Suffering/Interpersonal Aspects of Care Flashcards
1
Q
Definition of suffering
A
- State of severe distress that is personal, individual, and subjective
- Arises from the perception that something is threatening integrity of one’s self and personhood
- May include loss or damage to past, family life, roles, cultural or social identity, relationships, body, or perceived future
- Often causes intense emotion and impacts perception of future events
- Often multidimensional and with a strong physical component
2
Q
Frequency of suffering in patients in palliative care
A
25-55% in advanced cancer
High levels in young patients and those with non-cancer life-limiting illness
Suffering may also occur as a result of its treatment
3
Q
Sources of suffering
A
- Facing mortality
- Frightening and existentially confronting - Loss
- Self, relationships, control, purpose, meaning - Pain
- Suffering frequent when pain is not controlled, when patient feels out of control, source of pain is unknown, the meaning of the pain is dire, or when pain is chronic
- Not just about physical experience, but about the perception and meaning of the pain - Physical symptoms
- Suffering may arise even when there is low physical symptom distress - Psychological distress (unmet physical/psychological/spiritual/existential needs)
- Hopelessness
- Strong predictor of requests for a hastened death
- Sense of being a burden may contribute - Inadequately addressed spiritual pain
- May translate to hopelessness and demoralization
- Ability to find and sustain meaning during terminal illness may counteract despair
4
Q
Impact of healthcare providers upon suffering
A
- Positive impacts of HCPs upon patient suffering
- Being there for patients
- Attentive to needs
- Affirmation of dignity and personhood in the treatment of patients
- Therapeutic relationship - Communication
- Give sufficient information
- Answer questions
- Communicate a terminal diagnosis in a sensitive and caring way
- Validate patient expressions of suffering
- Normalize their feelings
5
Q
Suffering in Family Members
A
- New role identities
- Changes to life as previously known
- Stresses of caregiving (physical, financial, psychological)
- Witnessing loved one’s suffering
6
Q
Approach to alleviating suffering
A
- Never assume the basis of suffering
- Ask the patient directly about their experience of distress and what may be causing their suffering
- “Are you suffering?”
- Key strategy: Help patients root themselves in the present and reframe their abilities. E.g. passing on wisdom, shift in priorities, focus upon current priorities, what is most meaningful to the patient and how to make the most of the time that is left?
7
Q
Guiding questions to uncover sources of distress
A
- Are you frightened by all this?
- I know you have pain, but are there things that are even worse than this pain?
- Are there things that you wish you could still do that have now become difficult for you?
- What do I need to know about you as person to provide the best possible care?
8
Q
Dignity-Conserving care - goals
A
- Supports a patient’s sense of dignity
- Reduces the likelihood of suffering
9
Q
How to enact dignity-conserving care
A
ABCD
- Attitude
- Examine all attitudes, beliefs, and assumptions held towards patients
- “How would I feel in this situation?”
- “Is my attitude towards this patient based on my own experiences, fears, anxieties, or assumptions?”
- “What is causing me to draw these conclusions?”
- “Have I checked whether my assumptions are accurate?” - Behaviour
- Know that patients look to us for a reflection of their sense of worth and value
- Kindness and respect, always
- Acknowledge photos of children/grandchildren, offer water, ask permission before conduction a PE or including trainees
- Treat the patient, not just the illness - Compassion
- Awareness of the suffering of another and a desire to relieve it
- Convey with a look, a touch, an acknowledgement “I’m sorry - this must be difficult” - Dialogue
- Use language to acknowledge the whole person, not simply a sick patient
- Knowing enough of a patient to make sense of their experience of suffering
- Engage in the art of listening
- Converse sensitively and mindfully
10
Q
What can be done to alleviate refractory suffering?
A
- Presence and listening
- Psychotherapeutic approaches (life review, legacy therapy, meaning-centered therapy, dignity therapy) that allow patients to discuss aspects of their life and augment their sense of purpose and meaning.
- Engage in discussion and reminiscing, which may promote a greater sense of meaning
- There may need to be consideration for palliative sedation, depending upon goals of care and prognosis.
11
Q
Coping Theory: Folkman et al
A
- Appraisal of the stressful situation
- Coping response is made
Followed by re-appraisal, adjustment to the response, etc.
12
Q
Improving psychological coping (Folkman et al)
A
- Change conditions from threat to challenge (establish meaning, aims, and person control)
- Encourage productive behaviour to achieve goals (address loss of confidence, despair, start with small and concrete goals)
- Maintain background positive mood (including control of physical symptoms, psychotherapy)
13
Q
Symbolic Immortality (Theory of Coping)
A
- Ongoing process of creating new symbols of immortality for ourselves as we cope with the challenges of meaning-making, allowing us to cope with mortality.
Five activities:
- Biological (children ensure continuity after death)
- Theological belief (life after death)
- Creativity (sense of a creative legacy)
- Feeling part of eternal universe (most commonly through nature)
- Experiential transcendence (sense of time is lost, allowing us to connect to a higher power or spirit)
14
Q
Sense of Coherence (Model of Coping)
A
- Pervasive, enduring feeling of confidence that there is predictability and ‘things will work out’ - a “way of looking at the world”
- Strong sense of coherence means response to stress is with conviction that life will continue to be meaningful and function in a predictable way.
Requires:
- Comprehensibility (ability for people to understand what happens around them)
- Manageability (ability to manage the situation)
- Meaningfulness (ability to find meaning)
15
Q
Five-factor personality and coping
A
Extraversion Neuroticism Agreeableness Conscientiousness Openness
Extraversion, conscientiousness, and openness respond to stressors as challenges, rather than threats
Neuroticism and low conscientiousness predicts high stress levels and perceiving stressors as threats
More neuroticism correlates with poorer coping
