1. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Twelve: Psychological Issues in Advancing and Terminal Illness

2. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Death across the life span Psychological issues in advancing illness Are there stages in adjustment to dying? Psychological management of the terminally ill Alternatives to hospital care for the terminally ill Problems of survivors 2

3. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Lack of free or low-cost maternal care programs Congenital abnormalities Sudden infant death syndrome (SIDS): Condition where an infant stops breathing, which is to occur: In lower-class urban environments 3

4. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. If the mother smoked during pregnancy If baby is put to sleep on its stomach or side Children under age fifteen Accidents Cancer 4

5. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Think of death as a great sleep Curious about death Ages up to five Idea that death is final develops No biological understanding of death Ages between five and nine Moderate understanding of the processes involved in death Realize that the person who has died will not return Ages nine or ten 5

6. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Unintentional injuryHomicide SuicideCancerHeart diseaseAIDS 6

7. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Young adults facing a terminal illness Feel shock, outrage, and an acute sense of injustice May face a long and drawn-out period of dying 7

8. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Becomes more realistic since: It is more common Chronic health problems leading to death can develop Premature death: Occurs before the projected age of 78 Mainly caused by heart attack or stroke 8

9. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Most people prefer a sudden death as: It facilitates a more graceful departure Their family does not have to witness their worsening condition Finances and other resources are not severely taxed Socioeconomic status is a strong determinant of age of death 9

10. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The elderly are more prepared to face death as they have: Seen friends and relatives die Thought about their death and made some preparations Causes Degenerative diseases Physical decline that predisposes them to infectious disease or organ failure 10

11. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Factors that predict mortality in the elderly New illnesses and the worsening of preexisting conditions Poor mental health and reduced satisfaction with life Women live longer than men 11

12. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Patient Self-Determination Act - Requires health facilities to have policies concerning patients’ wishes for life-prolonging therapy Right-to-die movement - Maintains that dying is more a matter of personal choice and personal control 12

13. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Euthanasia: Ending the life of a person who is suffering from a painful terminal illness Living will: Instructions and legal protection for the physician So that life-prolonging interventions will not be indefinitely undertaken Does not always ensure patient’s requests are met 13

14. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Changes in the patient’s self-concept Issues of social interaction Communication issues 14

15. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Reasons for people falling prey to dubious remedies Hope for a miracle cure Deteriorating relationship with the formal health care system Desire for a more humanistic care 15

16. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Denial - Patient’s initial reaction on learning of the diagnosis Defense mechanism by which people avoid the implications of an illness Anger - Harder response for family and friends to deal with Patient is not really angry with them but at fate 16

17. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Bargaining - Trading good behavior for good health Depression - Time for anticipatory grief Patient mourns the prospect of his/her death Acceptance - A tired, peaceful calm descends Patients decide to divide up their possessions and say goodbye to friends and family 17

18. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Patients do not: Go through the stages in a predetermined order Fully acknowledge the importance of anxiety One of the most common responses 18

19. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Provide physical assistance Help reduce pain See patients on a regular basis Are the only source of realistic information Are privy to the patient’s act of dying 19

20. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Physical care that is palliative Palliative care: Designed to make the patient feel comfortable Curative care: Designed to cure the patient’s disease 20

21. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Staff may burn out from watching patient after patient die Patients interpret it as abandonment when the physicians spend less time with them Physicians spend less time with terminally ill patients to dedicate their time for patients who can most profit from it 21

22. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Informed consentSafe conduct Significant survivalAnticipatory griefTimely and appropriate death 22

23. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Therapy Short-term Nature and timing of visits depend on the patient’s desires and energy level Thanatologists: People who study death and dying Believe that cognitive-behavioral therapies can be constructively employed with dying patients 23

24. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Children infer about their condition by taking cues from: Their treatments People around them Counseling Helps therapists take cues about what to discuss from the child 24

25. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Helps parents to cope with the impending death Restores balance in a family with other children Provides supportive mental health services to the parents who experience post-traumatic stress disorder 25

26. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Provide palliative care and emotional support to dying patients and their family members Hospice: Place that provided care and comfort for travelers in medieval Europe Painful or invasive therapies are discontinued Oriented toward improving a patient’s social support system 26

27. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Taking care of the patient at home Most popular and economically feasible Provides psychological advantages for the patient Stressful for the family 27

28. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Grief: Feeling of hollowness marked by: Preoccupation with the image of the deceased Expressions of hostility toward others Guilt over the death Grief response is more aggravated in: Men Caregivers People whose loss was sudden and unexpected 28

29. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Biggest burden For women - Financial strain For men - Strains of managing a household Death of a sibling raises complications for children Children should be prepared for the death Questions should be answered honestly Information should be provided at the right time 29

30. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Developing realistic expectations about: What modern medicine can achieve The kind of care the dying want and need Colleges have developed courses on dying Volunteer work with dying patients Potential problem - Unintended encouragement for self-destructive leanings 30