• Social significant attachments and address the social implications of dying. • Spiritual tasks address meaningfulness, connectedness, and transcendence. tasks enhance This model teaches clinicians who work in palliative care and hospice care that as individuals find ways to manage their bodily changes, attempt to maintain a healthy mental perspective, and cherish their relationships, they are also exploring what is sacred to them in the time they have left.
one’s affairs, resolving relationships, finding a sense of meaning in one’s life, experiencing love of self and others, acknowledging the finality of life and a sense of a new self, and letting go.
Common myths of hospice and palliative care:
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Myth #1: Hospice is a place. ° Hospice is a philosophy and hospice care takes place wherever the patient calls home. Myth #2: Hospice is only for people with cancer. ° More than one-half of hospice patients have diagnoses other than cancer. Hospices serve patients with end-stages of chronic diseases such as COPD, Alzheimer’s, cardiovascular, and neuromuscular diseases. Myth #3: Hospice is only for old people or the last week of life. ° Although most hospice patients are older, hospices serve patients of all ages and may continue to serve patients who outlive their initial prognosis Myth #4: Hospice means patients can no longer choose their care. ° As a family-centered concept of care, hospice focuses as much on individualizing care for the patient and the grieving family as on the dying patient. Patients may decide to return to curative care and be discharged from hospice. Myth #5: Hospice can help only when family members are available to provide care or when hospice is staffed by volunteers. ° Recognizing that terminally ill people may live alone or with family members unable to provide care, many hospices coordinate community resources to identify a location for the patient to receive care. Hospices are staffed by professionals with volunteers as integral members of the team. Myth #6: Hospice means the patient will die faster. ° Hospice and palliative care is serious medicine and can be quite high-level care. Most hospices are Medicare- certified, requiring that they employ experienced and highly skilled medical and nursing personnel. Hospice is about making the most of the remaining time.
Spirituality-Based
A patient’s spiritual perspective across the dying trajectory stems from their belief system; faith; values; life’s purpose; and perception of the meaning of their existence in relation to others, including family members and close friends, nurses, physicians, social workers, and pastoral counselors. 37 Spiritual distress is just as critical as body and mind distress. 37 A spiritual approach to coping with dying can enhance the patient’s life and can be instrumental for those who have a life-threatening disease and for their family members. 37 Although chaplains, community-based clergy, and pastoral counselors recognize and explore spiritual distress, all professional care providers can inquire into this significant part of the patient’s being. Bowman notes that spirituality is now routinely included in palliative care and that spiritual care is not synonymous with religious practice. 38 This difference may cause tension for those providing end-of-life care because, all too frequently, patients near the end of life may reveal things when ready to clinicians with whom they experience comfort; clinicians need to be ready to address any spiritual and grief concerns when voiced. 38 Accordingly, a palliative care team may help patients and families move toward acceptance and peace if they are challenged by the illness and are looking for spiritual support. 39,40 Common myths and barriers Although hospice and palliative care allow patients autonomy to deal with their own illness, there are still misconceptions that contribute to fear and resistance. These misconceptions cause barriers to care delivery. Many people consider hospice synonymous with death, giving up hope, euthanasia, or assisted suicide. Zimmermann and colleagues found when palliative care was introduced to patients, they reported feeling shock and fear, resistance to it, and a lack of relevance to them. 41
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Phase-Based
The phase-based theory of dying process focuses on the living-dying interval that occurs from when the patient learns that death is imminent to the actual death, during which the patient oscillates between denial and acceptance of the prognosis. 34 Three clinical phases take place during the living-dying interval phase: acute, chronic, and terminal. As the patient moves through each of the phases, the dying process is determined by their feelings and reactions, which can continually change. 34 What this model can teach clinicians who work in palliative care and hospice care is to recognize how the varying changes emotionally affect the patient from the very first moment of learning of the terminal illness to the moment of death. 34
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Landmarks-Based
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Doka describes another theory of life- limiting illness that includes the pre-diagnostic, acute, chronic, terminal, and recovery landmarks. 35 Each landmark then has an associated task of coping. In the pre-diagnostic landmark, individuals suspect an illness and seek out medical attention. 35 The acute landmark, initiated by the diagnosis, is when individuals attempt to understand the disease, maximize health, develop coping strategies, explore the effects of the diagnosis, express feelings, and integrate the present reality into their sense of past and future. 35 The chronic phase involves managing the symptoms and side effects while carrying out health regimens, normalizing life, maximizing social support, expressing feelings, and finding meaning in the suffering. 35 Doka’s model is based on the work of Ira Byock, who identified the importance of patients with a life-threatening disease attaining certain landmarks before death. 36 At each landmark, individuals have taskwork to complete. These landmarks include completing
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