End of Life:Terminal Patients' Issues/Palliative Care

August 2010 Terrific NEWS: See article (NYTimes) on new Harvard study - "Palliative Care Extends Life"

Dying Patients Who Acknowledge Terminal Prognosis Less Depressed, Groundbreaking Study Finds

A groundbreaking Canadian study reveals that terminal cancer patients who are aware they are going to die are less likely to be depressed than those in denial. The study is published in the current issue (November-December, 2000) of the journal Psychosomatics.

"We found that depression was about three times greater in patients who didn't acknowledge their terminal prognosis," says the study's author, Dr. Harvey Chochinov, Professor of Psychiatry and Family Medicine, Division of Palliative Care, University of Manitoba.

"Denial may be a defence mechanism used by some patients to protect them from death anxiety. But our findings show that denial is often imperfect and doesn't necessarily eliminate underlying psychological distress," says Chochinov.

The study found that almost 10 per cent of dying cancer patients denied their terminal prognosis - even though they were hospitalized in palliative care units. Men were more likely than women to deny that death was near, as were older patients.

The study has implications for the care of dying people, says Chochinov. "When doctors see a dying patient who is in denial, they will know that the patient may in fact be distressed and quite vulnerable."

Chochinov also found that dying people who were aware of their impending death didn't necessarily feel hopeless.

"You would think that if people knew death was imminent, they would be more likely to feel hopeless," he says. "Although each patient's situation needs separate evaluation, the findings show that giving prognostic information to patients doesn't necessarily take away hope."

The study, which is the most comprehensive of its kind, was funded by the Canadian Cancer Society and The Open Society Institute, Project Death in America.

"Quality of care for cancer patients in the terminal stages of their disease is extremely important and quite often not enough attention is given to this stage of the disease," says Dr. Barb Whylie, Director, Medical Affairs/Cancer Control, Canadian Cancer Society. "These findings will help us to better understand what happens when people face a terminal prognosis, an unfortunate reality for many cancer patients."

Chochinov and his team interviewed 200 patients with advanced cancer who were in their final weeks of life at two Winnipeg palliative care units. The patients, aged 31 to 94, were asked about their level of awareness of their prognosis, depressive disorders, demographic and social variables.

Chochinov is also Head, Department of Psychosocial Oncology, at CancerCare Manitoba.

The Canadian Cancer Society is the largest, single non-governmental funder of cancer research in Canada. The Society also informs the public about risk reduction/prevention of cancer, provides services for people living with cancer and advocates for healthy public policy.

For questions about cancer, call the Canadian Cancer Society's cancer Information Specialists at 1-888-939-9333.

For more information, please contact:

Margaret Polanyi Senior Communications Officer (Research) Canadian Cancer Society/National Cancer Institute of Canada (416) 934-5684

End of Life Care

Lancet Oncology February 2001

Realities of End-of-Life Palliative Care
Family Perspectives:End-of-Life/Last Place of Care
Finnish Docs Responses to Terminal Pt & Unorthodox Thera
Wide Range of DNR Styles and Usage
Symptoms, Treatment & Dying Peacefully: Terminally Ill Pts
Worse QoL for those who die in ICU versus HOME
Palliative Care Extends Life

New York, Times, August 18, 2010

Best Place for Death = HOME
Nurses and Dying Patients-About Hospice Care Information

February 2001

Hospice Care - Advice From A Licensed Funeral Director
Living Wills

Patients wishes often disregarded 2/01

Communicating Prognosis

MEDSCAPE Med Students, 2001

Deceit Hurts More Than Truth
Communicate with Realism & Hope: Pt Perspectives
Providers & Public Differ on End-of-Life Issues
End-of-Life Discussions BENEFICIAL
Terminally Ill Patients Alone Too Much

Am J Medicine, 10/01

Comfort vs. Longevity: Who Decides

New York Times article, 3/12/02

Dignity-Conserving Care

JAMA, 4/02

Defining Dignity in Terminally Ill Cancer Patients
Patients Can Refuse Treatment (UK)

Reuters Health, 5/02

Assisted Suicide-Nurses/Social Workers Report

N Engl J Med, 8/02

Nurses' Experiences w/Hospice Pts
Viatical Settlements:Terminally Ill

Cancer Practice, 11/02

Last Acts Project

LINK to natl coalition to improve care/caring at end of life-resources, information

Elisabeth Kübler-Ross: Care of Terminally Ill, Dies at 78

Obituary, 8/26/04

Withdrawal of Life Support


Talking w/Terminally Ill Pts & Caregivers on Death, Dying, etc.

Arch Intern Med, 10/04

Hospice Patients Org

LINK to site with lots of information and criticisms of the system

Chemo Use Among Terminal Patients

Harvard Med School Study, 6/03

Hospice Referral For Children w/Cancer
Older Adults Receive Intensive Chemo at End of Life

LINK to source to convert life insurance into $$$ Many other companies too

"Green' Funerals

USA Today, 2/04

Alkaline Hydrolysis or Aquamation.
Viatical MD

LINK to site for viatical $

National Hospice & Palliative Care Org

LINK to resource

End of Life Choices Organization

LINK to former Hemlock Society (death-with-dignity)

Natl Institutes of Health:State of Science on End of Life Care


Caring Connections

LINK to free resources & information to help people make decisions about end-of-life care & svcs before a crisis.

Complementary therapies for pain mngemnt in palliative care

J Community Nursing, August 2007

Share the Care

LINK "How to organize a group to care for someone who is seriously ill"

Meaning/Purpose -Terminally People Lessens Despair

The Lancet, 6/03

Positive Outlook Comes From Within/Readjustment Constant
Coping Strategies for One's Own Impending Death from Cancer
Get Palliative Care

LINK to resources

Books relating to Palliative Care, Grief, Hospice

A category that is swiftly growing, thanks to recognition of need

Book: Living Consciously, Dying Gracefully
Final Gifts, a book
Book: "Lean On Me" Cancer Through a Carer's Eyes
The Last Adventure of Life
The Most Important Day of Your Life: Are You Ready?
About Hospice, Death & Dying

An explanation of what, why and a link to where

Obit: Andrea Martin, Founder The Breast Cancer Fund
Obit: Jessica Grace Wing, composer, Age 31
Josefina B. Magno Dies at 83:Oncologist Founded HOSPICE
Mary-Ellis Bunim, 57, Pioneer in Reality TV
OBIT: Susan Schecter, 57, Author Books on Domestic Violence
Families Facing Cancer

LINK: Emotional and Practical Support for families and caregivers

The Last Adventure of Life

LINK: "Sacred resources for Living and Dying from a hospice counselor" Maria Dancing Heart

Remember we are NOT Doctors and have NO medical training.

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