Death and Dying

What are the symptoms or distress of dying

Depression • Anxiety • Hopelessness and despair • Shock • Guilt • Loss of meaning • Feeling like a burden to family

How should providers foster hope

Maintain hope or change the meaning of hope • Set attainable goals that involve patients in the decision making and focus on what can be done (CARE CONTINUES…)

What are the stages of the grieving process

Denial • Anger • Bargaining • Depression • Acceptance

What are the signs of a complicated grief

Signs of grief beyond 6-12 months (being mindful of cultural norms) • Extreme reactions persisting over time • Intense yearning, longing, or emotional pain, Frequent pre occupying thoughts of the deceased • Inability to recognize or accept loss • Difficulty imagining meaningful future without the deceased.

What are the risk factors of a complicated grief

The specifics of the loss and who deceased – Loss of a child • Nature of the attachment – Dependent partner • Mode of loss or death – Sudden death.

What are the complications of a complicated grief

Increased risk of suicide • Increased risk of depression and anxiety • 30-50% chance of PTSD co-occurrence • Increased risk of alcohol or tobacco use • Increased risk of cardiovascular disease and cancer • Functional disability.

What do Patients and families in an ICU want

Timely, clear, and compassionate communication • Clinical decision making focused on patients’ preferences, goals, and values • Maintaining comfort, dignity, and personhood.

What do patients get when it comes to life ending care?

9000 patients hospitalized with life-threatening illness, 50% died within 6 months of entry • Half of conscious patients who died in the hospital had moderate-severe pain \>50% of time during last 3 days of life • 31% of patients preferred CPR to be withheld but only 47% of their physicians knew this preference • 49% of patients who wanted CPR withheld did not have a DNR order written during the hospitalization.

Describe modern day patient and family experience with the dying process

Providing dying persons with desired physical comfort • Helping dying persons control decisions about medical care • Relieving family members of the burden of being present at all times to advocate for their loved one. Educating family members so they felt confident caring for their loved ones at home • Providing family members with emotional support before and after the patient’s death

What do families get when it comes to life ending care?

Not enough contact with physician: 51% • Concerns about physician communication: 27% • Not enough information about what to expect with the dying process: 50% • Not enough emotional support for the patient: 51% • Not enough emotional support for family: 38% • Not always treating patient with respect: 20%

What are the communication barriers between patients, families and providers.

• Lack of Cultural Humility, Cultural beliefs on disclosure of information • Unrealistic expectations of the healthcare system especially in a culture which “denies death” • Societal values on the dying process • Trust • Feeling disrespected • Lack of advanced directives and burden of decision making on families

What are the Risk Factors of burn out amongst providers

Not being able to maintain a Work life balance • Not being able to say “no” • Organizational and financial pressures • Lack of social or spiritual support and “taking work home” • Younger age • Difficulty expressing one’s own emotions

What are the signs and symptoms of burn out amongst providers

Tiredness out of proportion to work being done • Low morale • Avoidance of patients • Easily irritable or getting angry • Errors in judgment • Depression or grief • Difficulties at home