Being a “Last Responder” to Patients With Cancer With Melinda Mayorga

Welcome to Onc Nurse On Call, the new podcast from Oncology Nursing News, hosted by editors-in-chief Patricia Jakel, MN, RN, AOCN, and Stephanie Desrosiers (formerly Jackson), DNP, MSN, RN, AOCNS, BMTCN, delivering maximum impact in minimum time.

This episode’s guest, Melinda Mayorga, RN, MSN, CNS, AGCNS-BC, OCN, a clinical nurse specialist at Norris Comprehensive Cancer Center University of Southern California in Los Angeles, discussed end of life care and those she calls “last responders.”

Mayorga described an experience in which she accompanied a patient through the last 32 minutes of her life, which, if not for the nursing staff, would have otherwise been spent alone—an occurrence altogether too familiar for many nurses.

Inspired by this experience, Mayorga developed a volunteer program that pairs individuals with those at the end of life to avoid patients dying alone, as well as an interdisciplinary toolkit that involved a chaplain, mental health professionals, the arts, and even environmental manager. The program provides QR codes to instantly reach prayers prepared by the chaplain along with videos on stages of grief, battery-operated candles to light, and the option to paint a rock in someone’s memory.

In a conversation that followed with her brother, who works in the funeral industry, he described their respective lines of work as last responders, a tag which stuck with Mayorga. After similar conversations with peers, Mayorga wrote an article published in the Journal of Hospice and Palliative Nursing on last responders: those who play a role in an individual’s transition from life to death.¹

Mayorga’s focus is currently on the outpatient oncology setting, where nurses and advanced practice providers (APPs) may receive little notice of a patient’s death.

“So many of the notifications come so casually as a physician is walking by you: ‘Oh, by the way, Mr. So-And-So died,’” said Mayorga. “You’ve been taking care of those patients for 2, 3, or 4 years as part of their cancer care, and all of a sudden they’re gone. …You’ve shared life’s discussions woven into assessments.”

Further, Mayorga interviewed other individuals like restorative cosmetologists and funeral directors to better understand how nurses can help prepare patients who have died for the next stages. From these individuals, Mayorga learned that removing as much tape and tubes as possible helps to better preserve a patient’s body.

Notably, Mayorga took from these conversations that patients’ families have time to make decisions. Walking those caregivers through these stages of care when appropriate, explained Mayorga, can make the emotional aspects of the end of life more approachable.

Reference

1. Mayorga M. Notes From a "Last Responder". J Hosp Palliat Nurs. 2024;26(4):179-180. doi:10.1097/NJH.0000000000001045