Psychological+Effects+of+a+terminal+diagnosis

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Presently, the Center for Disease Control and Prevention estimates that 20.3 million Americans are diagnosed with cancer, and 1.2 million people are diagnosed with HIV. As the public media increases their coverage of these diseases, many families of the ill and additional members of the community have come out to support research for the diseases by attending charitable events and raising money. As these diseases increase in awareness, many loved ones come out to support someone they know the disease has impacted. With this money, there have been various types of research to help the patients improve their treatments and after care.

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One of the main sections of research that has received some attention is the psychological impact of having a terminal disease. Multiple researchers have studied the physical and mental impacts of illnesses on subjects and how they cope with their illnesses. Along with that, researchers have also observed the social factors involved with a terminally ill patient’s state of mind and the way they view the world. These research studies were conducted to prove one’s psychological state has a medical impact on the way the human body heals or maintains itself with the treatment. For these reasons, scholars are discussing how physical, social, and emotional factors affect a terminally ill patient’s psychological “will to live” in an effort to help physicians predict medical outcomes and improve treatment.

=Research=



Scholars in the psychological field of medicine analyze the mental factors present during the treatment period and end of life stages of terminally ill patients and address ideas to improve their care and quality of life by changing the patient’s perspectives caused by the disease. Scholars like Chochinov say anxiety and depression are the leading psychological disorders determining a patient’s quality of life during their ill period. A poor quality of life causes problems emotionally and physiologically. For example, it is known that depression weakens the immune system. Additionally, Griva makes claims about anxiety disorder causing problems with the sympathetic nervous system and cardiovascular strains.

In this field of research, scholars Mosack and Jacobs, are conducting surveys and interviews with terminally ill patients to observe their views about their lives to develop improvements in care. What the scholars found was that not all patients were gravely afraid to die. When starting the conversation about death, patients can communicate their needs and worries to their physicians. This communication and effort to improve their lives gives them a sense of control in a difficult situation. Testimonials from Mosack's Interview:

//You know because I find myself some mornings when I get up out of the bed...my legs give out. So, my ankles, when I try to walk, my ankles hurt. So, I’m like well my bones [are] deteriorating slowly. As though as—I’m feeling that already. My body hurts a lot. So...I [am] looking forward to another maybe... if I’m lucky, ten more years.//

//I said that if I have to have tubes, I don’t want to suffer like that, you know. Just let me go ahead and die. I don’t want to suffer like that, you know. I don’t want them to do nothing to try and keep me alive, you know. Because I’ve seen it with my mom, you know. She wasn’t able to remember that, but I’m just saying. I had seen it with my mom, and that wasn’t, [whew] tubes and all that. She was dead all the time, you know. So, don’t make me suffer like that [the way her mom did]//.

Commonly, patients are afraid to die and fear leaving their loved ones behind. However, as Mosack’s research continues, scientists and physicians are noticing some circumstances where patients are more calm and open-minded about approaching death, and this mindset is because some patients have had more time to adjust to their situation over time, also known as acceptance. Patients closer to the end of their lives reach acceptance due to the order of the psychological stages of grief when approaching death: denial, anger, bargaining, depression, and acceptance. Patients are better able to complete the stages when they communicate their concerns to their loved ones and physicians to plan their situation. By addressing possible medical and personal options to a terminally ill patient, patients can think rationally, take control of their situation, and rest comfortably, all in hopes of improving their quality of life.

**Conclusions**

If physicians do not treat the mental disorders, then patients are unhappy and likely to suffer more throughout the treatment of their disease. Pain and hopelessness are factors that link to depression in terminally ill patients. These two notions also cause patients to lack the motivation to continue fighting for their lives. As a result, patients suffering from depression are more likely to turn to physician-assisted suicide.

Several people may believe that one’s mental stability does not affect the length of time one has to live. These people believe that their family member fought as much as they could to overcome their disease and that it did not lead to the conclusion they hoped. However, the majority of research points to the effectiveness of communication between patient, physician, and family members on patient quality of life. When patients accept their fate, they and their loved ones receive closure. One cannot bear the thought of someone close to them dying in pain, but if physicians can target the negative mentality, they can ease the pain of the patient which is the goal of the research. The patients with a more positive outlook on life have a stronger will to live due to their better quality of life and are less reluctant to accept their possible medical outcomes. Likewise, psychology tells us that the severity of pain starts from the mind. Receptors in the body identify the physical sensation of pain, and the brain interprets how the body feels toward it through pain thresholds and mental statuses. For these reasons, a majority of physicians think eliminating negative notions of terminally ill patients is beneficial to their medical treatment.

Mosack, Chochinov, Griva, and Jacobs all focus on the physical and psychological issues affecting medical outcomes. Additionally, all the scholars recognize a patient’s quality of life to indicate his or her view of the future and death. For these reasons, health providers believe terminally ill patients need to be kept comfortable, pain-free, and reminded not to lose hope. A patient’s comfort or happiness will strengthen their will to live protracting their life with a pleasant ending. The scholars’ research of the psychological disorders before death add to the bigger conversation in the psychiatric field of medicine, therefore helping my claim that a patient’s mentality will bring them closer to a soon painful or a later peaceful death.

=Coping Mechanisms = =

= The ways in which people cope or make sense of whats happened to them can be really useful in determining the state of someone's psyche.

Coping mechanisms tend to vary from person to person, but they can tell a lot about how a person is feeling, or how they deal with certain situations. For example, when someone is stressed, they may binge eat, or they may work out-- it depends on the kind of person they are, and of course, on their mental state. Now, as for those who are dying, their coping methods may be different from someone who has other problems.

From the research conducted by Sand, Olsson, and Strang, in their case study of different coping methods in cancer patients, it would seem that those who are aware they are dying develop various mental defenses, such as using humor as a way of keeping their death sort of distanced from them. Another example would be patients using words such as "dots", "bubbles", "nuts", or "it" to refer to their condition instead of using the words "tumor" or "cancer", and using "vitamin C" to refer to chemotherapy, and other diminutive words to help make their looming threat seem not so scary.

Another coping method mentioned was "togetherness", in which the patient focuses more and more on close personal relationships with family, friends, and even the staff taking care of them. The authors noticed during their research that togetherness played a big part in even changing mental perspectives. For example, one patient testified that because she had been given her diagnosis, she now "realized just how beautiful every living creature is", and just "how fantastic everything around her truly is". She says that because she is now forced to come to terms with the fact that she will die, she has gained an expansive newfound appreciation for life and living things.

From this study, what has been found is that the majority (if not all) of these coping mechanisms used and developed by the cancer patients are all for the purpose of keeping the idea of death as far away from them as possible. It makes sense, considering that, of course, nobody wants to die.

=Mental Stages = =

= In a phenomenological study, conducted by authors, Freiberg, Joakim, and Ohlen, the observation was made that when one is informed of their own impending death, there is a very distinct set of changes and shifts that occur in one's mental state.

This, of course, is a very natural reaction. After all, one only gets to die once. However, these reactions and changes take place more or less as a way to help the individual first, make sense of what is happening to them and what exactly that means, and second, to help them come to terms with their fate.

The authors describe three distinct paths (or "stages") they noticed while observing their patient. There is "The Stable Path", in which one manages their own existential uncertainty, "The Turning Point", in which the patient confronts their existential uncertainty, and "The Waiting", in which the patient shifts towards living with existential certainty.

__ The Stable Path __ It is in this "stage" that that patient strives to maintain a sort of "normalcy" within him, as he continues to monitor his bodily changes and simultaneously keep stable social relationships. this is sort of a "denial" type situation: while the patient knows what is going on, he is trying to learn about it and yet, keep it as far away from him as possible. It is in this stage that the patient strives for knowledge, but at the same time does not want to find out too much, for fear of learning "too much". It is also in this stage that the patient seeks information about his illness in particular from health care professionals.

__ The Turning Point __ This stage comes about as a result of the patient not being able to more or less "deny" his fate any longer. Instead, due to worsening symptoms, the patient //actively// seeks out information, and more than the "confusing" and "vague" responses he received before. His social behavior shifted from that of an extrovert, or trying to maintain social relationships, to that of an introvert, and now analyzing closesly the actions and words of the nurses and healthcare professionals involved. This behavior is so that the patient can better understand his situation, and what is happening to him.

__ The Waiting __ This is the third and final "stage" or "path" the patient goes through, and it is during this time that the patient reaches a point of existential certainty and comfort; he has accepted his fate, come to terms with what is happening to him, and is now simply waiting. He comes to this conclusion by managing to conceptualize the drastic changes going on within his body and realizing that his time was getting shorter and shorter.

The study demonstrated that these mental “stages” were a way for the patient to cope with what was happening to him as he learned more and more about his illness and what that meant for him as a human being. It should be noted that no single stage leads into the next, as the stages do not occur in the order described. It his quite possible for a patient not to go through all of the stages before the end of his or her life. However, these “stages” serve a significant purpose in allowing the patient to make sense of their situation via the information given to them, through the use of a technique called “multidimensional learning”. It is in this way that the authors expand their knowledge of the patient’s mental state. =Further Reading=

Death Anxiety Ghosts as coping mechanisms: Cultural Psychology in Southeast Asia Physician Assisted Suicide/Inalienable Right The Death Molecule The Debatable Life of a Fetus

= References =

"Cancer." //Centers for Disease Control and Prevention//., 22 Feb. 2016. Web. 11 Apr. 2016. Chochinov, Harvey Max, Thomas Hack, Thomas Hassard, Linda J. Kristjanson, Susan Mcclement, and Mike Harlos. "Understanding the Will to Live in Patients Nearing Death." //Psychosomatics// 46.1 (2005): 7-10. PubMed. Web. 11 Feb. 2016.

Griva, Konstadina, Augustine W. C. Kang, Zhen Li Yu, Vanessa Y. W. Lee, Sotiris Zarogianis, Moong Chen Chan, and Marjorie Foo. "Predicting Technique and Patient Survival over 12 Months in Peritoneal Dialysis: The Role of Anxiety and Depression." //Int Urol Nephrol International Urology and Nephrology// (2016): n. pag. Web.

Jacobs, Shana, Jennie Perez, Yao Iris Cheng, Anne Sill, Jichuan Wang, and Maureen E. Lyon. "Adolescent End of Life Preferences and Congruence with Their Parents' Preferences: Results of a Survey of Adolescents with Cancer." //Pediatric Blood & Cancer Pediatr Blood Cancer// 62.4 (2014): 710-714. PubMed. Web. 21 Feb. 2016.

Mosack, Katie E., Ph.D., and Rachel L. Wandrey. "Discordance in HIV-Positive Patient and Health Care Provider Perspectives on Death, Dying, and End-of-Life Care." //SAGE Publication//, 2015. Web. 22 Feb. 2016.

"The Stages of Grief." // The Respite //. N.p., 2014. Web.

Sand, Lisa, Olsson, Mariann, and Peter Strang, Original Article: "Coping Strategies in the Presence of One's Own Impending Death from Cancer" //Journal of Pain and Symptom Management//, vol 37, pp. 13-22, //ScienceDirect//, Web. 27 Feb 2016.

Friberg, Febe, and Joakim Ohlen. __ “Searching For Knowledge And Understanding While Living With Impending Death – A Phenomenological Case Study.” __ //International Journal Of Qualitative Studies On Health & Wellbeing// 2.4 (2007): 217-226 Academic Search Complete Web 18 Feb 2016.

** Media References **
Relayforlifedotorg. "Relay For Life - Paint Your World Purple." YouTube. YouTube, 02 Sept. 2015. Web. 19 Apr. 2016.

Bartholomew, Kathleen. The Sad and Unsettling Truth of the Cancer 'Business. ' Digital image. NurseTogether.com. NurseTogether LLC, 15 Aug. 2014. Web. 20 Apr. 2016.

The Science Show Search RN Search RN Search. Digital image. ABC. ABC, 26 Feb. 2016. Web. 20 Apr. 2016.

Peterson, Tanya. Four Reasons Why Anxiety and Depression Can Occur Together. Digital image. Healthy Place. Healthyplace.com, 24 Mar. 2016. Web. 19 Apr. 2016.

The Stages of Grief. Digital image. The Respite. The Respite, 29 Sept. 2014. Web. 19 Apr. 2016.

// Coping with the Death of a Parent. // 2011, Digital Image, When a Parent Dies, Web. 27 Apr 2016
Ngasike, John. "Ho Unit 7_human_growth_and_development." Ho Unit 7_human_growth_and_development. Web. 27 Apr. 2016. Slide 36 of 61