Palliative Cancer Care Stress and Coping Among Clinical Nurses Who Experience End-of-Life Care

Hyunju Kim, MSN, RN; Kisook Kim, PhD, RN


Journal of Hospice and Palliative Nursing. 2020;22(2):115-122. 

In This Article

Abstract and Introduction


The increasing number of cancer patients and prolonged periods of illness have led to an increase in nurses' stress and various other problems. This research aimed to identify the stress resulting from caring for cancer patients and the methods for coping with stress among cancer care nurses. The research subjects were 180 clinical nurses caring for cancer patients in a hospital in Korea. Stress caused by excessive workloads, inappropriate compensation, and interpersonal conflicts with physicians was high. There was a difference in stress according to age. Coping strategies differed according to religion, education, occupation, hospice education, job satisfaction, and leisure activities. The higher the stress, the greater the number of coping strategies used. Problem-related coping was associated with more diverse stressors. Stress characteristics differed according to various factors, whereas stress coping strategies depended on the stress characteristics of clinical nurses caring for cancer patients. Future research following a critical approach will be needed to elucidate the compassion fatigue related to the stress strategies of clinical nurses. These findings could contribute to the development of interventions to reduce stress in clinical nurses by providing evidence on the stress and coping methods of nurses who provide palliative care for cancer patients.


Globally, the number of individuals being diagnosed and living with cancer is growing, which further burdens the already overwhelmed cancer health care professionals.[1] In addition, the rapid advancements in cancer treatments and the increasing rate of cancer survivors amplify the need for competent, empathetic, and up-to-date nursing care.[2] Despite the remarkable development of modern medical technology, cancer is the number 1 cause of disease-related deaths in Korea and remains a threat to human beings trying to lead healthy lives.[3] Currently, an estimated 1.46 million people are being treated after having survived cancer treatment.[4]

Concurrently, the need for systematic, high-quality, and reliable nursing is gradually increasing because of the increase in the severity of cancer in patients, the emergence of new therapies, and the increased survival and cure rates.[5,6] Along with increasing cancer care needs, stress and burnout among clinical nurses who care for cancer patients are also on the rise.[7,8] In Korea, the death rate of cancer patients in medical institutions, which was 22.8% in 1995, increased to 45.0% in 2003 and 73.4% in 2014, which indicates that a larger number of these patients than in the past are receiving end-of-life care from clinical nurses in medical institutions.[9] Therefore, interest in palliative care for cancer patients, nurses' stress, and aggressive cancer care nursing is increasing.

The physical and emotional demands of the patient-nurse relationship, the oncology unit, and daily patient care tasks generate significant stress among oncology nurses.[2] Oncology nurses are regularly exposed to high-stress situations, which may cause them to experience more compassion fatigue and burnout than nurses in other units.[2,10] They are likely to experience compassion fatigue after repeated exposure to patients undergoing the numerous, repetitive traumas associated with cancer, such as the aggressive adverse effects of chemotherapy and severe pain in the end stages of the disease.[1] Accumulated stress and burnout among oncology health care professionals result in decreased quality of care, absenteeism, and staff retention owing to the reduced number of nurses specially trained in oncology.[1,11]

Nevertheless, not only is research on the cancer care stress levels and stress coping methods of oncology nurses limited, but there is also a lack of evidence-based interventions to prevent the burnout of oncology health care professionals.[12] In particular, research on stress that focuses on clinical nurses providing palliative care for cancer patients is insufficient, especially when taking the increasing number of cancer patients in Korea into consideration. Therefore, the purpose of this study was to identify the stress and methods of coping among clinical nurses caring for cancer patients to contribute a basis for an effective stress management program to enhance the quality of nursing care.