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Modules:

  • 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
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    Back to Module 3: Whole-Patient Assessment
    Nine Dimensions

    Step 8. Practical Step 9. Anticipatory Planning for Death

    Step 8. Practical Assessment

    See Module 16: Social and Psychological Considerations

    Caregivers

    Who Cares

    • Ask about who is available to help with practical needs
    • Most patients have or need someone to be a primary caregiver from their family and circle of friends
      • This is true even in a health care institution
      • When at home, the responsibility of caregiving can be a full-time and demanding task
    • Studies show that most caregivers in the home are wives or daughters
    • In the case of dying children caregivers are usually the parents
    • Consequently, widows and single people may be more isolated and may have to rely on paid or volunteer community help to meet their needs if they are to stay at home

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    Patient-Caregiver Relationship

    • The relationship between the patient and the caregiver is important
    • Some patients, and some caregivers, find the relationship difficult and it can leave a lasting negative impact on them
    • Others do not want to have their families caring for them, no matter how loving or willing
    • Likewise, some family members are unwilling to care for an ill relative
    • To intervene positively, both the patient and the caregivers must be assessed

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    Assessing Unmet Needs

    • Even with a willing family caregiver at home, there are often unmet needs
    • Ask how well the patient (or parent if the patient is a child) feels his or her needs are being met
    • Be particularly aware of potential needs for:
      • Care on holidays
      • Supplementary help
      • Respite care

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    Domestic Needs

    • Transportation
      • As illness progresses, difficulty getting between the health care site and home is common
      • Ask about transportation needs
    • Food
      • Difficulty obtaining food and/or cooking is also common
      • Ask: Who does the grocery shopping? Who does the cooking?
    • Utilities
      • Keeping the lighting and heating paid for can be a challenge
      • Ask who is responsible for banking? Bill payment?
      • Ask whether basic needs for lighting and heat are being met

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    Dependents

    • Many patients may have others who are dependent upon them for caring, help, or survival
    • Be aware that dependents may include:
      • Children
      • Elders
      • Others with illnesses or disabilities
      • Pets
    • When these people face dying, dependents have to be cared for in a different way and often by a different person
    • Ask about family and what arrangements have been made
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