Lecture 12 - PSYC Issues in Terminal Diseases

Question 1

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

Answer 1

A. Controltheir emotional reactions to illness

Question 2

explain Death Across the Lifespan: First Year of Life

Answer 2

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

Question 3

what campaign cure SIDS deaths by 50%

Answer 3

‘Back to Sleep’ campaign cut SIDS deaths by 50% (from 1999-2004)

Question 4

Death between ages 1-15 years ì Causes?

Answer 4

1. accidents 2. childhood lukymia

Question 5

how is Death in Middle Age viewed

Answer 5

Prospect of dying becomes more realistic
ì More common
ì Development of chronic mortality-related diseases

Question 6

how it Death Across the Life Span: Old Age viewed

Answer 6

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

Question 7

is death anxiety real

Answer 7

yes

Question 8

what is Thanatophobia

Answer 8

fear of death

Question 9

what is necrophobia

Answer 9

fear of dead bodies

Question 10

what are some Fear of Death - Intervention

Answer 10

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

Question 11

why is communication an issue around death

Answer 11

ì Death is still a taboo subject
ì Medical staff, family, and patient
ì May believe the others don’t want to discuss death

Question 12

Are There Stages in Adjustment to Dying? Kϋbler-Ross’ 5 Stages (1969)

Answer 12

denial, anger, bargaining, depression, acceptance

Question 13

explain the stage of denial

Answer 13

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)

Question 14

explain the stage of anger

Answer 14

Why me? Why not him? Or her?

Question 15

explain the stage of barganing

Answer 15

A pact with God, trading good

behaviour for health

Question 16

explain the stage of depression

Answer 16

Coming to terms with lack of control, a time of “anticipatory grief􏲐

Question 17

explain the stage of acceptance

Answer 17

Tired, peaceful (not always pleasant),

calm descends

Question 18

why did Kϋbler-Ross’ 5 Stages become popular

Answer 18

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

Question 19

Are There Stages? Evaluation of Kϋbler-Ross’ Theory

Answer 19

not really

Question 20

What are the criticisms? of Kϋbler-Ross’ Theory

Answer 20

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)

Question 21

why re the stages a problem for clinical practice?

Answer 21

We now know that dying is a complex and individual process, subject to no rules and few regularities

Question 22

Where are People Dying?

Answer 22

Approximately 67% of Canadian deaths take place in the ICU’s of hospitals
ì In 1950s: just over 50%

Question 23

why is it an increasing trend for people to die in ICU

Answer 23

it was normal to die at home

now med. advances have people expecting that they can be kept alive longer in ICU

Question 24

why is Dying in a the ICU unpleasant

Answer 24

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

Question 25

what is another option for dying

Answer 25

Other Situations: Hospice Care and HomeCare

Question 26

explain Hospice Care

Answer 26

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

Question 27

explain Home Care for a dying individual

Answer 27

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