurses (who are specialists in palliative care and symptom control)
• Marie Curie nurses
• Home-helps
• Carers
• Physiotherapists
• Occupational therapists

Their aim is to attend to all the patient's needs and to keep them as comfortable as possible in their own home.

Sometimes, if symptoms aren't well-controlled a doctor will suggest that the patient go into a hospice or hospital to improve things. This may only be for a short time and then the patient can go home again. Hospices specialise in controlling symptoms and caring for people dying of cancer and their families. Many hospices have day care facilities that patients with a terminal illness can attend. Hospices also have services such as physiotherapy, complementary therapies, spiritual care and bereavement support.

Choosing where to die

Most people want to die in their own homes, with their family there. Often, for lots of reasons, this isn't possible. It may be that the patient develops symptoms that cannot be well-controlled at home and they need to be in a hospital or hospice to be made comfortable. For families, it's very hard work, both physically and emotionally, caring for someone dying at home and they need to know that there is support for them when they need it. It is a good idea to talk things through with the community nurses and or GP so that there is a plan in case of emergencies.

This article was first published in February 2009.