Administrative medical assisting 5th by lindh chapter06

Life-threatening Illness• Cultural perspective on life-threatening illness – How you live, think, speak, and behave – Viewed differently by different cultures – Family strongest influenc

Chapter 6

The Therapeutic Approach to the Patient

with a Life-threatening Illness

Life-threatening Illness

• Cultural perspective on life-threatening illness

– How you live, think, speak, and behave

– Viewed differently by different cultures

– Family strongest influence

• Work with family and belief system

Choices in Life-threatening Illness

• Urgency of decisions depend on

possible life expectancy

• Patients have right to choose or refuse treatment

• Palliative care focuses on quality of life, relieving symptoms of pain and

suffering

Choices in Life-threatening Illness

• VSED (voluntarily stop eating and

drinking)

• Total sedation; medication causes

unconsciousness and eventually death

• In a few states, option to seek aid in

dying

Choices in Life-threatening Illness

• Issues appropriate to discuss with

patients facing life-threatening illnesses:

– Alternative methods of treatment

– Pain management and treatment

– Loss of self image and independence

– Legal protection

• Durable power of attorney for health care or health care proxy

• Health care directives

• Patient Self-Determination Act

Choices in Life-threatening Illness

• Issues appropriate to discuss with

patients facing life-threatening illnesses:

– Finances; insurance coverage

– Emotional needs of patient and family

– Life-threatening illnesses are family illnesses

• Primary patients (the one with the illness)

• Secondary patients (family and friends of patient)

• Helping patients live their last days is important

The Range of Psychological Suffering

• 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

The Patient with HIV/AIDS

• Patients will have great stress when

diagnosed with HIV or 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

The Patient with HIV/AIDS

• HIV affects mostly individuals who are relatively young

• Treating HIV expensive

• Many patients have little or no

insurance coverage

The Patient with HIV/AIDS

• May experience central nervous system involvement

• AIDS when patients’ CD4 counts

decline to less than 200

• Particular type of opportunistic infection

or tumor, AIDS-related brain or lung

illness, severe body wasting

The Patient with Cancer

• Patients believe cancer and death

equated

• Choosing treatment complicated and has many facets

• Treatments are surgery, radiation,

chemotherapy or combination

The Patient with Cancer

• Patients can experience 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

The Patient with ESRD

• Loss of kidney (renal) function leads to end-stage renal disease (ESRD)

• 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

The Stages of Grief

• Dr Elisabeth Kübler-Ross determined stages of grief

– Denial

– Anger

– Bargaining

– Depression

– Acceptance

The Stages of Grief

• 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

The Stages of Grief

• The acronym TEAR

– To accept the reality of the loss

– Experience the pain of the loss

– Adjust to what was lost

– Reinvest in a new reality

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