Aim: For newly diagnosed patients with metastatic lung cancer who receive their care in an ambulatory setting, questions relating to timing of referral to palliative care have been raised in the literature. This article examines these issues and formulates recommendations to further improve care for patients with newly diagnosed metastatic lung cancer. Design: An integrated literature review Method: Search terms included lung neoplasm, palliative care and referral and consultation. Full text articles in English between the years 2008 and 2014 were included. Titles and abstracts were reviewed to determine their suitability for inclusion in the review. Those that did not relate to metastatic non-small lung cancer, duplicates or those that only referred to end of life referrals were excluded. Result: The initial search yielded 45 articles once inclusion and exclusion criteria were applied eleven articles were included in the review. Key themes that were identified were: time of referral to palliative care, stigma associated with the term palliative care, duration of chemotherapy, health care professional perceptions and attitudes to death and dying. Conclusion: There is a need for planning end of life care in the early stage of diagnosis of this disease for these patients. Nurses working within a palliative care team are ideally placed to provide this supportive care and initiate this important conversation.