Beyond striae cutis: A case report on how physical skin complaints unveiled end-of-life total experience

2020 ◽  
pp. 1-3
Author(s):  
Miguel Julião ◽  
Paula Calçada ◽  
Vasco Coelho Macias ◽  
Pedro Mendes-Bastos
Keyword(s):  
Case Report ◽  
End Of Life ◽  
Multidisciplinary Team ◽  
Life Experience ◽  
Terminally Ill ◽  
Multidisciplinary Teams ◽  
Terminal Cancer ◽  
Physical Pain ◽  
Holistic Approaches ◽  
Physical Distress

Abstract Background End-of-life is a unique and multidimensional experience, and physical complaints can reveal other areas of distress. Method A case report of a woman with terminal cancer with painful and deforming skin striae cared by a multidisciplinary team. Results After initially treating her physical pain, other end-of-life psychosocial, spiritual, and existential aspects could be addressed. Significance of results Physical distress can unveil other essential areas of end-of-life experience when multidisciplinary teams caring for the terminally ill patients use holistic approaches.

Childhood trauma, attachment style, and a couple's experience of terminal cancer: Case study

2010 ◽  
Vol 8 (2) ◽  
pp. 227-233 ◽  
Author(s):  
Linda M. McLean ◽  
Sarah Hales
Keyword(s):  
End Of Life ◽  
Childhood Trauma ◽  
Attachment Style ◽  
Multidisciplinary Team ◽  
Marital Distress ◽  
Empirical Literature ◽  
Cancer Case ◽  
Terminal Cancer ◽  
Team Approach

AbstractObjective:The primary objective of this article is to elucidate the significance of psychosocial distress and risk in a sub-population of end-stage cancer patients and their spouse caregivers who present with an especially challenging attachment style and histories of childhood trauma. The case study presented highlights the need to both identify and offer an empirically validated couple–based intervention, along with a multi-disciplinary team approach over the trajectory of the illness and at end of life.Method:A validated marital protocol (emotionally focused couple therapy [EFT]) is modified for this population and conducted by an EFT-trained psychologist as part of a pilot investigation as to the feasibility and effectiveness of EFT for the terminal cancer population. Measures of marital distress, depression, hopelessness, and attachment security are completed at baseline and subsequent intervals, as reported in another publication. Attachment insecurity and the exquisitely intimate relationship with caregiving and care receiving are underscored, given the couple's traumatic childhood history.Results:The couple described herein, followed from diagnosis of metastatic disease to end of life illuminates the potential effectiveness of a modified EFT protocol, and underscores the need to both identify and intervene with a population potentially at significantly high risk for marital distress, suicidality, depression, and hopelessness.Significance of Results:The benefits of a multidisciplinary team is evident as the patient's symptoms of physical distress increased toward end of life and she returned to earlier behaviors, namely suicidal ideation and an attempt to alleviate her experience of suffering. The strength of the marital bond, possibly as a result of the intervention, and the efforts of the multidisciplinary team approach, demonstrate potential to mitigate a catastrophic end of life and a complicated spousal bereavement. This case study adds to the current empirical literature in an area that is currently under-studied and under-reported.

Effect of Dignity Therapy on Distress and End-of-Life Experience in Terminally Ill Patients: A Randomised Controlled Trial

2013 ◽  
Vol 11 (4) ◽  
pp. 576-587 ◽  
Author(s):  
Harvey Max Chochinov ◽  
Linda J Kristjanson ◽  
William Breitbart ◽  
Susan McClement ◽  
Thomas F Hack ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
End Of Life ◽  
Life Experience ◽  
Controlled Trial ◽  
Terminally Ill ◽  
Terminally Ill Patients ◽  
Dignity Therapy ◽  
Randomised Controlled

A more balanced approach to opioid use and management is also needed in end-of-life care

2016 ◽  
Vol 12 (6) ◽  
pp. 371
Author(s):  
Sydney Morss Dy, MD, MSc ◽  
Cynda Hylton Rushton, PhD, RN, FAAN
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Multidisciplinary Teams ◽  
Life Care ◽  
Physical Pain ◽  
Opioid Use ◽  
Balanced Approach ◽  
Psychosocial Consequences ◽  
Increase Risk ◽  
Pain And Suffering

Significant pain and suffering are frequent at the end-of-life, and opioids are often essential for relief. Although opioids must be readily available when appropriate, particularly for unbearable physical pain, some of the same issues causing current reconsideration of aggressive opioid guidelines for chronic pain1 also apply at the end of life. These patients may be given opioids when other potentially beneficial treatments should be tried first or for reasons other than physical pain, prescribed excessive doses, and insufficiently counseled or supported. Opioids are easy to start but challenging to discontinue and can cause dependence and psychosocial consequences, and vulnerability at end-of-life may increase risk of and burden from harms and side effects. These patients and their families usually also have multifactorial suffering requiring multidisciplinary teams and approaches other than or in addition to opioids.

scholarly journals Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial

2011 ◽  
Vol 12 (8) ◽  
pp. 753-762 ◽  
Author(s):  
Harvey Max Chochinov ◽  
Linda J Kristjanson ◽  
William Breitbart ◽  
Susan McClement ◽  
Thomas F Hack ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
End Of Life ◽  
Life Experience ◽  
Controlled Trial ◽  
Terminally Ill ◽  
Terminally Ill Patients ◽  
Dignity Therapy ◽  
Randomised Controlled

scholarly journals End-of-Life Discussions, Goal Attainment, and Distress at the End of Life: Predictors and Outcomes of Receipt of Care Consistent With Preferences

2010 ◽  
Vol 28 (7) ◽  
pp. 1203-1208 ◽  
Author(s):  
Jennifer W. Mack ◽  
Jane C. Weeks ◽  
Alexi A. Wright ◽  
Susan D. Block ◽  
Holly G. Prigerson
Keyword(s):  
End Of Life ◽  
Odds Ratio ◽  
Terminal Illness ◽  
Goal Attainment ◽  
Terminally Ill ◽  
Full Sample ◽  
Patients With Cancer ◽  
Physical Distress ◽  
Eol Care ◽  
To Receive

Purpose Physicians have an ethical obligation to honor patients' values for care, including at the end of life (EOL). We sought to evaluate factors that help patients to receive care consistent with their preferences. Methods This was a longitudinal multi-institutional cohort study. We measured baseline preferences for life-extending versus symptom-directed care and actual EOL care received in 325 patients with advanced cancer. We also measured associated sociodemographic, health, and communication characteristics, including EOL discussions between patients and physicians. Results Preferences were assessed a median of 125 days before death. Overall, 68% of patients (220 of 325 patients) received EOL care consistent with baseline preferences. The proportion was slightly higher among patients who recognized they were terminally ill (74%, 90 of 121 patients; P = .05). Patients who recognized their terminal illness were more likely to prefer symptom-directed care (83%, 100 of 121 patients; v 66%, 127 of 191 patients; P = .003). However, some patients who were aware they were terminally ill wished to receive life-extending care (17%, 21 of 121 patients). Patients who reported having discussed their wishes for EOL care with a physician (39%, 125 of 322 patients) were more likely to receive care that was consistent with their preferences, both in the full sample (odds ratio [OR] = 2.26; P < .0001) and among patients who were aware they were terminally ill (OR = 3.94; P = .0005). Among patients who received no life-extending measures, physical distress was lower (mean score, 3.1 v 4.1; P = .03) among patients for whom such care was consistent with preferences. Conclusion Patients with cancer are more likely to receive EOL care that is consistent with their preferences when they have had the opportunity to discuss their wishes for EOL care with a physician.

Dignity Therapy

2021 ◽  
pp. 495-501
Author(s):  
Harvey Max Chochinov ◽  
Maia S. Kredentser
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Empirical Research ◽  
Life Experience ◽  
Meaning Making ◽  
Terminally Ill ◽  
Dignity Therapy ◽  
Impact Scale ◽  
Desire For Death ◽  
Loss Of Dignity

Maintenance and promotion of patient and family dignity is a core tenet of palliative care and has significant implications for end-of-life experience, with loss of dignity associated with increased suffering and desire for death. This chapter provides an overview of empirical research on dignity at the end of life, including the model of dignity in the terminally ill, measures to assess dignity including the Patient Dignity Inventory and the Dignity Impact Scale, and dignity therapy, an intervention aimed at bolstering dignity, meaning-making, and generativity needs to improve the end-of-life experience for patients and families. These topics are discussed in the context of a proliferation of research in the last decade across a diversity of cultures, languages, and illness groups.

Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

2019 ◽  
Vol 28 (3) ◽  
pp. 1356-1362
Author(s):  
Laurence Tan Lean Chin ◽  
Yu Jun Lim ◽  
Wan Ling Choo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Multidisciplinary Team ◽  
Biopsychosocial Model ◽  
Family Members ◽  
Clinical Decisions ◽  
Goals Of Care ◽  
Complex Needs ◽  
Aspiration Risk ◽  
Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

Sign in / Sign up

Export Citation Format

Share Document