Being There for a Friend or Loved One at the End of Life

Pictured: Talia Zaider

Clinical psychologist Talia Zaider

After a cancer diagnosis, patients and their loved ones often initially focus on choosing a course of action and fighting the disease.

But if the cancer becomes terminal, the effort may shift from taking action and “fixing things” to easing the dying process and accepting that the end of life is near. For many people, this is an even more difficult and frightening place to be.

If a loved one or a close friend is nearing the end of life, you may desperately want to say or do the right thing, but you may not know what that is. And even as you try to be strong and supportive, you may feel so helpless and overwhelmed by fear and grief that you wonder if you’re up to the task.

Those feelings are normal, says Talia Zaider, a Memorial Sloan Kettering clinical psychologist. “It’s really important and helpful to recognize that most people don’t know how to navigate this territory, emotionally or pragmatically,” Dr. Zaider says. “I tell people that it’s OK to not know what to do and not know what to say. There is no manual here.”

Nor is there one right way to react to, cope with, or approach the end of life. “I have not met any two people who navigate this the same way, and that applies to the initial diagnosis, terminal illness, and how people grieve,” Dr. Zaider says.

With that said, if you have questions about how you can best support a friend or loved one through the end of life, Dr. Zaider offers this guidance.

Let your friend or loved one take the lead.

When people have a terminal illness, they may want to fulfill last wishes or create meaningful experiences with the time they have left. But not everyone does. Just as some people may enjoy reminiscing, others find memories of better times painful to think about and prefer to stay in the here and now. Depending on the stage of their illness, your friend or loved one may not be up to talking but could appreciate the chance to sit quietly in your company.

Take your cues from them. If you’re unsure of what to discuss, listen more than talk. If you don’t know how long you should stay during a visit, it’s OK to ask if they’re getting tired and need to rest or if there is something you could do to make them more comfortable.

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Don’t wait until the last minute.

At the end of life, there may be certain conversations you or your loved one need to have. This could be about practical matters such as making final care decisions or getting finances in order. It may also involve discussions about what’s going to happen after your loved one is gone and their wishes for your life going forward.

These are incredibly painful talks, but try not to delay having them, since a deteriorating medical condition can make it more difficult for your loved one to express their wishes.

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There are no perfect words.

We spend so much of our lives communicating — texting, emailing, talking on the phone. Yet when it comes to talking about dying or saying good-bye to someone you love, words may fail you. “With someone we know so well, we can feel that we are supposed to know what to do or say,” Dr. Zaider says. “Releasing yourself from that pressure to craft the perfect response or to find the perfect thing to say is important.”

Sometimes you don’t need to say anything at all. Nonverbal communication —sitting beside them, holding their hand, lightly massaging them if that would be a normal part of your relationship — is all the communication you need.

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Support the immediate family.

Partners and immediate family members are likely mentally and physically exhausted. Emotional anguish, caretaking responsibilities, and having to make difficult decisions can leave families feeling isolated in their pain and grief.

They need support, too. Ask if you can stop by for a visit. It may be appreciated not only by the person who is ill, but also by their family, who may feel less alone. “Families remember these little acts of kindness,” Dr. Zaider says.

There may come a point that a visit is not welcomed or even possible. If that’s the case, a phone call, a thinking-of-you note, or an offer to pick up groceries or drop off dinner can help make things a little more bearable for families.

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Don’t let fear keep you from being there.

Knowing someone is approaching the end of life can stir up all kinds of fears — of your own mortality, of how difficult it may be to see someone you care about very ill. Being scared and wondering if you’ll be able to keep it together is a very understandable reaction, Dr. Zaider says.

It only becomes a problem when fears lead you to avoid spending time with the dying person, Dr. Zaider says. It takes courage to be there, but it can also be of great comfort to the person who nearing the end of life — and could be one of the most important, meaningful things you’ll ever do.

“Maintaining a meaningful presence with a loved one at the end of life, and jointly acknowledging that death is imminent, can actually open opportunities to both give and receive comfort, to feel more prepared for the loss, to huddle and share grief with others, to celebrate a life lived well, and to highlight stories of pride and legacy,” Dr. Zaider says. “Research suggests that those who are able to engage in these kinds of conversations and who feel more prepared for the death of a loved one are then much better able to manage their grief in the aftermath of loss.”

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Commenting is disabled for this blog post.

As a caregiving partner of an MSK brain cancer patient, I need information about when to ask for hospice care. I've given up my illusion of invincibility. My confusion comes from not knowing when to ask for hospice help. Is the determining factor physical or mental or both. I'd appreciate your help. Thanks.

Jan, we’re sorry to hear that you and your partner are going through this. Unfortunately we are not able to answer personal medical questions on our blog. This is something you should discuss with your partner’s healthcare team. They will be able to work with you to make this decision and to help refer you to the right resources. You might also want to check out the section of our website that has information for caregivers. There you’ll find information about counseling and support groups that might be right for you. You’ll find it here: Thank you for your comment.

Hi Jan,
The response that Sloan-Kettering gave is right in directing your questions to your medical provider. There better able to let you know if there are other treatment options, and if not, what ought to be the next step. Make sure that you've had this discussion with your partner prior to visit and questioning doctor. I've been there with my dad and currently going through it again with a close friend. Stay strong and be well.

My girlfriends husband has Basal Cell Carcinoma on his head. He has had some surgery years ago. The cancer is back and he has taken to the internet and "special lotions" to attempt to cure himself. My girlfriend takes a picture of the area once a week and it has grown from just a small red bumpy patch to an area of aprox. 6" in length to 3" wide. It starts at the top of his head and spreads over his temple and below his ear. He puts this cream on several times during the day, and says "he feels it working" . She sees it getting worse everyday! HE will not listen to reason and refuses to seek outside help! She doesn't know what more to do, or to expect. Can you help with some advise?

Thank you for your comment. We strongly recommend that your friend’s husband consult with a doctor who can evaluate this skin condition and discuss what treatments may be appropriate.

Thank you for the advice about handling a friend with stage IV cancer. My dear friend is not terminal, but is in treatment at your wonderful hospital. I am a breast cancer survivor, and am very greatful. I was only stage 1. However, As greatful as I am, often I feel "Guilty" that she has it so much worse than I did. I am always here for her, and don't want her to know that I feel this way. Any advice? Thanking you in advance.

A friend's daughter has a form of rare cancer that is usually terminal. I see you have counseling services for those whose loved ones have passed on, but do you have counseling for family members who are dealing with someone who is currently undergoing life-threatening disease? Thank you.

Dear Lynn, we’re very sorry to hear about what your friend and her family are going through. Yes, we do offer counseling for both patients and their family members who are at all stages of the cancer journey. Information about the counseling services that we offer is here:

Your friend may also find it helpful to join Connections, our online support group for patients and caregivers. You can find more information here:… This group is open to anyone, regardless of where they or their loved one is receiving treatment.

Thank you for your comment.