Incorporating a Death Doula into the Oncology Care Team


The death doula is a unique role that can help oncology care teams improve the quality of end-of-life care delivered to patients.

Death doulas may be able to fulfill an unmet need and bring quality end-of-life care to patients with cancer. However, institutions should seek to ensure that the funding is sufficient to make this service available to those who need it, according to results of a poster presented at the 47th Annual Oncology Nursing Society’s Annual Congress.

The addition of death doulas to end-of-life care teams has represented a novel change in care in this setting, the study authors explained. The role of these caregivers is similar to that or a birth doula; instead of supporting labor, these individuals help patients with a terminal illness navigate their dying process.

The death doula provides the opportunity to combat the medicalization of dying and to instead offer an individual the ability to bring choice, autonomy, and person-centered care into their dying process. These professionals bring knowledge of community-based, traditional, and culturally safe practices to the process.

The Canadian Hospice Palliative Care Association’s 2013 Square of Care could potentially be used as a framework to help ease the inclusion of death doulas into their interactions with oncology nurses, according to the presented literature review.

The square of care helps healthcare providers address the following issues that patients may face; the framework requires them to take an assessment of the patient’s disease management, physical, psychological, social, spiritual, and practical well-being, as well as their end-of-life/death management, and loss or grief.

The guide then outlines the process of providing care for these issues. The process includes assessment, information sharing, decision-making, care planning, care delivery, and confirmation. Importantly, the patient and the family are at the center of the square, and their needs determine the issues that need to be addresses.

This model helps provide a road map for excellent hospice and palliative care. When used correctly, the goalposts outlined in the model help to shape care plans in a fashion will not overwhelm team members.

In the presentation, Lorraine Holtsland, PhD, RN, CHPN, outlined how the oncology nurse and death doula might work together under the conceptual square of care framework.

“We used the CPCSA framework because it helps to explain the roles and how they might work together within that model of care,” Holtsland said.

“The role of the oncology nurse is focused on assessment, and supporting medical needs treatments, care planning, and care delivery. Whereas the death doula can really focus on building relationships that allow for advanced care planning, sitting vigil with families, supporting a home death, and home funerals, [and even] different options like a green burial,” she added. “It really depends on that relationship and [the patient’s] goals and values.”

Over the next 10 years, there will continue to be many cancer-related deaths. “The death doula can help to fill many gaps” Holtsland said. “As they provide support for patients and families to remain at home and in their communities. A concern is access to funding and accessibility of these services to everyone.”

A good goal for the oncology community would be that the death doula would become part of the healthcare team and that everyone, whether they can afford such services or not, be able to have access to these services, she concluded.


Holtsland L, Hall St. Improving end-of-life care through interprofessional collaboration with death doulas: Implications for oncology nurses. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P44.

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