Hope in Dialogue

Psycho-oncological Precision at the End of Life Between Dignity, Truth, and Choice

Abstract

The final phase of advanced cancer is rarely a purely medical endpoint. It represents a concentration of fear, pain, relational challenges, and existential questions of meaning, dignity, and connectedness. In this context, psycho-oncological support can be effective not primarily through extended treatment programs, but through precise, well-timed interventions. This requires a shift in perspective: away from an exclusive focus on survival time toward the question of how life can remain shapeable even under conditions of limited time. Based on an experience-informed, integrative, and practice-oriented synthesis of literature and concepts, this article develops an orienting model for psycho-oncological care at the end of life that is not limited to psycho-oncology specialists. Psychological distress is conceptualized as typically manifesting as demoralization, fear of progression or death, depressive symptoms, and «total pain», each requiring distinct priorities for indication, communication, and intervention across care settings. Three narrative case vignettes drawing on Meaning-Centered Psychotherapy, CALM, and Dignity Therapy illustrate the clinical logic of this approach.