PSY 802 Chapter Notes - Chapter 5: Palliative Care, Health System, Terminal Illness

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Published on 27 Apr 2016
School
Ryerson University
Department
Psychology
Course
PSY 802
Professor
Health care system oriented around goal of sustaining life, consisting of: patients, staff, and institutions
70 years ago: 50% deaths in institutions, now 80%
40% of deaths in hospitals are in ICU
Three categories of institutional medical care:
Hospitals
Acute intensive care of limited duration (aggressive medical techniques to diagnose
symptoms, provide treatment, and sustain life)
Patients expect to regain well-being shortly and return to normal life
Chronic or life-threatening illness: alternate between acute hospital care and
supportive care in nursing homes, hospices, or at home
Transitioning to integrated approach, including outpatient/extended care and palliative
care (to prevent pain/distressing symptoms or reducing severity of illness without curing
underlying disease)
Nursing homes
Long-term residential care for chronically ill, or for those whose illness does not
require acute, intensive care
Most patients return to community
Hospices
Meets needs of dying patients and their families
Comfort, not cure
Cure to care; extension of life to quality of life
Not always a place; can be a program (home care is directed by physicians, coordinated
by nurses, and supported by interdisciplinary team, including family)
General prognosis of 6 months or less; average stay of 2 months
2011: 45% of all U.S. deaths in hospice
Provide bereavement follow up for one year after death
Previously mostly cancer patients (1970s); now, chronic illnesses
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Teno/Connor: all care provided by hospices is palliative; however, not all palliative care is provided by
hospices
Stephen Connor’s essential components of hospice programs:
1. Patient/family are unit of care
2. Care provided in home or inpatient facility
3. Symptom management is focus
4. Whole person treatment
5. Interdisciplinary care
6. 24/7 services
Reductionism: complex phenomena are reduced to simple terms that distort the phenomena, or when
only a piece of a given system is acknowledged, rather than whole system
Depersonalization: dying patients given less attention because physicians and nurses avoid contact due
to their own death anxiety or because “nothing more can be done”
Terminal illness: ability of medicine to predict death at an early stage in some diseases led to “terminal
illness”; sophisticated medical technology can now extend terminal stage past a decade
Quarter of Medicare budget spent on last year of patients’ lives; 40% of that in last 30 days
Rationing: any system (e.g. insurance company) that limits amount of health care a person can receive,
thus, not all care expected to be beneficial is provided due to cost
Managed care: arrangement for health care in which an organization (e.g. insurance company) attempts
to control costs by acting as an intermediary between physicians and the patient
Daniel Callahan’s principle of symmetry (extension/quality balance): technology should be judged by
its likelihood of enhancing a good balance between extension/saving of life and the quality of life
Paternalism (“Aesculapian”): assumption of parent-like authority by medical practitioners
Infringes upon patient’s autonomy to make medical decisions
Covenantal: type of relationship shared by physicians and patients, which implies a mutuality of
interests
Surveys indicate that most people do want to be told if diagnosed with life-threatening illness
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