1. Chapter 6
The Therapeutic Approach to the Patient with a Life-threatening Illness

2. 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

3. Choices in Life-threatening Illness
Urgency of decisions depend on possible life expectancy
Patients have right to choose or refuse treatment
Palliative care focuses on quality of life, relieving symptoms of pain and suffering

4. Choices in Life-threatening Illness
VSED (voluntarily stop eating and drinking)
Total sedation; medication causes unconsciousness and eventually death
In a few states, option to seek aid in dying

5. Choices in Life-threatening Illness
Issues appropriate to discuss with patients facing life-threatening illnesses:
Alternative methods of treatment
Pain management and treatment
Loss of self image and independence
Legal protection
Durable power of attorney for health care or health care proxy
Health care directives
Patient Self-Determination Act

6. Choices in Life-threatening Illness
Issues appropriate to discuss with patients facing life-threatening illnesses:
Finances; insurance coverage
Emotional needs of patient and family
Life-threatening illnesses are family illnesses
Primary patients (the one with the illness)
Secondary patients (family and friends of patient)
Helping patients live their last days is important

7. The Range of Psychological Suffering
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

8. The Patient with HIV/AIDS
Patients will have great stress when diagnosed with HIV or 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

9. The Patient with HIV/AIDS
HIV affects mostly individuals who are relatively young
Treating HIV expensive
Many patients have little or no insurance coverage

10. The Patient with HIV/AIDS
May experience central nervous system involvement
AIDS when patients’ CD4 counts decline to less than 200
Particular type of opportunistic infection or tumor, AIDS-related brain or lung illness, severe body wasting

11. The Patient with Cancer
Patients believe cancer and death equated
Choosing treatment complicated and has many facets
Treatments are surgery, radiation, chemotherapy or combination

12. The Patient with Cancer
Patients can experience 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

13. The Patient with ESRD
Loss of kidney (renal) function leads to end-stage renal disease (ESRD)
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

14. The Stages of Grief
Dr. Elisabeth Kübler-Ross determined stages of grief
Denial
Anger
Bargaining
Depression
Acceptance

15. The Stages of Grief 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

16. The 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

17. 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