Facing Death notes

What are Corr’s 4 primary dimensions in coping with dying?

Physical, psychological, social, and spiritual.

Physical dimention

satisfying bodily needs and symptom management

psychological dimension

addresses emotional and cognitive responses to dying

social dimension

sustaining relationships, role, interpersonal connections

spiritual dimension

emphasizes meaning, purpose, and existential/religious beliefs - not exclusively religious

what are the four contexts of awareness about dying (Glaser and Strauss)

closed awareness, suspected awareness, mutual pretense, and open awareness

closed awareness

patient does not know they are dying, but others do

communication is lacking, vague, or withheld

cannot prepare for death

suspected awarness

suspicion not confirmed by others, tries to read between the lines

communication involves indirect questioning, or testing others for honesty

even children are very intuitive

creates anxiety, uncertainty, and mistrust

mutual pretense

communication is avoided, but everyone knows the outcome

act as if the patient is getting well, and patient pretends things are normal

this avoidance may continue through the very end and limits expression and closure

open awareness

death is acknowledged and discussed

allows for sharing of support and closure

what are the stages of dying

(DABDA) denial, anger, bargaining, depression, and acceptance

Criticisms of DABDA

it is too linear - it became the prescription for how people should cope

focused on western cultures

not everyone reaches the acceptance stage

What are the phases of Ken Doka’s model

Acute, chronic, and terminal

Ken Doka’s acute phase

understand the disease

maximize health and lifestyle

optimize coping strengths

develop strategies to deal with issues created by disease

explore effect of diagnosis on self and others

express feelings and fears

integrate present reality into sense of past and future

Ken Doka’s chronic phase

manage symptoms and side effects

carry out health regimens

manage stress and examine coping behaviors

normalize life to extent possible in face of disease

maximize social support and preserve self-concept

express feelings and fears

find meaning in uncertainty and suffering

Ken Doka’s terminal phase

manage discomfort, pain, incapacitation, other symptoms

cope with health procedures and institutional stress

manage stress and examine coping behaviors

prepare for death and saying goodbye

sustain self-concept and appropriate relationships with others

express feelings and fears

find meaning in life and death

Weisman’s three phases of coping

existential plight - from symptoms to diagnosis

mitigation and accommodation - time from final diagnosis and final decline

preterminality and terminality - from decline until death

three coping strategies

emotion-focused, problem-focused, meaning-based coping

emotion-focused coping

could be due to losing a relationship, family member, etc.

finding a way to cope with emotions

ex: exercise, complaining to others, journaling

problem-focused coping

Dealing with stress by directly addressing the cause of the problem 

ex: in a toxic relationship and deciding to leave; seeking information about a diagnosis

meaning based coping

finding positive meaning or purpose in a difficult situtation

pain

the most common symptom in terminally ill patients

“Fifth vital sign” (temp, pulse, respirations, BP)

1 in 2 patients are undertreated for pain (opioid epidemic)

what are the steps to treating pain

1. non-opioid pain relievers

2. opioid derivatives

3. strong opioids

a combination is most effective

what are the three dying trajectories

trajectory 1: steady decline followed by rapid decline (clear terminal phase) - common in cancer

trajectory 2: gradual decline with period of serious episodes with some recovery (last episode leads to sudden death) - common with organ failure

trajectory 3: prolonged gradual decline or dwindling (common with frailty of dementia)