Terminal illness

Finding out that you have a terminal illness can be emotionally and physically very painful. People respond differently when they are newly diagnosed with a condition that has a poor prognosis. The general reaction of the patient involved is one of shock or disbelief however the experience is unique for each person and their family or loved ones. This essay will discuss the varying responses a patient undergoes once newly diagnosed with a condition that has a poor prognosis.

The areas covered will involve their physical, emotional, cognitive and behavioural responses. It will also analyse the differing stages of ‘coping’ with chronic disease those being denial, anxiety, anger fear and depression. Some responses come in stages but can also co exist at the same time. It will also look briefly into the ideas of Hope and Religion and measure their importance in a patients care and coping management. As it can be seen that through this process and journey some people might try to resolve and reconnect with family and friends and or alternatively start searching for a sense of spirit or religion in their life. This may help patients to cope better with disease and dying (Candy et al., 2012).

BODY
The coping with terminal illness is challenging for the patient because it is a traumatic event but also has a big impact on the patients’ family members and friends. The term ‘coping’ has been defined as a process whereby behavioural and cognitive efforts are constantly changing in order to manage or meet specific internal or external demands that have been assessed to be physically or mentally demanding for the individual involved (Corr et al., 2012).Once diagnosed with a terminal illness a patient undergoes their own process of coping with the illness and the poor prognosis. This act of coping is a response that changes cognitive and behavioural efforts of the patient. Corr et al. (2012) explains there are four important aspects that can be identified in coping with dying. Those are physical, psychological, social and spiritual.

Having been a carer for my mother who recently passed away after a long 8 year struggle with cancer the process of coping was evident as was its metamorphosis. The pain, exhaustion and feelings of hopelessness in that situation were not resigned only for my mother, they transcended over to me. To be a carer or family member for a person diagnosed with terminal illness involves physical and psychological challenges (Candy et al., 2011).

According to Kubler (1981) there exist five stages when a person is facing death. These are denial, anger, bargaining, depression and acceptance. Denial is a common coping strategy for those who refuse to accept the diagnosis of a terminal disease. Most people use denial to one degree or another. Kubler (1981) confirms this stating “the denial is usually a temporary defence and will soon be replaced by partial acceptance” (p.32). In denial patients often refuse to talk about their illness, searching for many doctors trying to find assurance and optimistic answers to escape the fatal outcome (Kubler, 1981).

‘Œƒƒ  The anger is the other common response for patients newly diagnosed with a terminal illness. I often witnessed signs of anger throughout my mum’s terminal cancer illness. In stages of depression and defeat she would behaviourally respond with anger and frustration. She would also at times rebel against her situation and often lash out at us and family making us feel guilty about decisions we made regarding her hospital stays.

The hope is essential for all patients who suffer with chronic disease. Snyder et al. (2002) describes if hope is present patients can see a meaningful outcome and it will help them to cope better in the process of dying. Research demonstrates that hopeful, optimistic patients experience lower rates of depression, anxiety, and anger, adjust better to negative outcomes, and have longer survival (Snyder et al., 2002).

As Krikorian et al. (2012) clearly stated, “Suffering is individual, unique, and inherent to each person” (pp.799–808). Suffering is associated with negative emotional responses and it is related with fear, depression and anxiety of death. The best way to deal with all this is through peaceful acceptance and the development of a spiritual approach. That can help to improve the end stages of patient’s life (Krikorian et al., 2012).

The pain is a common response for patients especially in advance or late stage of chronic disease. White (2014) confirms that the pain is an uncomfortable feeling or unpleasant sensation in the body related with tissue damage. There is a two different type of pain acute or chronic. Acute pain is direct stimulation of sensory neurons related to physical injuries. This type of pain usually comes on fast and often goes away. Acute pain can become chronic when the cause is difficult to treat (White 2014).

‘Œƒƒ Ž‡œ The chronic pain generally refers to pain that exist for three or more months and often cannot be treated or cure. Davison (2007) claims that chronic pain can often linked to psychological distress. The cause of chronic pain, depression and other psychological symptoms are not acknowledged diagnosed and it might be unknown or poorly understood (Davison 2007). Today with improvements in pain managements, palliative care is the option which relieves the pain and distress of cancer dying patients.

There may be limited physical pain due to medications involved, depending on the illness. In the case of my mother’s terminal cancer experience, towards the end stages of her suffering physical limitations arose where eventually she wasn’t able to physically walk. This consequently meant she then wasn’t able to go the toilet on her own, or shower herself independently. This for my mother who was always independent and proud of that fact and whom helped others was a huge challenge and disappointment to overcome. Her worst fear was to eventually be dependent on others and in need of a wheelchair. So whilst her physical suffering may have involved actual minimal pain because of all the medications she was on, her physical limitations directly impacted her emotionally and behaviourally in a huge way. She was no longer self sufficient and her pride was taken from her by her illness.

Krikorian et al. (2012) claims that loss of dignity can often be desire for death. Through the last stages of life some patients develop acceptance and adhere to a spiritual approach while others experience emotional numbness. Generally the fear of death is the main trigger in some patients for emotional numbness Maciejewski et al., (2012).

CONCLUSION
As illustrated above for a person who has been newly diagnosed with a terminal illness that has a poor prognosis, they may experience a plethora of responses. These responses can be synchronous for some patients and this highlights the complexities involved in treating and providing necessary care and support during the different stages of terminal illness. Whilst responses are individual and will vary, the most common experienced by the patient encompass emotional, physical, behavioural and cognitive responses. These responses experienced by the patient can be synchronous or come at varying stages of a terminal illness. A poor prognosis doesn’t signify the end of a patient’s life journey and whilst initially it may evoke negative responses from the patient it may also instil a desire to be resilient and fight the illness and poor prognosis. In some cases even when the initial diagnosis and prognosis was poor and bleak a patient has ‘beaten the odds’ and made a complete recovery or evolved to live a manageable life with a chronic disease or illness.

REFERENCE

Corr, C., Nabe, C., & Corr, D. (2012). Death & Dying: Life and Living. (7th ed.). Belmont CA: Wadsworth/ Cengage Learning USA.

Candy, B., Jones, L., Drake, R., Leurents, B., & King, M. (2011). Interventions for supporting informal caregivers of patients in the terminal phase of a disease. The Cochrane Collaboration, 15(6), 1-63, doi: 10.1002/14651858.CD007617

Candy B, Jones L., Varagunam, M., Speck P., Tookman, A., & King, M. (2012).Spiritual and religious interventions for well-being of adults in the terminal phase of disease. Cochrane Database of Systematic Reviews, 1(5), 1-29,

doi:10.1002/14651858.CD007544

Davison, S. N. (2007).Chronic kidney disease: Psychosocial impact of chronic pain. Geriatrics, 62(2), 17-23.

Krikorian, A., Limonero, T. J., & Mate, J. (2012). Suffering and distress at the end of life: Psycho Oncology, 21(8), 799-808, doi: 10.1002/pon.2087

Kubler, R. E. (1981). Living with death and dying: How to communicate with the terminally ill (1st ed.). New York: Macmillan.

Maciejewski, K. P., & Prigerson, G. H. (2013).Emotional numbness modifies
the effect of end of life care. Journal of pain and symptom management, 45(3), 841-847.

Snyder, C. R., & Amber, G. (2002). Coping with terminal illness: The role of hopeful thinking, Journal of palliative medicine, 5(6), 883-894.

White, C., & McDonnell, H. (2014).Psychosocial distress in patients with end stage kidney disease. Journal of Renal Care, 40(1), 74-81.