week 6 - Life-limiting illness and dying

Question 1

Why has the % of people who die at home decreased from 1910 to 2002?

Answer 1

• Due to increased medical facilities/technology we have

* If someone has lung care/any condition most likely to be in hospital at the time

Question 2

When are the hospital costs the highest within our lifetime?

Answer 2

• when we are undergoing a life-limiting disease or we are reaching our end of life point
• see graph on lecture slides

Question 3

How can you explain this massive shot of increase in medical cost for individual that is near his/her death?

Answer 3

• Explained by increased in chronic illness as the leading cause of death
• Increased medical procedures to treat chronic illness and prolong life
• Difficulty in discontinuing active treatment
• Challenges confronting home-based care - particularly if someone has a very long and unpredictable illness trajectory

Question 4

What are the 5 stages of adjustment to dying in Kubler-Ross’s model?

Answer 4

DABDA

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

Question 5

what are some critisims and strengths associated with this model?

Answer 5

Critisicims - *
Individuals do not move though these stages in a sequential fashion
* BUT Kubler-Rosshighlighted this, but her statement was not highlighted
* Does not account for common reactions like anxiety
Strengths:
* Significant breakthrough form what was once recognised as a taboo topic
* This allowed conditions/illness to be viewed in different ways which allowed different approaches in dealing with this

Question 6

What are the two common mental reactions when someone is facing death/near dying stage?

Answer 6

1. Depression
   
   • Appears to become more apparent as illness increases
   • Associated with adverse outcomes
     
     • Increased risk of death
     • Prolonged hospitalisation
     • Reduced quality of life
     • Increased want to suicide and requested to hasten death
2. Anxiety
   
   • Usually associated with confronting condition/prognosis
   • Problematic when it interferes with the ability to function/quality of life
   • Anxiety in this situation does NOT reach the clinical threshold of what is considered to be anxiety
     
     • T.F simple things can make a huge improvement on anxeity such as:
     • emotional support from family/frieds, basic counselling
     • psychological interventions (not always needed)

Question 7

What are the 6 components that when managed well - is associated with a good health?

Answer 7

• When all these components are managed well - it is associated with a “good” death
  1. Pain and symptom management
  2. Clear decision making - research show clear decision making are valued by stakeholders
  3. Preparation for death
  4. Completion - if person has ability to suck up/culminate their life as meaningful = good death
  
  • i.e. getting out of hospital and appreciating the sunshine and dying at home in the presence of his/her family members
    
    5. Contributing to others
  • Just because someone is facing death, studies show that when people do NOT just focus on themselvess leads to a good death
  • Example: someone who facing death still tries to help others who are going through the same thing like inviting them to go for a ride around the healthcare centre etc..
    
    6. Affirmation of the whole person
  • When person is treating like a normal human being and there is no divide between the sick person and other healthy people
  • Example: doctor goes into the patient rooms, talks to the patient as a friend and talkes about their own families/what they did on weekend etc..

Question 8

what is palliative care?

Answer 8

• Approach that improves quality of life in patients AND families
• Palliative care can happen anytime but it is advised it is started at EARLY EARLY stages of someones illness
• Emphasis on multidisplinary care - phycology included NOT JUST medical care from docotrs
• Inclusion of family and significant others - believed that parents/family bring very important insight/expertise on how to care for someone
• Palliative care provided in any setting - home, hospital, hospice

Question 9

Based on evidence what will pallitative care improve?

Answer 9

1. communication

2. care planning

Question 10

What illness does palliative care mostly offered to? Is it just effective in the particular illness or to many?

Answer 10

• Palliative care if seen to be most effective for those with cancer
• Evidence also supports application of palliative care is affective to other illnesses - heart failure, choleric obstructive pulmonary disease, dementia

Question 11

why should we treat indivisuals on a case-by-case basis?

Answer 11

• not all people from certain cultural groups will have the same views towards death/illness
  i. e. not all anglo-AUS will want the same things/believe in the same things

Question 12

why is it really important to consider linguistic diversity when it comes to end of life care?

Answer 12

• death is communicated in very INDIRECT ways
• for e.g. practioners often say “we’re running out of options” as another way of saying “we can no longer treat you with curative intent”
• > very easily lost in translation

Question 13

are children able to understand things about illness/death?

Answer 13

• even at young age children can develop complex understandings about death
• especially if the children are hospitalised
• exmaple: lukemia children - they understand what is about to happen to them or the consequences of their illness by observing other lukemia children go through different things

Question 14

why are health care professionals including psychologists so important in families with children who are very ill?

Answer 14

• children and adult may have the same amount of knowledge and idea about the conseuqneces of the childs illness
• but often experiences great difficulty communicaitng with eachother about the illness -> results in no discussion/talk about the illness
• . T.F health psychologists and or health care professionals act as shuttle in communicating between children and the adults

Question 15

which illness is palliative care mostly offered to?

Answer 15

• mostly offered to cancer patients
• evidence also supporing palliative care is effective in treating other chronic diseases such as - dimentia, heart failure

Question 16

what is euthanasia?

Answer 16

refers to termination of a very sick person in order to relieve them from their suffering. Some cases the patient themselves make the desision and other times they are too ill to make those decisions for themselves

Question 17

what is active and passive forms of ethanasia?

Answer 17

active: referes to actiosn that assist in dying - active euthanasia only accepted in few jurasdictions
passive: withdrawing from curable treatment - more ethically and legally accestable

Question 18

despite active ethanasia being illegal in australia, what are the general views about euthaasia?

Answer 18

• most AUS 80% support it
• half of doctors
• people who dont support it - 37% are NOT from religious grounds
• even though it is usually assumed people who are against euthanasia are usually from religious grounds, significant percentage who are against it are NOT from religious grounds

Question 19

when asking about euthaniasia is framing the question in postiive or negative manner result in better responses?

Answer 19

more patients likely to respond better to postive framing -> i.e patients life should not be prolonged or patients like SHOULD be prolonged
-> positive framinign refers to the use of “proloning” instead of “ending”

Question 20

Why is assessing reluctance to burden others an important measure when communicating EOL illnesses?

Answer 20

• when some people are so sick and cannot make the deiciosn themselves, their closest family/friends make choice for them
• friends/family should communicate well with the person or know what the person wants in terms of EOL preferences
• people with HIGH reluctance to burden others -> afraid to burden the patients and therefore does not communicate well with them on the choices they have made for that patient
• > T.F important to assess RBO to enable appropriate interventions for those people

Question 21

when siblings are are nearly at EOL, why should we not immediately assume that their siblings are going through a traumatic stage in which cannot be handled?

Answer 21

• studies have shown that siblings who have brohters/sisters with life limiting illness have adopted techniques themselves to cope with the tragedy
• common technique used by siblings is compartmentalising
• although these siblings felt different from other people in their age group, they were able to cope with this burden

Question 22

What sort of techniques are usually used when communicating end of life?

Answer 22

• indirect, allusive/vague talk
• e.g. mum: i dont think its too far away - doctor: yeah i have to agree with you on that one
• hypotheical talk . people often in your situation find X
• converying sensivitiy/seriousness of subject through being hesistant talk/touch
• framing difficult matters as universal/general
• using silence other than words to encourage further discussion
• steering negative views to more optimisitc views of something difficult

Question 23

are these tehcniques always good or bad? or can it be both?

Answer 23

• all techniques used in communicating end of life can be good and bad

Question 24

how can indirect talk be good and bad tehcnique? when should indirect talk be used and not used?

Answer 24

indirect can be good
- sensitively and sensibly approach end of life discussions
- make it easy for people to avoid engaging
indirect talk should be used when wanting to approach a sensitive topic
- should NOT be used when needing to talk about somehting very urgent - more direct techniques should be used

Question 25

why is communicating effectively so important?

Answer 25

• patients engaging in effecting communication were more likley to get thier end of life wishes

Question 26

Why is opioids / sedatives which are used for pain management referred to as doctrine of double effect?

Answer 26

• Has both positive and negative effects
• Positive being that relieves pain
• Negative that hastens death - suppresses respiration

Question 27

What are the diff. Types of stress?

Answer 27

• Eustress: postive attribution to stress - e.g. feeling high in energy and excited
• Distress: -ive attribution to stress - negative emotions
• Acute: immediately feel stress
• Chronic: long term

Question 28

What are some examples of acute stressors?

Answer 28

• Stuck in traffic jam
• Sitting exam
• Fighting with spouse

Question 29

Can acute stress turn into chronic stress? Why/why not

Answer 29

If acute stress happens over and over again -> chronic stress

Question 30

What is hassles? What type of stress is it?

Answer 30

• Hassles is stressors that happen on a day-to-day basis
• Considered a acute stress
• But when hassles accumulate -> can lead to chronic stress -> physical health affected

Question 31

what is the process of stress?

Answer 31

threat -> stress (appraisaing stage)

stress -> coping (coping stage)

Question 32

what is threat, primary appraisal and secondary appraisal?

Answer 32

threat: event in which percieveed as harmful - threat to someones self esteem etc..
primary appriapsal: where the inidivisual assess whether or not the situation/event is stressful or not - i.e. you evaluate whether or not the event is relevant to you
secondary appraisal: where indivisual assess their available resources and if they are able to cope well with the stressful situation