Lecture 12 - PSYC Issues in Terminal Diseases Flashcards
Denial is useful in helping patients
A. Controltheir emotional reactions to illness
B. Monitortheirphysical condition
C. Becomeactivein their treatment regimen
D. Denial is never helpful
A. Controltheir emotional reactions to illness
explain Death Across the Lifespan: First Year of Life
In the first year of life, the main causes of death congenital abnormalities and sudden infant death syndrome SIDS:
ì Causes not entirely known
ì Infant simply stops breathing during sleep ì Enormous emotional toll for parents
what campaign cure SIDS deaths by 50%
‘Back to Sleep’ campaign cut SIDS deaths by 50% (from 1999-2004)
Death between ages 1-15 years ì Causes?
- accidents 2. childhood lukymia
how is Death in Middle Age viewed
Prospect of dying becomes more realistic
ì More common
ì Development of chronic mortality-related diseases
how it Death Across the Life Span: Old Age viewed
ì ‘readiness to die ì Typically die of degenerative diseases ì preparations for dying with dignity ì Women live longer than men (average 5 years) – Why? ì Hypotheses: less risk taking; more social support; see doctors more often
is death anxiety real
yes
what is Thanatophobia
fear of death
what is necrophobia
fear of dead bodies
what are some Fear of Death - Intervention
Some CBT strategies:
ì Activities to face (i.e., not avoid the idea of)
death:
ì Considering any situation avoided because of fear
of death. If these are situations others would face,
making a plan of graded exposure
ì Help preparing a will
ì Help reading obituaries
ì Help preparing person’s own obituary
ì Practicing dealing with first person accounts of
someone who is coming toward their own death
ì Visiting the cemetery
why is communication an issue around death
ì Death is still a taboo subject
ì Medical staff, family, and patient
ì May believe the others don’t want to discuss death
Are There Stages in Adjustment to Dying? Kϋbler-Ross’ 5 Stages (1969)
denial, anger, bargaining, depression, acceptance
explain the stage of denial
ì A mistake must have been made; test
results mixed up
ì Is both normal and useful early on in adjustment to life-threatening illness (Lazarus, 1983)
explain the stage of anger
Why me? Why not him? Or her?
explain the stage of barganing
A pact with God, trading good
behaviour for health
explain the stage of depression
Coming to terms with lack of control, a time of “anticipatory grief
explain the stage of acceptance
Tired, peaceful (not always pleasant),
calm descends
why did Kϋbler-Ross’ 5 Stages become popular
makes sense, happy end, people know what to expect
Why is it a valuable contribution? ì Broke the taboos surrounding death
ì Pointed out counseling needs of people who are dying ì Helped establish hospice care
Are There Stages? Evaluation of Kϋbler-Ross’ Theory
not really
What are the criticisms? of Kϋbler-Ross’ Theory
Mixed evidence that there are indeed 5 distinct stages and
that people go through them in this predetermined order
ì Stages can occur in different orders (K-R admitted this herself)
ì some patients never go through a particular stage(e.g. might go right to acceptance)
Stages do not have a (psychological) explanation
ì No explanation in theory itself why adaptation to dying is organized into sequential stages, what function they serve, or how people move from one stage to the next
Stages are somewhat random:
ì Some are emotional stages (anger, depression)
ì Others are cognitive processes (acceptance, denial)
why re the stages a problem for clinical practice?
We now know that dying is a complex and individual process, subject to no rules and few regularities
Where are People Dying?
Approximately 67% of Canadian deaths take place in the ICU’s of hospitals
ì In 1950s: just over 50%
why is it an increasing trend for people to die in ICU
it was normal to die at home
now med. advances have people expecting that they can be kept alive longer in ICU
why is Dying in a the ICU unpleasant
ì Depersonalized
ì Tubes everywhere
ì Focus on medical aspect and lack of staff: ì Lack of emotional support
ì Restricted visits
ì Disagreements between family members about
end-of-life decisions
Death can be long, mechanized, painful and dehumanized
what is another option for dying
Other Situations: Hospice Care and HomeCare
explain Hospice Care
ì Pain is managed, invasive treatments discontinued
ì Psychological comfort is stressed
ì Due to these factors, hospices are increasingly being incorporated into traditional treatment
explain Home Care for a dying individual
Care for people who are dying in the home ì Favored choice of terminally ill patients
ì Provides them with higher personal control and social support
Can present challenges for family members
