My Daily Domestic Diigolet 06/30/2009

• The Care of Dying Patients — Feinberg 126 (2): 164 — Annals of Internal Medicinetags: death, cancer

  • Why, despite our honest efforts, are we doing such an inadequate job with end-of-life care? Why did SUPPORT fail even to begin to alleviate the problems it set out to address? What are the implications of the public’s perception that care is frequently impersonal and mechanical? And, finally, what can be done about this perception?

  • Hospice offers humane care with an emphasis on the relief of both physical and mental pain. But only a small percentage of patients avail themselves of this opportunity, perhaps because entering hospice means accepting death and “defeat.”
• A good death for cancer patients: still a dream? — Aitini and Cetto 17 (5): 733 — Annals of Oncologytags: cancer
  • If a lot has changed in recent years in the field of controlling physical pain, thanks to new medicines and new therapeutic approaches, it is also important to remember that the cancer patient‘s pain at this stage is global, not only physical but made up of numerous other components which are not always recognised by others such as anger, anxiety, rejection, depression, abandon and exhaustion, which are frequently experienced not only by the patient but also by the people who share this dramatic experience with the patient.
  • These feelings become more and more negative as time slowly passes and patients become more and more aware that there is no future; that their days are ending. They re-live the whole experience of the illness seeing some events as insignificant such as time in remission or symptoms, while magnifying others such as late diagnosis, bureaucratic difficulties and useless suffering (given the outcome) due to therapy. Therefore every action taken or decision made is seen as a mistake since they have not been definitively cured. In this situation, apart from the anger with those who have suggested or imposed a diagnosis or a course of treatment, a patient can also start to blame him or herself for not having accepted advice or on the contrary for having insisted on a certain course of treatment. To all this we can add other feelings of fear of being in hospital far from home, from family, of physical pain or worrying about how the family will cope ‘after’.
  • The knowledge that you are in the last days of your life, a time which is not seen as a residual moment before death but more as a moment to prepare for death, is often terrifying because it continues for a period of time, it is a process. This is why people wish death to be quick and not to have this experience of being aware that they are dying.
  • The illness may be incurable but the patient can always be treated in the most honest way possible while respecting just to what extent the patient is willing to share this experience.
  • Maybe even today a ‘good death’ in many cases is still only an illusion, but maybe, even if only in a very limited way, we are moving closer to death in patients with degenerative illnesses which is no longer dominated by physical pain or by those components which make dying and leaving loved ones such a terrifying experience.

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