Research Paper on "Denial in the Death"

Research Paper 15 pages (4587 words) Sources: 10

[EXCERPT] . . . .

All these are end of life concerns which can only be dealt with if the patient knows about his impending death.

In some cultures talking about death or planning things according to person's death are considered unethical and often regarded as welcoming death. Other end of life concerns are related to decisions about the treatment and care possibilities which cannot be made without open communication with the family and the patient.

Literature Review Of Current Research

Learning to cope with the losses and needs in the context of terminal illness, it becomes a challenge for the patient, for family and health professionals.

Communication Between Doctor And Patient

Numerous studies have shown that patients often think about the treatment they would receive if they were terminally ill and who would make decisions about palliative care. Although patients often say they would like to talk to their doctors about care at the end of life, few have had such conversations. One of the studies on the subject found that 66% of elderly patients and patients with chronic illness who visited an outpatient department of medicine had ever thought about the decisions taken in case of a disease incurable, 62% had been asked the question of what treatment they would like, but only 9% had talked with their doctors (Luthy, Cedraschi, Pautex, Rentsch, Piguet, Allaz, 2009).

Studies in other contexts are even lower numbers of communication between doctor and patient on these issues. A study based on veterans who consulted a geriatric clinic (mean age 82 years) showed that 17% of the patients had previously discussed with someone else, your preferences about CPR, but none had done with their physicians (Zimmerman, 2007). Other studies indicate however that in other situations there is a high percentage of patients discuss with their doctors about facts relating to the end of life. For example, Yalom (2008). studied a group of highly trained elderly living in a nursing home. More than half had discussed CPR with their physicians, indicating that individuals transferred to a nursing home can be a particularly active and motivated group, different from the general community.

The physicians play a vital role in communicating the patient's condition and prognosis. Many studies have shown that patients want to receive truthful information about their diagnosis and prognosis. Bonanno (2009) conducted an interview type in outpatients. 30% of patients had more than 60 years, 30% had a life expectancy less than 18 months. The researchers found that most patients expect their doctors to talk about their condition and wished to have honest and complete information, without worrying about how to handle such information. Kastenbaum (2008) reported that 95 of 101 cancer patients in a American teaching hospital wanted to get as much information as possible, whether good or bad.

Phillips (2007) conducted a study in U.S. teaching hospitals to determine the medical approach in communication with the patient. The author defined as those with terminal patients a 95% probability of dying within 3 years. Their study found that physicians often limit information to their patients because they think that if the patient or his family does not ask questions it means that they do not want to know more, however if doctors judge that the patient needs to know information for legal reasons, then they would communicate openly with the patient. Physicians also reported in the study that they modify the content and information regarding the disease of the patient according to the maturity and level of knowledge of the patient. The same author found that most physicians were willing to give information on the diagnosis and treatment but were vague when talking about the prognosis. For example, although 84% of doctors said they thought most of the patients knew they were dying, half of respondents did not talk to patients about the matter.

As a result of lack of proper communication about the prognosis, patients can often have a very optimistic view of the situation which can keep them in denial that everything is under control. In a study by Luthy et al. (2009) compared the survival estimates done by physicians about patients with advanced cancer. The results of the study found that doctors often did not give more than 6 months of survival for their patients, which in contrast had a more optimistic view. These results suggest that patients were more likely to choose aggressive treatments that reduced their quality of life, even in cases where the prognosis changed very little.

Many studies have examined various aspects of the process and content of the discussions between doctor and patient about facts relating to the end of life. Some have compared what it would like to discuss patients and what else they discussed with their physicians. For example in a study conducted in U.S. By Hegedus et al. (2008), examined the experiences of cancer patients regarding communication of the diagnosis and prognosis. Patients over 75 years were excluded. They found that life expectancy was discussed in only 27% of cases, although 57% of patients wanted to discuss the issue, only 35% of patients discussed the effects of cancer on other aspects of life with their doctors, while 65% wanted a discussion of this topic. The study showed variability about the patient's desire to have the presence of their spouse (50%), friend (3%) or being alone (38%) upon learning of his diagnosis.

Tomer et al. (2008) conducted one of the few studies that collected data on the current discussion about Do Not Resuscitate orders on the (NR). They used coded videotapes of the interviews between doctors and their patients. In describing the nature of cardiopulmonary resuscitation, most physicians cited intubation (84%) and mechanical ventilation (100%), but few mentioned other common aspects of resuscitation and chest compression (55%) or admission to an ICU (32%). Few doctors discussed the small chance of survival after resuscitation or give statistical estimates of the likelihood of survival or risk of cardiopulmonary resuscitation including: an extended stay in the ICU (3%), neurological sequelae (13%) or procedure-related complications such as rupture of ribs, pharyngeal trauma, or pain and suffering (16%). Most physicians (94%) did not mention alternatives to resuscitation as letting the patient die.

Communication Issues Between The Patient And The Famly: Towards The End Of Life Of A Terminally Ill Person

At the end of life the patient has special needs which can be met only through open communication between the family and the patient. These needs can be met through spiritual and emotional care, with the help of those who can help the patient connect to things, practices, ideas and principles that are the essence of life's meaning.

Studies suggest that open communication between the family and the patient is essential in order to deal with issues related to end of life of the patient. Due to denial of the impending death of the patient, certain issues are not dealt with pose serious problems for the family, patient and the caregivers.

When there is lack of communication between the family and the patient financial concerns are not being discussed which may be related to handing over power of attorney of property by the patient to his/her offspring. Finances related to treatment of the patient as to how much is being spent and how much would be required further for more treatment plans if necessary.

There is evidence that some patients in end of life, like the fact that health professionals are more attentive to their spiritual and emotional need (Bonanno, 2009). This favors the establishment of the trust, support, simultaneously directing interventions. Chochinov et al. (2006) developed a model derived from the dignity to the end of life based on qualitative analysis of therapeutic intervention for human dignity, for treating existential anguish among terminally ill.

In this context of spiritual care when dying (Yalom, 2008) proposes some steps as practical guidance, such as control of physical symptoms and the presence to support, promote a life review, to recognize the purpose, value and meaning of life, related to guilt, regret, forgiveness and reconciliation, aiding religious expression reformulating goals, encouraging meditation practices with a focus on helping the patient to heal.

Thus, the existence of interventions is useful as guidelines are becoming valuable spiritual and emotional assessment models. Johnson (2009) describes the case of a patient hospitalized in critical condition in an intensive care unit whose religious choice was Buddhism, who wanted to say goodbye to his family in accordance with their beliefs. By detecting this need, the team sought to develop an intervention plan and met with high barriers to communication with the family. For this situation the model the proposed by Phillips (2007), which categorizes important data for the implementation of an effective care plan, was implemented. This model consists of categories such as: Beliefs and… READ MORE

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