Health - End of Life Flashcards
To enhance awareness and understanding of:
• End of Life issues
• Palliative care
• The grief and bereavement process
• Factors affecting grief experience
• Early vs. current bereavement theories / models of grief
• To reflect on how to provide effective grief and bereavement
interventions/support
d
About ___% of people are forewarned of their death, but less than ____% are offered palliative services.
Most people want to die with _______. Autonomy, peaceful, respect what was important to them and their values, wishes respected, quality of life, pain-free, other family members not taking over, etc
People fear the ______ of dying and the _____ and _______.
50
30
dignity
process
pain
suffering
Palliative care is an approach that improves the _______ of _____ of patients and their families.
It aims to prevent and relieve _______ by means of early __________, assessment and __________ of pain and other problems.
It affirms life and regards dying as a ______ process. Does not hasten or _______ death.
There is a huge ____-______ team behind it.
quality of life
suffering
identification
treatment
normal
postpone
multi-disciplinary
What do the old and new approaches look like with palliative care vs hospice care?
Old - palliative care the same as hospice care
New - life-prolonging care - but also introduce palliative care (as part of the time).
As the disease progresses and curative care stops, focus on pain relief. Then you introduce palliative care more and more. It is also important to offer bereavement counselling after the death for the family.
ALL hospice care is palliative care BUT not all palliative care is hospice care.
What kind of evidence exists for referring people to palliative care early-on?
Better QOL, longer survival, better mood, minmises car-giver distress, less aggressive treatments (b/c they want to fight to the very end), etc
From 2 RCT studies and one qualitative study
–> PC is key to maintain the highest possible quality of life
Given the evidence, it is clear that PC should be strongly considered and referral should come from health professionals. It is important to raise the topic and be open/honest. It is especially important to clarify and correct _______.
misconceptions
Grief
What do the terms bereavement, grief and mourning mean??
Bereavement - the state of having experienced a loss
Grief - passive and involuntary reaction to the state of bereavement (holistic reaction), including affective, cognitive, physical, behavioural and spiritual experiences
Mourning - the active process of coping with bereavement and grief –> social/public displays of brief based on cultural, religious and philosophical beliefs.
Grief is a _____ and ______ process. We not only lose the _____ but also the ______.
It is a very _______ process. You never recover from grief - there are always ______.
We have to be careful not to _______ grief too much.
normal
natural
past
future
individualised
triggers
pathologise
What affects grief responses?
- length of time to prepare
- intimacy of relationship
- nature of the relationship
- change of lifestyle required leading up to the death (money changes, work adjustments)
- physical and mental health
- history of loss
- religion
What is the Widower Effect?
First month after partner dies (or those over 65 yrs) - risk of death is significantly higher (50%) and about 20% in the first year.
Reasons are mainly due to:
- increase in unhealthy behaviours
- social withdrawal
- type of medical condition (and how involved the partner was as a carer)
Ross (1969) 5 stages of grief was established initially to explain emotions _____ someone dies.
Complementing this were ____ theories - if you do these tasks and actions you will increase your chances of ______ ___. (TEAR)
- To ______ the loss (participating in death rituals)
- E______ pain of loss (expressing the pain)
- Adjusting to the new _______, new _____ (widow, not wife), etc
- R______ in the new reality (make new friends, go out and laugh, etc)
before
task
moving on
accept experience environment roles reinvest
Pros and Cons of Ross 5 stages of grief theory and task theory?
PROS
- Useful therapeutic tools - easy to use to normalise and validate the experience
- task theory identifies specific actions the person can do
- easy to understand
- can explain experiences
CONS
- definite number of responses to bereavement - descriptive and limited in scope (the process is much more fluid)
- overly-simplify something that is very complex
- individual differences
- gender/cultural differences
- outcome oriented “moving on”
- used for pathologising grief (unresolved grief of parents who lose their child)
—> this stage model does NOT address the number of physical, psychological, social and spiritual needs of the bereaved.
Current models of grief
Bonanno et al., 2002 interviewed and assessed many, many people. He found that most people are very ______, and there is often no need for ______.
Often intervening too early can be harmful.
resilient (there is still distress there but people can function)
therapy
Current models of grief
Current trends are moving away from…
They are questioning the role of…
There is a shift from detachment or “moving on” to…
Acknowledging….
Development of…
…linear stage models
…grief work
…maintaining symbolic bond with the deceased
…individual and cultural differences
…growth models and resilience (good things need to be recognised too)
Current models of grief
Stroebe and Schut (1999) Dual Process Model describes….
Oscillation between:
1. Loss-oriented coping (emotional/reactive aspects)
AND
2. Restoration-oriented coping (dealing with many life changes and new roles)
