disease and palliative 3

Question 1

Psychosocial
symptoms in the
palliative patient

Answer 1

 Anxiety/ restlessness/ agitation
 Anger
 Depression
 Unrealistic goals
 Request to die
 Confusion
 Support for the family: grief, bereavement.

Question 2

Risk factors for psychosocial
stressors in cancer patients
Individual factors

Answer 2

 Younger age
 Single, separated, divorced, widowed, living alone
 Having children younger than 21 years
 Economic adversity
 Poor marital functioning
 Past psychiatric treatment, especially depression
 Cumulative stressful life events
 History of alcohol or other substance abuse
 Female gende

Question 3

Causes for psychosocial

stressors in cancer patients

Answer 3

1. Untreated anxiety and depression.
2. Medication induced/ multiple medications.
3. Untreated symptom management: pain,
   breathlessness.
4. Family distress
5. Fear of death
6. Loss of control.
7. Previous drug/ nicotine/ alcohol dependence

Question 4

Principles of symptom
management psychosocial
stressors in cancer patients

Answer 4

 Evaluation
 Explanation
 Discussion
 Individualised treatment
 Attention to detail
 Monitoring progress.
 Rapid dose escalation as
symptoms progress.

Question 5

Terminal sedation

Answer 5

Terminal sedation is often given for patients who have not
accepted death and would rather just “go to sleep”
 Normally, midazolam is used in a syringe driver for a continual
subcutaneous infusion.
 It is given at therapeutic levels, so that if small amounts are
needed that can be given, and escalated as needed.

Question 6

Terminal sedation for patients and symptoms

Answer 6

This treatment is only used in patients who have intractable
symptoms, i.e. symptoms that are unrelieved by any other method.
 These symptoms can include anxiety, extreme distress, extreme pain
unrelieved by any analgesia, uncontrolled haemorrhage.

Question 7

Ethical dilemma of terminal

sedation

Answer 7

Is this just euthanasia with another name?
 Discussion of the Principle of Double Effect.
“Doing something good (relieving a patient’s pain) may
have a bad side effect (hastening death): It is still morally
good, because the INTENTION was not to kill.”

Question 8

terminal

sedation should be

Answer 8

1. the nature of the act is itself good.
2. the agent intends the good effect and does not intend
   the bad effect and minimises the harm.
3. The circumstances are sufficiently grave to justify
   causing the bad effect.

Question 9

Depression

in dying

Answer 9

Depression is NOT a normal part of dying. It needs to be

assessed and managed.

Question 10

Signs and symptoms of major depression

Answer 10

 Depressed mood and an inability for this to be
lightened
 Loss of pleasure or interest (even within the limitations
of the illness)
 A sense of worthlessness or low self-esteem (eg feeling
a burden to others)
 Fearfulness / anxiety
 Brooding or excessive guilt / remorse
 A pervasive sense of hopelessness or helplessness
 Suicidal ideation
 Prominent insomnia
 Excessive irritability
 Indecisiveness.

Question 11

Treatment of Depression dying

Answer 11

 Assessment of any organic cause, like an
electrolyte imbalance, hypothyroidism, drug
reactions: steroids can cause mood imbalances,
excessive sedation, etc.
 Supportive counselling, including social worker,
psychologist if necessary.
 A trial of anti-depressants.
 Referral to a psychiatrist may be needed.

Question 12

 Dying brings decline in many aspects of a person’s

existence

Answer 12

: health, loss of social networks, loss of
control and the feeling of being completely alone
with the reality of the end of one’s existence.

Question 13

Existential distress at the end of life has been defined

as:

Answer 13

1. Feeling hopeless
2. Feeling like a burden to others
3. Loss of sense of dignity,
4. Desire for death or loss of will to live

Question 14

There is a significant relationship between a cancer

patient’s distress

Answer 14

and the distress of his or her carer -
they experience similar levels of distress.
(Care Search from caresearch.com.au)
 Multidisciplinary palliative care team needs to find a
way to address these needs.
 Recent research show that stress in teams can
influence an individual’s experience.
 Evidence has shown that if the palliative team does
not attend to these issues, they may contribute to the
unnecessary use of deep continuous sedation and
even euthanasia.