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. Life-Threatening Illness
Choices in life-threatening illness
Urgency depends on life expectancy
Patient has right to choose or refuse treatment

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. The Patient with Cancer
Even if “no treatment” is chosen, there is much that can be done to assist the patient in remaining comfortable

12. 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

13. Stages of Grief Dr. Elisabeth Kubler-Ross established stages of grief
Denial
Anger
Bargaining
Depression
Acceptance

14. 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

15. 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

16. 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