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  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
  • More About:

  • Hospice Care
  • Clergy and Faith Communities
  • Additional Links
    Site Index
    Back to Module 14: Table of Contents
    Part II: Common Needs and Goals

    Click here for a Special Note
    Finding Hope The Search for Meaning
    Sustaining Personhood and Community
    Coping with Change and Uncertainty
    Taking Care of Unfinished Business/The Need for Forgiveness
    Fear of Death, Questions About Life After Death & Spiritual Care at the Time of Death

    Finding Hope

    Hope is a Fragile Thing

    • At one and the same time, a patient or family member may accept the news that no curative treatment remains yet still proclaim that they will “beat this”
    • Coming to terms with their prognosis is a process
    • The palliative care team can help patients and families identify other objects of hope


    Assessing Hope

    • To assess a patient’s or family’s sense of hope, you might ask, “Are there other things you are hoping for during this time?”
    • Some suggestions you might offer include:
      • Hope to not be in pain
      • Hope to be treated with dignity
      • Hope that their family will be ok
      • Hope to be remembered well
      • Hope they won’t be abandoned
      • Hope to go to Las Vegas one last time
      • Hope to see their son graduate from college
      • Hope to find peace
    • Hoping for Death: Be aware that for some religious persons hope may lie in:
      • Being forgiven by God
      • The promise of life after death (heaven or reincarnation)
      • Reunion with deceased loved ones
    • Temporary despair or hopelessness is a common and understandable response to finding out that one is terminally ill, that no curative treatment remains
      • Persons need time to grieve the many losses that accompany this prognosis

      • Moving on to other objects of hope too quickly may short-circuit this process

      • Some religious persons may feel as if God has not answered their prayer or even abandoned them when news of terminal diagnosis is received--This may cause a crisis in their faith

      • A referral to a chaplain may be appropriate at this time
    • Belief in a miracle cure
      • Perhaps most challenging to medical professionals is when a patient or family member accepts the news that the doctors have run out of curative measures, accepts palliative care or hospice

      • Yet holds firm to the belief in a miraculous (divine) cure

          Case Example

          A young resident who had been on rounds with the palliative care team returned to the room of Mrs. S. for follow up. As he was getting ready to leave, she said to him: “I know the doctors have told me I only have a few days to live, but I believe God will send me a miracle. What do you think?”

          Consider, what does this woman really need to hear? Statistics? The “truth” that she is dying? Perhaps she needs to have her faith affirmed as a significant part of her life, as a resource for coping with the news, as a place of hope in the face of despair? Perhaps she can hear both perspectives — the medical and religious — and prepare for both eventualities?
    • Hoping for death is normal
      • Sometimes, the only hope is that there will be an end

        • an end to suffering
        • an end to what is experienced or perceived as a pointless existence
        • an end to life itself

      • Many persons feel as if they are weak or that it is unacceptable to wish they were dead; yet it is a common experience for persons with life-threatening illness


    Health Care Professionals Can Do Many Things to Help Those Who Hope for Death

    • Normalizing the wish for death
    • Confirming that a person is indeed growing weaker or that they have multiple symptoms that indicate that death is near
    • Merely stating that you know this will not go on forever
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