Chapter 6 The Therapeutic Approach to the Patient with a Life-threatening Illness
Life-Threatening Illness Cultural perspective on life-threatening illness How you live, think, speak, and behave Viewed differently by different cultures Family strongest influence Work with family and belief system
Life-Threatening Illness Choices in life-threatening illness Urgency depends on life expectancy Patient has right to choose or refuse treatment
Life-Threatening Illness Issues appropriate to discuss with patients facing life-threatening illnesses are: Any alternative treatment methods Pain management Legal protection Durable Power of Attorney for health care Health care directives Patient Self-Determination Act
Life-Threatening Illness Finances, insurance coverage Emotional needs of patient and family Life-threatening illness is a family illness Health care professionals have primary patients (the one with the illness) and secondary patients (family members and loved ones of the patients) Helping patients live their last days is important
The Range of Psychological Suffering Help patients understand that relationships change Encourage patients to set goals for themselves Listen carefully and seek clues to nonverbal communication
The Patient with HIV Patients will have great stress when diagnosed with HIV May have fairly good health for a period or very serious near-death illness Patients now living much longer with recent treatment modalities
The Patient with AIDS AIDS is diagnosed by symptoms and any patient immunodeficient illnesses Some physicians use the patients’ CD4 counts for diagnosis Others find this too discouraging for patients
The Patient with AIDS There is added stress if patient is estranged from family Treatment of AIDS is very expensive; some have little or no insurance See the text for possible symptoms patients may display
The Patient with Cancer Patients believe cancer and death are equated Choosing treatment is complicated and has many facets Patients fear the side effects of cancer treatment and their loss of dignity Refer to the Critical Thinking Box for class discussion
The Patient with Cancer Even if “no treatment” is chosen, there is much that can be done to assist the patient in remaining comfortable
The Patient with ESRD Patients cannot live long when kidneys fail Kidney dialysis can sustain life for years Without kidney dialysis, a kidney transplant is the only hope There are not enough kidneys for all patients who need one See the text for symptoms to expect as death nears
Stages of Grief Dr. Elisabeth Kubler-Ross established stages of grief Denial Anger Bargaining Depression Acceptance
Stages of Grief The acronym TEAR To accept the reality of the loss Experience the pain of the loss Adjust to what was lost Reinvest in a new reality
Stages of Grief Patients may not go through all the stages, may go through all stages many times, may move back and forth through the stages Family members and loved ones related to the person with the life-threatening illness experience the same stages, but usually not in the same stage at the same time as the patient
The Challenge for the Medical Assistant Must be sensitive and respectful Must be comfortable treating all patients Nonmedical forms of assistance Referrals to community-based organizations Recommend support groups Spiritual support Refer students to Critical Thinking Box for discussion