Article

Dying, dignity, and new horizons in palliative end-of-life care.

DepartmentManitoba Palliative Care Research Unit, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
CA A Cancer Journal for Clinicians (Impact Factor: 162.5). 56(2):84-103; quiz 104-5.
Source: PubMed

ABSTRACT Palliative care practitioners are now better able than ever before to ameliorate end-of-life symptom distress. What remains less developed, however, is the knowledge base and skill set necessary to recognize, assess, and compassionately address the psychosocial, existential, and spiritual aspects of the patient's dying experience. This review provides an overview of these areas, focusing primarily on empirical data that has examined these issues. A brief overview of psychiatric challenges in end-of-life care is complemented with a list of resources for readers wishing to explore this area more extensively. The experience of spiritual or existential suffering toward the end of life is explored, with an examination of the conceptual correlates of suffering. These correlates include: hopelessness, burden to others, loss of sense of dignity, and desire for death or loss of will to live. An empirically-derived model of dignity is described in some detail, with practical examples of diagnostic questions and therapeutic interventions to preserve dignity. Other interventions to reduce existential or spiritual suffering are described and evidence of their efficacy is presented. The author concludes that palliative care must continue to develop compassionate, individually tailored, and effective responses to the mounting vulnerability and increasingly difficult physical, psychosocial, and spiritual challenges facing persons nearing the end of life.

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    Palliative and Supportive Care 01/2014; 12:423-424. DOI:10.1017/S1478951514001400 · 0.98 Impact Factor
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    ABSTRACT: There is a lack of research into suffering and what it means to the individual patient with advanced cancer and its importance in end of life care. To explore the concept of suffering and distress by eliciting what individual patients with advanced cancer perceived as suffering and how they utilised their own resources to manage suffering. A qualitative study design of focused narrative interviews analysed by thematic analysis was conducted with a heterogeneous sample of 49 palliative day care patients. For those patients who perceived they were suffering, this study revealed a wide spectrum of definitions which could be described within the following areas; the unavoidable and avoidable suffering, physical and emotional suffering, suffering as loss and finally transformation through suffering. These findings provide important insight that broadens and enriches our understanding into the concept of suffering and how patients utilise their resources, which may have important implications for end of life care. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
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May 21, 2014