Suffering CBM and Dignity Oxford and Coping Oxford Flashcards
1
Q
What is suffering?
A
- State of severe distress that is personal, individual and subjective.
- Perception that something is actually or potentially threatening the integrity of one’s self and personhood.
- Recognition of one’s mortality
- Expressed as fear, sadness, anguish, abandonment, despair
2
Q
List sources of suffering in palliative care
A
- physical, social, psychological and existential distress
- associated with loss (self, relationships, control, purpose)
- role identity loss
- out of control when pain ++, source of pain unknown, meaning of pain, chronic pain.
- hopelessness - requests for hastened death
- feeling of being a burden
- spiritual pain
3
Q
What influence do health care providers have on patient and family suffering?
A
- positive and negative
- affirm sense of dignity and personhood
- negative: insufficicent information, not answering questions, uncaring communication, blunt communication
- suffering must be heard and accepted at face value
- normalizing feelings and responses
4
Q
Suffering in caregivers and families
A
- new role identities
- physical, financial, psychological dimensions of caregiving
- witnessing a loved one’s suffering
- poor QOL, more regret, high risk of MDD if eol conversations not happening with physicians
- more suffering in caregivers if aggressive interventions used.
- family members suffering proportional to patient’s suffering
*
5
Q
Approach to alleviate suffering/ preserve dignity
A
- never assume basis of suffering.
- “Are you suffering?”
Questions to uncover sources of distress
- “Are you frightened by all this?”
- “Are there things even worse than this pain?”
- “Are there things that you wish you could still do that have become difficult?”
- “What do I need to know about you as a person to provide the best possible care?”
6
Q
Dignity conserving care
A
-
A: Attitude
- beliefs, assumptions we hold towards patients
-
B: Behaviour
- kindness, respect. acknowledge WHO the person is
-
C: Compassion
- awareness of suffering and desire to relieve it.
- humanites, literature, art, self reflection on own humanity, vulnerability
- look, touch, simple comments.
-
D: Dialogue
- mindful, sensitive communication
- art of listening to what is said and unsaid.
7
Q
What can be done when suffering seems interminable?
A
- must be lived through and endured
- acknowledgment and bearing witness
- conveys their worthiness of our attention and respect.
- Psychotherapy:
- life review
- legacy therapy
- meaning centred therapy
- dignity therapy : tangible document from tape recorded sessions with the patient, augments sense of meaning and purpose
- Sedation : last resort and controversial
8
Q
Model of dignity in the terminally ill
A
- Illness related concerns:
- symptom distress
- physical and psychological distress
- level of independence (cognitive and functional)
- Dignity conserving Repertoire
- continuity of self
- role preservation\
- generativity
- legacy
- maintenance of pride
- hopefulness
- autonomy/control
- resilience
- living in the moment
- maintaining normalcy
- Social dignity inventory
- privacy boundaries
- social support
- burden to others
- aftermath concerns
9
Q
Patient Dignity Inventory
A
- 25 point self report validated
- identify, track and measure dignity distress
10
Q
Dignity therapy with professional
A
- trained professional
- patient elicits memories, hopes and wishes for family members
- life lessons they want to share
- legacy content they wish to leave behind
- engagement with this process meant to enhance sense of meaning and purpose and self
- Sessions are recorded, transcribed and edited into a readable narrative or generativity document.
- patient can distribute as they like.
11
Q
Definitions of existential and spirituality
A
- relationship to God or higher power
- something greater than the self
- transcendance or connectedness to a bigger picture
- conviction there is more to life
- communion with
- self
- others
- nature
- higher being
12
Q
Common existential issues for patients with advanced cancer
A
- hopelessness
- futility
- meaninglessness
- disappointment
- remorse
- death anxiety
- disruption of personal identity
13
Q
Identifying families at risk of spiritual distress
A
- perceived lack of caregiver social support
- caregiver history of drug and alcohol abuse
- poor caregiver coping skills
- hx mental illness
- patient that is a child
- global family function (high conflict, low cohesiveness)
14
Q
Health care provider distress
A
- constant exposure to suffering, loss, grief
- high work pressure
- frequent life and death decisions in ambiguous circumstances
- interstaff conflict
- high consumer expectations
- severe emotional distress
- over identification with patients
15
Q
Formulating care plan for suffering
A
- medical condition and goals of care
- description of involved family and team
- patient issues : physical, psychological, existential, social
- family issues: same
- professional carer issues : staffing, training, resources, emotional coping
- Coping assessment : patient family staff
- contingency planning
