Hundreds of years before the 1971 proclamation by President Nixon of the war on cancer, military metaphors were already used to describe responses to illness. The National Cancer Act and the creation of the National Cancer Institute formalized usage of war messaging in cancer medicine,1 messaging that is currently ubiquitous throughout the health care enterprise. The war on drugs, winning the battle but losing the war on obesity and diabetes, and combating heart disease are common phrases that suggest conflict and warfare of epic proportions. The connection of this vocabulary to war and battle may not be obvious to patients and providers; however, the influence of war-like messaging, including common use of words such as "battle," "fight," "enemy," "punishment," "winning," and "losing," impacts care encounters in ways that may be unnecessarily reductionist and polarizing. These words and phrases portray illness experiences as representing 2 extremes, winning or losing, without an intermediate state. Nurses need to consider this messaging and its potentially adverse influence on illness and healing experiences.

Some health care professionals assert that patients' and providers' cancer experiences are diminished when war vocabulary is used to describe these events. Nurses should reflect on whether "the vocabulary of war ultimately diminishes and politicizes the suffering of cancer patients.1^(p4A) When patients are characterized as soldiering through the cancer battle, if they lose this battle, it suggests that they did not fight fiercely enough, an untrue representation of the terminal care experience, particularly given that not all cancers or other illness can be cured. This depiction of patients diagnosed and living with cancer as representing soldiers in war places significant burden on people who are already struggling with illness and the associated challenges of cancer. Burdening them further with the obligations of soldiering on is unreasonable and, perhaps, unfair.2

Published literature offers insight into the difficulties encountered by oncologists when needing to accept the reality that sometimes treatments fail to work or they stop working and active treatment needs to shift into palliative care.3 Duska3 suggests that the analogy of the care provider as strategist who holds and controls the weapons of the cancer battle contributes to the idea that the provider has lost rather than having appropriately recognized and respected the limits of treatment. This perspective makes it more difficult to shift the care approach to better suit the circumstances of the whole patient. A healthier and more positive tactic would be to support a transition to palliative care or hospice care without the patient or health care professional feeling a sense of personal failure or metaphorically waving a white flag during battle. An example of a helpful protocol to guide professionals with end-of-treatment conversations includes a discussion organized by setting, perception, invitation for information, knowledge, empathy, summarize, and strategize, otherwise known as the SPIKES protocol.3 This tool may also assist in helping the provider and the patient to move away from the messaging of a war lost to a call for a remaining life that is well lived.

Modern triage is informed by sorting strategies that were initiated during war centuries ago. Treatments are often described as fighting the illness of concern; for example, "battling" heart disease, Alzheimer disease, or osteoporosis. Health care professionals discuss with patients the importance of "destroying" certain types of cells or bacteria. It is not uncommon to hear health care team members discuss the need to "defeat" certain illnesses or associated illness components. The phrases, "we'll fight this together," "the fight of your life," or an "arsenal of therapies," conjure visions of violence and battle. The victor of this battle will win and earn good health and continued life. This visage of winning versus losing as experienced by living versus dying is problematic.

War messaging metaphors are not confined to the cancer fight. Chronic illnesses or acute event experiences are also often described using battlefield metaphors. A recent publication describes war metaphor usage during COVID-19.4 The pandemic was referred to as an armed battle in which care providers were deployed to the front lines to wage war. The federal government's efforts included mobilizing supply chains to pull necessary personal protection equipment and other ammunition from national stockpile reserves. A genuine military response to COVID-19 included field hospitals and military ships designed to triage, treat, and manage the ill and the dead. Like the writings of many others, Clark and Altin4 observe that the language of health care often includes words of war. They assert that this metaphoric language is associated with worsened stigmatization because personal experiences of suffering are expunged from the narrative. The depiction of a battle against COVID-19 has been like the war against the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic and because HIV/AIDS was similarly poorly understood, fear and shame were triggered, in part, in response to this militarization of language in health care.4

The lessons informed by the literature concerning war and battlefield metaphoric messaging need to be carefully considered by nurses and their colleagues. Nurses should lead interprofessional team discussions about being conscious of metaphors that promote an either-or/winning-losing conceptualization of illness. There is value associated with metaphor usage. The literature suggests that patients understand metaphors and they feel positively about physicians using metaphors because doing so is perceived as the provider putting effort into making certain that the patient understands his or her conditions and circumstances. The concern is that metaphors linking health and illness experiences to a war-like state may be counterproductive and damaging to patients and health care professionals.5 Nurses should reflect on their role in partnering with patients and families on their journeys through illness experiences, including cancer, COVID-19, chronic illness, and acute events. Health care professionals should assure patients of a partnership that focuses on the best way forward to healing the illness, managing the illness experience, or living their remaining time with the quality of life and dignity that they deserve with the expert guidance required to achieve the most positive patient-centered outcomes.

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