1. Chapter 5
The Therapeutic Approach to the Patient with a Life-Threatening Illness
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2. Life-Threatening Illness
Implies a life that in all probability will be shortened because of a serious or debilitation illness or disease
Cultural perspective on life-threatening illness
How you live, think, speak, and behave
Viewed differently by different cultures
Pain is viewed in the same manner
Family strongest influence
Work with family and belief system
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3. Choices in Life-threatening Illness (Slide 1 of 3)
Urgency of decisions depend on possible life expectancy
Provider may ask the patient how they might like to be involved in the decision- making process
Patients have right to choose or refuse treatment
Palliative care focuses on quality of life, relieving symptoms of pain and suffering
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4. Choices in Life-threatening Illness (Slide 2 of 3)
Choices to be made in life-threatening illness
May forgo treatment
Palliative care
Voluntarily stop eating and drinking
Total sedation
In a few states, option to seek aid in dying, usually through self-administration of prescribed medication
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4

5. Choices in Life-threatening Illness (Slide 3 of 3)
Issues to be considered/discussed with patients
Alternative treatment
Pain management
Health care directives
Emotional needs of patient and family members
Finances
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6. The Range of Psychological Suffering
Anxiety, depression, denial, hopelessness
Often leads to physical symptoms
Help patients understand that relationships change
Encourage patients to set goals for themselves
Listen carefully and seek clues to nonverbal communication
Examples of life-threatening illness: coronary artery disease, chronic obstructive pulmonary disease, diabetes, Alzheimer's
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7. Patients with Cancer Patients equate cancer with death
There are many treatment options available
Surgery, radiation, chemotherapy, hormone therapy, transplants, immunotherapy, combination therapy
Patients may feel empowered by taking an active role in the decision making process
Serious side effects from both radiation and chemotherapy
Even when there is “nothing more to do” related to the cancer, there is still “much to do” to maintain comfort
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7

8. Patients with HIV/AIDS (Slide 1 of 2)
Patients will have great stress when diagnosed with Human Immunodeficiency Virus (HIV) or Acquired Immune deficiency syndrome (AIDS)
May have fairly good health for a period or very serious near-death illness
Recent developments in treatment of HIV infection and AIDS help patients to live longer
Lives greatly compromised because of suppressed immune system
With diagnosis comes anger, fear, guilt
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8

9. Patients with HIV/AIDS (Slide 2 of 2)
HIV affects mostly individuals who are relatively young
Treating HIV is expensive, and many patients have little or no insurance coverage
Patients may experience central nervous system involvement
Late stage HIV is called AIDS when CD4 count is less than 200
Other criteria for AIDS are types of opportunistic infections or tumors, AIDS-related brain or lung illnesses, and severe body wasting
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10. Patients with End Stage Renal Disease
Loss of kidney (renal) function leads to end- stage renal disease
Patients cannot live long unless they receive dialysis or kidney transplant
Dialysis is filtering blood to remove wastes and can sustain life for years
Some patients will opt not to have dialysis and to let death come from kidney failure
Kidney failure leads to little or no urine output
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10

11. Communication in End-Of-Life Care
Most patients choose to have some control over the end-of-life process
Questions to the patient may include
What is most important to you now?
What are you hoping for?
What plans have you made for this transition?
How can my team assist you?
Professionals must remain respectful and empathetic
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11

12. The Stages of Grief (Slide 1 of 2)
Dr. Elisabeth Kübler-Ross determined stages of grief
Denial, anger, bargaining, depression, and acceptance
See Quick Reference Guide: Stage of Grief
TEAR is also used to describe grieving process
T = To accept the reality of the loss
E = Experience the pain of the loss
A = Adjust to what was lost
R = Reinvest in a new reality
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12

13. The Stages of Grief (Slide 2 of 2)
Not all patients go through all five stages
Some patients go through all five stages over and over again, each time with a little less stress
Others get stuck in one stage
No two patients follow the same pattern
Family members also suffer grief and are often in different stages
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14. The Challenge for the Medical Assistant
Be sensitive and respectful
Must be comfortable treating all patients
Nonmedical forms of assistance
Referrals to community-based organizations
Recommend support systems
Spiritual support
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14