Palliative Psychological Care for Terminal Illness

11 September, 2020
Getting diagnosed with a terminal illness shakes a person to their very core. So what kind of psychological interventions can help in this situation?
 

Adapting to your surroundings is always challenging. After all, they’re ever-changing, and you can only have very limited control over them. In addition, you’ve probably asked yourself why some people who are financially set for life would make commitments or get involved in new projects. Well, on the flip side of this natural tendency to seek out complications and problems, lies the situation that presents the biggest challenge to your adaptive skills: being diagnosed with a terminal illness.

We all know we’re going to die. You could die suddenly in a car accident, with no way of knowing it was coming when you woke up that morning. However, most of us operate under the assumption that we have years left to live, even if it’s only because we still have things to check off our to-do list.

This is how we live. We make plans for tomorrow, next week, next month, and next year. In other words, imagining death as a far-off event or as a very remote possibility locates us in space-time in a unique way.

This strange edifice that we build around ourselves starts to crumble with a terminal illness diagnosis. In today’s article, we want to talk about the grief that this kind of diagnosis involves. We’ll also discuss the important aspects of terminal illness psychologists usually focus on.

A sad guy in winter.
 

Anticipatory grief in the face of terminal illness

In this situation, the body tends to react as if it were facing a threat. On an emotional level, anxiety is the most common reaction, but other responses are possible as well. It mostly depends on how the individual processes the news. Immediately after being diagnosed with a terminal illness, many people go into denial. That’s especially true if the diagnosis is sudden and unexpected, instead of coming after a treatment to eliminate or slow the progress of a disease.

Consequently, one of the most important things that psychologists can do is help the patient process the news in a way that makes sense to them. Thus, our first task as mental health professionals is to listen and be there. We need to get to know our patients.

A good evaluation will tell us everything that’s shattered, along with the patient’s hope. Also, it’ll help identify the most painful regrets associated with knowing you’re running out of time.

Our help becomes meaningful when the patient starts to see us as a useful resource. A go-to for effective strategies to deal with their suffering. It isn’t the terminal illness in and of itself that requires our attention but the suffering that it causes.

First steps

Following the anxiety caused by the news, it’s important to work with the patient to identify their emotions on different levels. On the cognitive level, we can help the person find a place in this new space-time dimension.

 

Living in the here and now, which so many self-help books encourage, isn’t an option for terminally ill patients. When you want to leave the house, you get dressed. If it’s time to go to bed, you brush your teeth. When you go on a trip, you pack your suitcase. In other words, terminally ill patients will think about the future.

Most of the interventions in this context focus on the feeling of being threatened, caused by:

  • Compromised life integrity.
  • Uncertainty about what’ll happen after they die.
  • Lack of resources.
  • A negative attitude towards the illness.

On a physiological level, anxiety triggers activation. Remember that it’s the emotion that helped our ancestors escape from predators in the jungle. Consequently, it’d be very good for the patient to be able to stop that over-activation.

Relaxation techniques and exercise can be helpful. The options will depend heavily on the patient’s physical condition. Their lifestyle, health history, willingness, and support network will also play a role.

Meeting the patient’s needs

Therefore, the most important starting point for intervention, as Mariant Lacasta proposes in her article The Role of Psychology in Palliative Care [translation from original Spanish], is identifying the patient’s needs. The effectiveness of any intervention depends on whether we’re able to meet the needs of the patient that are within our capabilities.

We’ve talked about listening, which includes normalizing the patient’s emotions (especially contradictions that can come up during the process), coping with anxiety, which we mentioned, fear of abandoning the people around them, and managing the hope that almost always persists, no matter how dire the news.

 

It’s important not to create unrealistic expectations, but we also shouldn’t discourage moderate optimism about future events. This is actually one of the most delicate parts of any treatment or intervention because it requires great sensitivity. Keep in mind that we won’t always be working with someone who’s fully aware of their imminent passing or who’ll talk like someone who isn’t going to get better.

A man with his doctor.

Intervention with friends and relatives

One of our roles might also be to train with an individual’s support network. There are people who’ll also be coping with anticipatory grief and potential mental health issues. There will be moments when the patient probably won’t want to talk, and those around them need that communication, and vice-versa.

Whatever the case, if you find that someone’s in a risky situation, propose treatment directly to that person. In many cases, the best thing would be for a different professional to take on the case, while maintaining open communication lines.

It’s ideal for the intervention to occur with input from all the healthcare workers involved in the case. That kind of collaboration boosts the chances of making sure the patient feels in control of the process.

 

Maybe the patient won’t be able to go out on their own anymore, but they’ll be able to choose when they go or what clothes they want to wear. Although this may seem insignificant, it’s very important for patients who deal with many more limitations.

Sánchez Sobrino M y Sastre Moyano P (1996). Cuidados paliativos domiciliarios y hospitalarios. En González Barón M, Ordoñez A, Feliu J, Zamora P, Espinosa, E. Medicina Paliativa. Madrid: Médica Panamericana.