Living actively in the face of impending death: constantly adjusting to bodily decline at the end-of-life

This study explores how medical students feel about caring for terminally ill patients as well as how their medical courses prepare them for addressing end-of-life (EOL) issues with patients. Four hundred and five Mexican medical students were surveyed through the Student Views on Death questionnaire. The vast majority of students (94%) felt that physicians should inform patients of their impending death. Most students said they felt comfortable talking with (61%) or examining (76%) terminally ill patients. However, only half the students actually talked with patients about death. Participants in our study were interested in learning about EOL medical attention, yet most considered themselves poorly prepared to offer this type of care to terminally ill patients. The study provides objective data on a topic that has scarcely been explored in Mexico, data that will be useful in designing educational activities to improve EOL medical training.

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Meaning-Centered Psychotherapy

Psycho-Oncology ◽

10.1093/med/9780190097653.003.0062 ◽

2021 ◽

pp. 489-494

Author(s):

Melissa Masterson Duva ◽

Wendy G. Lichtenthal ◽

Allison J. Applebaum ◽

William S. Breitbart

Keyword(s):

End Of Life ◽

Advanced Cancer ◽

Psychosocial Care ◽

Well Being ◽

Cancer Center ◽

Existential Psychology ◽

Patients With Cancer ◽

Spiritual Well Being ◽

The Face

Existential concerns carry significant distress, particularly among patients with advanced cancer. For patients who are facing death, a sense of meaning—and the preservation of that meaning—is not only clinically and existentially important but also central to providing holistic, high-quality end-of-life care. Nearly two decades ago, the authors’ research group at Memorial Sloan Kettering Cancer Center began to understand that a meaning-centered approach to psychosocial care was imperative to alleviate the existential distress that plagued many patients with advanced cancer. Based on Viktor Frankl’s work on the importance of meaning and principles of existential psychology and philosophy, they developed Meaning-Centered Psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives in the face of terminal cancer. This chapter provides an overview of MCP in working with patients with cancer. It summarizes the ever-growing body of research that has demonstrated the effectiveness of MCP in improving meaning, spiritual well-being, and quality of life and in reducing psychological distress and despair at end of life. Adaptations of MCP for other purposes and populations, such as cancer survivors, caregivers, and bereavement, are mentioned but are elaborated on in other specific chapters related to these issues in this textbook.

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Comparison of the experience of caregiving at end of life or in hastened death: a narrative synthesis review

BMC Palliative Care ◽

10.1186/s12904-020-00660-8 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Jane Lowers ◽

Melissa Scardaville ◽

Sean Hughes ◽

Nancy J. Preston

Keyword(s):

End Of Life ◽

Assisted Suicide ◽

Healthcare Professionals ◽

Critical Time ◽

Stress Coping ◽

Narrative Synthesis ◽

Impending Death ◽

Aid In Dying ◽

Hastened Death ◽

Time Awareness

Abstract Background End-of-life caregiving frequently is managed by friends and family. Studies on hastened death, including aid in dying or assisted suicide, indicate friends and family also play essential roles before, during, and after death. No studies have compared the experiences of caregivers in hastened and non-hastened death. The study aim is to compare end-of-life and hastened death caregiving experience using Hudson’s modified stress-coping model for palliative caregiving. Method Narrative synthesis of qualitative studies for caregivers at end of life and in hastened death, with 9946 end-of life and 1414 hastened death qualitative, peer-reviewed research articles extracted from MEDLINE, CINAHL, Web of Science, and PsycINFO, published between January 1998 and April 2020. Results Forty-two end-of-life caregiving and 12 hastened death caregiving articles met inclusion criteria. In both end-of-life and hastened death contexts, caregivers are motivated to ease patient suffering and may put their own needs or feelings aside to focus on that priority. Hastened death caregivers’ expectation of impending death and the short duration of caregiving may result in less caregiver burden. Acceptance of the patient’s condition, social support, and support from healthcare professionals all appear to improve caregiver experience. However, data on hastened death are limited. Conclusion Caregivers in both groups sought closeness with the patient and reported satisfaction at having done their best to care for the patient in a critical time. Awareness of anticipated death and support from healthcare professionals appear to reduce caregiver stress. The modified stress-coping framework is an effective lens for interpreting caregivers’ experiences at end of life and in the context of hastened death.

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Health Care Professionals’ Awareness of a Child’s Impending Death

Qualitative Health Research ◽

10.1177/1049732320911627 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1314-1325

Author(s):

Kathie Kobler ◽

Cynthia Bell ◽

Karen Kavanaugh ◽

Agatha M. Gallo ◽

Colleen Corte ◽

...

Keyword(s):

Health Care ◽

End Of Life ◽

Health Care Professionals ◽

End Of Life Care ◽

Life Care ◽

Structured Interviews ◽

Study Approach ◽

Multiple Data ◽

Impending Death ◽

Record Review

Health care professionals’ (HCPs) experiences during early pediatric end-of-life care were explored using a theory-building case study approach. Multiple data collection methods including observation, electronic medical record review, and semi-structured interviews were collected with 15 interdisciplinary HCPs across four cases. Within- and across-case analyses resulted in an emerging theory. HCPs’ initial awareness of a child’s impending death is fluid, ongoing, and informed through both relational and internal dimensions. Initial cognitive awareness is followed by a deeper focus on the child through time-oriented attention to the past, present, and future. HCPs engage in a “delicate dance of figuring out” key issues. Awareness was exemplified through four themes: professional responsibility, staying connected, grounded uncertainty, and holding in. The emerging theoretical model provides a framework for HCPs to assess their ongoing awareness, identify personal assumptions, and inform gaps in understanding when facilitating early end-of-life care discussions with families.

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Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

Nursing Research and Practice ◽

10.1155/2011/869302 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Amy J. Thurston ◽

Donna M. Wilson ◽

Jessica A. Hewitt

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Chart Review ◽

Life Care ◽

Canadian Study ◽

Care Needs ◽

Common Diagnosis ◽

Impending Death ◽

Care Practices ◽

End Stage

A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8%) and urbanite (79.5%), and cancer was the most common diagnosis (36.2%). Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3%) had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.

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Female Intersubjectivity: Violence, Women, and Elegy in Lee Chang-dong’s Poetry

Journal of Korean Studies ◽

10.1215/07311613-7932324 ◽

2020 ◽

Vol 25 (1) ◽

pp. 237-261

Author(s):

Jung Ja Choi

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Young Girl ◽

Korean Society ◽

South Korean ◽

Impending Death ◽

The Face ◽

The Dead ◽

Sex Crime

Abstract This article explores the configuration of female intersubjectivity demonstrated in the film Poetry (Si, 2010) by Lee Chang-dong (Yi Ch’angdong), as well as the power of poetry to conjure the dead and provide space and voice for marginalized and silenced women. The focus of the film is Mija, a woman in her mid-sixties who works as a caregiver to a disabled man while raising a grandson on her own. Just as Mija discovers that her grandson has been implicated in a sex crime that led to a girl’s death, she learns that she herself is in the first stage of Alzheimer’s disease. It is through poetry that Mija mourns her own impending death and also that of the young girl, who is otherwise consigned to oblivion under the phallocentric order of South Korean society. Lee Chang-dong’s film, this article argues, shows that despite the impossibility of poetry in the face of tragedy, lyric imagination offers women the power to escape the patriarchal imposition of silence and preserve a story of their own.

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Managing Do Not Attempt Cardiopulmonary Resuscitation conversations in the community

British Journal of Community Nursing ◽

10.12968/bjcn.2020.25.2.58 ◽

2020 ◽

Vol 25 (2) ◽

pp. 58-64 ◽

Cited By ~ 1

Author(s):

Jennifer M Hadley

Keyword(s):

Palliative Care ◽

Cardiopulmonary Resuscitation ◽

End Of Life ◽

Communication Strategies ◽

Structured Interviews ◽

Clinical Nurse ◽

Patient Understanding ◽

Clinical Nurse Specialists ◽

Impending Death

Clear, sensitive and timely communication with palliative and end-of-life (EoL) patients and their families is important. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) conversations can help patients accept their impending death and achieve a more dignified death. This research explored the experiences and communication strategies of clinical nurse specialists (CNSs) in palliative care when managing DNACPR conversations in the community. Six semi-structured interviews were conducted with community palliative care CNSs, and the results were summarised using autoethnography. Delays in EoL discussions mean that some community palliative care CNSs are having DNACPR conversations at their first meeting with patients. Balancing being clear and sensitive is challenging, especially when patients and families have previously been informed inappropriately or insensitively about DNACPR decisions. DNACPR discussions should be initiated by exploring patient understanding and preferences while emphasising care continuation and a more dignified death.

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Cicely Saunders

10.1093/oso/9780190637934.001.0001 ◽

2018 ◽

Cited By ~ 7

Author(s):

David Clark

Keyword(s):

Twentieth Century ◽

Palliative Care ◽

End Of Life ◽

Advanced Disease ◽

Professional Life ◽

The World ◽

The Face ◽

The Individual ◽

Hospice And Palliative Care ◽

First Time

Cicely Saunders founded St Christopher’s Hospice in London in 1967 as a centre for teaching, research, and care. Its influence quickly spread around the world. Cicely Saunders — A Life and Legacy shows how she played a crucial role in shaping a new discourse of care at the end of life. From the nihilism of ‘there is nothing more we can do’, medicine and healthcare gradually adopted a more purposeful approach to care in the face of advanced disease and at the end of life. This came to be known as palliative care. This biography links for the first time the ideas and practice of Cicely Saunders to the spreading global interest in hospice and palliative care. It explores her deep reflection on the nature of suffering at the end of life, the possibilities of a more informed approach to the medical management of pain and other symptoms, and above all the importance of remaining focussed on the personal and spiritual concerns of the individual patient as death approaches. It is a story of a remarkable personal and professional life and of a seismic shift in twentieth-century medical history.

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Population-based end-of-life care

Oxford Handbook of Palliative Care ◽

10.1093/med/9780198745655.003.0026 ◽

2019 ◽

pp. 739-762

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Quality Care ◽

Population Based ◽

Ageing Population ◽

Life Care ◽

Care Services ◽

The Face ◽

The Uk ◽

Developed Nations

This chapter describes the changing face of end-of-life care in the face of demographic changes and the need for a population-based approach in providing end-of-life care in a meaningful manner. Building on the major advances in palliative or end of life care across the world over recent decades, there now seems to be radical groundswell of change in this area, as we face the major challenge of meeting the needs the ageing population. This challenge, most noted in the developed nations, now places specific and seemingly overwhelming unprecedented demands on all our health and social care services. Some would argue that a new approach is needed, building on lessons learnt, to care for the rising numbers of people nearing the last stage of life within our population—in other words, a population approach to end-of-life care. Using examples from the Gold Standards Framework in the UK, the chapter explores the importance of enabling generalists to deliver high quality care across a population, citing a variety of examples and programmes promoting person-centred care at the end of life.

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Konversi di Kalangan Orang Percaya: Analisis Biblika Kata “Murtad” Menurut Ibrani 3:12

Jurnal Teologi Amreta (ISSN: 2599-3100) ◽

10.54345/jta.v5i1.65 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Paulus Kunto Baskoro

Keyword(s):

End Of Life ◽

Jesus Christ ◽

Future Study ◽

Relevant Literature ◽

Biblical Studies ◽

Family Work ◽

The Face ◽

Special Concern ◽

The Church ◽

Descriptive Method

ABSTRAKKeputusan untuk mengikut Yesus sebagai Tuhan dan Juruselamat seharusnya sudah final bagi setiap orang percaya. Tentunya ada banyak tantangan dalam kehidupan seseorang dalam mengikut Yesus dan ini yang disebut sebagai proses kehidupan. Proses kehidupan bisa terjadi dalam keluarga, pekerjaan, jodoh, masa depan, studi, lingkungan, dll. Setiap orang percaya diharapkan menang menghadapi segala tantangan dan tetap setia dalam mengikut Yesus. Namun dalam kenyataannya, banyak di antara umat Kristen yang katanya sudah mengaku menerima Yesus, setia dalam ibadah, bahkan terlibat aktif dalam pelayanan di gereja lokal, tiba-tiba menyatakan diri menyangkal Yesus Kristus, serta tidak lagi menjadi bagian orang Kristen, dan akhirnya berpindah kepada keyakinan lain. Kemurtadan terjadi karena beberapa aspek yang sebetulnya tidak fundamental dalam kehidupan. Hal ini kiranya menjadi perhatian khusus, supaya setiap orang percaya dapat teguh dalam imannya kepada Yesus Kristus. Artikel ini menggunakan metode deskritif kualitatif berdasarkan kajian pustaka, dengan studi biblika atas Ibrani 3:12. Tujuan penulisan antara lain: Pertama, setiap orang percaya mengerti betul serta memahami bahwa mengikuti Yesus harus setia sampai akhir hidup. Kedua, mengerti secara jelas apa makna dari murtad dan tidak melakukannya. Ketiga, gereja-gereja dapat secara serius mengajarkan tentang kesungguhan dalam mengikut Yesus, sehingga murtad tidak banyak terjadi di antara orang Kristen. Temuan yang dikaji adalah sebuah pemahaman tentang kata konversi (“murtad”), dan ditutup dengan pesan agar kita senantiasa menjaga iman yang teguh dalam Yesus Kristus. ABSTRACTThe decision to follow Jesus as The Lord and The Savior should be final for every believer. There can be many challenges in the life of Jesus’s followers and this is called the process of life. The process of life can occur in family, work, mate, future, study and environment. Every believer is expected to overcome in the face of all challenges and always follow Jesus. But in reality, many Christians who claim to have accepted Jesus and be faithful in worship, and are even involved in various ministry, suddenly decide to deny Jesus Christ and become apostates and are no longer part of Christians, and eventually convert to other beliefs. Apostasy occurs because of some aspects that are not fundamental in life. This is a special concern, so that every believer can keep a firm faith in his/her accompaniment to Jesus Christ. This writing uses a descriptive method research based on relevant literature, and supported by biblical studies of Letters to Hebrew 3:12. The goal here is that trough this article: First, every believer fully understands that following Jesus must be faithful to the end of life. Second, he/she clearly understands what apostasy means and not do it. Third, the church can teach about why one shall be serious in following Jesus, so that apostasies do not occur much among Christian believers. The findings here include understanding the meaning of conversion word (“apostate”), and a few messages for believers on how to maintain a strong life in Jesus Christ.

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