Caring for the Terminally Ill Patient

¶ … population ages, it will become increasingly important to know how to care for the chronically ill and dying elderly patients. An article in American Family Physician details one of the problems that arises in such cases: denial. The article tells about an incident where a man who is in constant pain repeatedly goes to the doctor, but will not accept that his symptoms could be caused by cancer. When the doctor offers to make a referral to hospice for extra help, the patient adamantly refuses the care. At first the physician does not give up his potential persuasions, which include stressing the patient's personal responsibility concerning the need for loved ones to see him free of pain. Yet the same scenario continues until, unfortunately, the man dies.

The author of the article, Dr. Karen Ogle, explains that denial is a common coping mechanism in the terminally ill. People rely on denial in different degrees, for example refusing to believe some aspects of their illness at least some of the time. This denial may also vary widely on a day-to-day, or even a minute-to-minute basis. In this case, the denial is very strong and irreversible.

Dr. Ogle adds that although the doctor said he tried his best to persuade the man to get additional care, perhaps more could have been done. By coming back to the doctor's office time and time again, he may have been approachable by establishing "an alliance around the pain" and building slowly to a mutual understanding of the current situation: "You have been having a lot of pain . . . We have done a number of tests . . . The results show that . . . This means that . . ."

One of the ways to break bad news, she adds, is to retain respect patient's personal choices about coping, while expressing concerns in a balanced and clear manner: "I know you try to maintain as optimistic a view as possible about the cancer. I want to support your hopes about this. At the same time, I want to be sure that we have covered the decisions that need to be made if that is not how things turn out."

Denial is one of the most challenging reactions to dying, because it makes the doctor confront a lack of ability of accomplishing his or her first priority -- making life the best possible for the patient. When not being able to persude the terminally ill person to face the truth, the physician often gives up and becomes convinced that all that could be done, was done. The doctor then gives up and lets the family member or another loved one take over and accept the responsibility.

Unforunately, notes Ogle, there will always be those idividuals who never want to accept the truth and remain in denial until they die, like this above-noted patient,. This is even when such people realize the negative effect this is having on their spouse, children and other family members and friends.