Chapter 5 The Therapeutic Approach to the Patient with a Life-Threatening Illness © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Life-Threatening Illness Implies a life that in all probability will be shortened because of a serious or debilitation illness or disease Cultural perspective on life-threatening illness How you live, think, speak, and behave Viewed differently by different cultures Pain is viewed in the same manner Family strongest influence Work with family and belief system © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2

Choices in Life-threatening Illness (Slide 1 of 3) Urgency of decisions depend on possible life expectancy Provider may ask the patient how they might like to be involved in the decision- making process Patients have right to choose or refuse treatment Palliative care focuses on quality of life, relieving symptoms of pain and suffering © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3

Choices in Life-threatening Illness (Slide 2 of 3) Choices to be made in life-threatening illness May forgo treatment Palliative care Voluntarily stop eating and drinking Total sedation In a few states, option to seek aid in dying, usually through self-administration of prescribed medication © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4

Choices in Life-threatening Illness (Slide 3 of 3) Issues to be considered/discussed with patients Alternative treatment Pain management Health care directives Emotional needs of patient and family members Finances © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5

The Range of Psychological Suffering Anxiety, depression, denial, hopelessness Often leads to physical symptoms Help patients understand that relationships change Encourage patients to set goals for themselves Listen carefully and seek clues to nonverbal communication Examples of life-threatening illness: coronary artery disease, chronic obstructive pulmonary disease, diabetes, Alzheimer's © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 6

Patients with Cancer Patients equate cancer with death There are many treatment options available Surgery, radiation, chemotherapy, hormone therapy, transplants, immunotherapy, combination therapy Patients may feel empowered by taking an active role in the decision making process Serious side effects from both radiation and chemotherapy Even when there is “nothing more to do” related to the cancer, there is still “much to do” to maintain comfort © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7

Patients with HIV/AIDS (Slide 1 of 2) Patients will have great stress when diagnosed with Human Immunodeficiency Virus (HIV) or Acquired Immune deficiency syndrome (AIDS) May have fairly good health for a period or very serious near-death illness Recent developments in treatment of HIV infection and AIDS help patients to live longer Lives greatly compromised because of suppressed immune system With diagnosis comes anger, fear, guilt © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8

Patients with HIV/AIDS (Slide 2 of 2) HIV affects mostly individuals who are relatively young Treating HIV is expensive, and many patients have little or no insurance coverage Patients may experience central nervous system involvement Late stage HIV is called AIDS when CD4 count is less than 200 Other criteria for AIDS are types of opportunistic infections or tumors, AIDS-related brain or lung illnesses, and severe body wasting © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9

Patients with End Stage Renal Disease Loss of kidney (renal) function leads to end- stage renal disease Patients cannot live long unless they receive dialysis or kidney transplant Dialysis is filtering blood to remove wastes and can sustain life for years Some patients will opt not to have dialysis and to let death come from kidney failure Kidney failure leads to little or no urine output © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10

Communication in End-Of-Life Care Most patients choose to have some control over the end-of-life process Questions to the patient may include What is most important to you now? What are you hoping for? What plans have you made for this transition? How can my team assist you? Professionals must remain respectful and empathetic © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11

The Stages of Grief (Slide 1 of 2) Dr. Elisabeth Kübler-Ross determined stages of grief Denial, anger, bargaining, depression, and acceptance See Quick Reference Guide: Stage of Grief TEAR is also used to describe grieving process T = To accept the reality of the loss E = Experience the pain of the loss A = Adjust to what was lost R = Reinvest in a new reality © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12

The Stages of Grief (Slide 2 of 2) Not all patients go through all five stages Some patients go through all five stages over and over again, each time with a little less stress Others get stuck in one stage No two patients follow the same pattern Family members also suffer grief and are often in different stages © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13

The Challenge for the Medical Assistant Be sensitive and respectful Must be comfortable treating all patients Nonmedical forms of assistance Referrals to community-based organizations Recommend support systems Spiritual support © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14