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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 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


    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


    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


    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


    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



    • 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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