Lecture 8 - Death and Dying Flashcards
What is the culture about dying in the US?
It’s not something to be talked about, it’s to be avoided rather than a natural part of life.
It’s seen as a failure of our medical care and reflects negatively on the physician.
What did Dr. Kubler-Ross feel about death?
That modern technology was to blame for the increase fear of death and dying.
It’s opposite to our cultures defining values like youth, progress, and achievement.
What is thanatology?
The study of death and dying.
What is the belief about dying that many physicians hold?
That death is to be fought and avoided at all costs.
What are the stages of death/illness? What is the order?
Denial, anger, bargaining, depression, and acceptance.
No sequence of stages has been established.
What stage is a person in late in life? Describe each component.
Integrity vs. Despair
Despair: loss of hope, sense that life is meaningless, fear of death.
Integrity: satisfaction of productive life, enjoys fruits of one’s labors, acceptance of life cycle, acceptance of death.
What are characteristics of the end of life in the US?
Treatment often more intense than pts and family want.
Pts not dying where they want to die.
Care is fragmented.
Where do people WANT to die? Where do they actually die (these are in parenthesis)?
Home : 60-70% (34%)
Hospital: 20-40% (25%)
Nursing home: 0% (28%)
46% of families of patients who died in the hospital reported dissatisfaction with what?
Symptom control, level of participation in the decision making process, and communication with clinicians.
Why is death considered a failure on the part of the provider?
Due to the fear of missing a “treatable” problem.
Poor training in end-of-life care communication and decision making.
Fear of ethical or religious impropriety.
Fear of litigation.
What are difficulties that the patient and family face with approaching death?
Difficulty accepting death.
Over-expectations regarding the effectiveness of medical care.
Failure to participate in advance care planning discussions.
Fear of dying at home and fear of giving up.
What are system based forces that come into play in terms of death?
Increased # hospital bends = increased hospital deaths.
Lack of structure to support excellent end of life care in all settings.
Advances in life prolonging treatment for many illnesses.
What is palliative medicine and what does it emphasize?
Care for patients with serious illnesses.
Emphasized quality of life involving the physical, psychological, spiritual, and social aspects of the pts well-bring.
Works with pts other providers.
What is hospice?
A care plan that focuses on comfort as the primary goal vs care.
Support for pts and families nearing end of life.
Is an insurance benefit.
What is the criteria for hospice admission?
Recommendation of physician, life expectancy of 6mo or less if illness runs its normal course, no longer seeking cure, and a desire to stay out of the hospital.
What are the goals of hospice?
Treat the pt, not the disease.
Affirms life and regards dying as a normal process.
Emphasizes quality of life rather than length of life.
Addresses the pt and family’s medical, social, emotional, and spiritual needs.
Who are the core hospice team members?
Nurse, social worker, chaplain, volunteer coordinator, bereavement coordinator, pts personal physician, hospice medical director.
Where can hospice be provided?
Home, nursing facility, assisted living, hospital, residential hospice facility, prison, or wherever the pt is.
