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Definition
| When a patient is told that he or she has a terminal illness, a disease that cannot be cured and will result in death, the patient may react in different ways. Some patients react with fear and anxiety. They fear pain, abandonment, and loneliness. They fear the unknow (strange people). They become anxious about their loved ones and about unfinished work or dreams. Anxiety diminishes in patients who feel they have had full lives and who have strong religious beliefs regarding life after death. Some patients view death as a final peace. They know it will bring an end to loneliness, pain, and suffering. |
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Term
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Definition
| "No, not me!" stage, which usually occurs when a patient is first told of a terminal illness. It occurs when the person cannot accept the reality of death or when the person feels loved ones cannot accept the truth. The person may make statements such as "The doctor does not know what he is talking about" or "The test have to be wrong." Some patients seek second medical opinions or request additional tests. Others refuse to discuss their situations and avoid any references to their illnesses. It is important for patient to discuss these feelings. The healthcare worker should listen to a patient and try to provide support without confirming or denying. Statements such as "It must be hard for you" or "You feel additional tests will help?" will allow the patient to express feelings and move on to the next next stage. |
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| Anger occurs when the patient is no longer able to deny death. Statements such as "Why me?" or "It's your fault" are common. Patients may strike out at anyone who comes in contact with them and become very hostile and bitter. They may blame themselves, their loved ones, or healthcare personnel for their illnesses. It is important for the healthcare worker to understand that this anger is not a personal attack; the anger is caused by the situation the patient is experiencing. Providing understanding and support, listening, and making every attempt to respond to the patient's demands quickly and stage continues until the anger is exhausted or the patient must attend to other countries. |
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| Occurs when patients accept death but want more time to live. Frequently, this is a period when patients turn to religion and spiritual beliefs. At this point, the will to live is strong, and patients fight hard to achieve goals set. They want to see their children graduate or get married; they want time to arrange care for their families; they want to hold new grandchildren; or other similar desires. Patients make promises to God to obtain more tim. Healthcare worker must again be supportive and be good listeners. Whenever possible, they should help patients meet their goals. |
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| Occurs when patients realize that death will come soon and they will no longer be with their families or be able to complete their goals. They may express these regrets, or they may withdraw and become quiet. They experience great sadness, and, at times overwhelming despair. It is important for healthcare worker to let patients know that it is "OK" to be depressed. Providing quiet understanding support, and/or a simple touch, and allowing patients to cry or express grief are important during this stage. |
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| Acceptance is the final stage. Patients understand and accept the fact that they are going to die. Patients may complete unfinished business and try to help those around them deal with the oncoming death. Gradually, patients separate themselves from the world and other people. At the end, they are at peace and can die with dignity. During this final stage, patients still need emotional support and the presence of others, even if it is just the touch of a hand. |
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| care can play an important role is meeting the needs of the dying patient. Hospice care offers palliative care, or care that provides support and comfort. It can be offered in hospitals, medical centers, and special facilities, but most frequently it is offered in the patient's home. Hospice care is not limited to a specific time period in a patient's life. Usually it is not started until a physician declares that the patient has six months or less to live, but it can be started sooner. Most often patients and their families are reluctant to begin hospice care because they feel that this action recognizes the end of life. |
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