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Chapter 7

PSY 802 Chapter Notes - Chapter 7: Radiation Therapy, Chemotherapy, Palliative Care


Department
Psychology
Course Code
PSY 802
Professor
Thomas Hart
Chapter
7

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Chapter Seven: Living with Life-Threatening Illness
Charles Corr’s Holistic View of Death: Four Primary Dimensions in Coping
1. Physical
Satisfying bodily needs and minimizing physical distress
2. Psychological
Maximizing psychological security, autonomy, and richness in living
3. Social
Sustaining and enhancing relationships and addressing social implications of dying
4. Spiritual
Identifying, developing, or reaffirming sources of spiritual energy or meaning; thus, fostering hope
Awareness of Dying
Glaser and Strauss’ four ways (MOSC) in which death awareness context shapes communication
(can change with altering circumstances):
Closed context: dying person unaware of impending death (others may know)
Lack of communication about either illness or impending death
Suspected awareness: person suspects their prognosis, but those who know do not verify
Patient may try to confirm/deny suspicions by testing others to elicit information
Patient observes disruptions in communication patterns and senses others’ anxiety (thus,
tending to confirm suspicions)
Mutual pretense: everyone is aware of impending death, but act as if patient will recover (can be
carried on until very end)
Avoid direct communication about patient’s condition or “dangerous” topics
oThreats to reality disclosure are ignored, or may elicit anger
Complicated, unspoken rules of behaviour intended to sustain illusion patient is getting
well
Participants pretend things are normal
Open awareness: death is acknowledged and discussed
Does not necessarily make death easier to accept, but allows for opportunity of sharing
support
Adapting to “Living-Dying”
Life-threatening illness experience described as “living-dying”
Fluctuation between denial and acceptance
Weisman’s middle knowledge: balance between sustaining hope and acknowledging reality
Kubler-Ross’ Common Emotional and Psychological Responses to Life-Threatening Illness (DABDA, 1969)
Kubler said that patients tend to go back and forth among stages and may experience more than one
simultaneously
Despite this, for a time, her model became the way to cope
Individuals expected to move sequentially through
1. Denial/avoidance
Can be maladaptive or adaptive according to timing and duration; Kubler ignores the adaptive
possibility
2. Anger (masks anxiety; often manifested in displaced hostility toward caregiver)
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3. Bargaining (attempting to strike a deal with fate; trying to find a way to deal with the inevitable)
4. Depression (profound sense of loss)
Reactive depression: response to disruptions caused by disease
Preparatory depression: awareness that one is dying and must prepare for death
5. Acceptance (facing mortality in an essentially positive manner)
Kubler-Ross’ Stages of Dying (“On Death and Dying,” 1969)
Based on interviews with 200 adult patients over 3 years
Stage theory also applied to divorce and grief; can address any loss
Criticism: implicates a linear progression through mutually exclusive stages
Doka’s Model of Chronology of Living-Dying (ACT-PR)
All previous issues and problems of life remain part of larger struggle of life and living (terminal illness
does not liberate us from these ordinary challenges of life)
1. Acute phase (initiated by diagnosis)
2. Chronic phase (living with disease)
3. Terminal phase (coping with impending death)
Sometimes additional two phases:
4. Prediagnostic phase (suspicion of illness and seeking of medical attention)
5. Recovery phase (follows cure/remission of previously life-threatening disease)
Coping Patterns
Link between finding meaning and achieving a sense of mastery (control in stressful situations)
Coping is dynamic, not static
Coping is interdependent; strategies supplement each other
Continual flow among various styles according to implementation opportunities
Best copers have a “fighting spirit” who view illness as a challenge
Optimistic; try to discover positive meaning in ordinary events
Hold a sense of meaning larger than the threat
Strive to inform themselves about illness and actively participate in treatment
Two categories of responses to make threat manageable/ease distress:
Defense mechanisms: occur unintentionally, without conscious effort or awareness (e.g. denial)
Change internal psychological states rather than external reality
Long-term: may hinder positive outcome if prevent patient from seeking out resources
and taking appropriate action
Coping strategies: conscious, purposeful effort to solve a problem situation
Rando’s Major Psychological and Behavioural Patterns to Cope with Threat of Death
Main goal of establishing control over stressful situation
Generally requires multiple coping strategies working in concert
Strategies may be used at different times for different purposes
1. Retreat and conserve energy
2. Exclusion from threat of death
3. Attempting to master or control threat of death
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Focused Coping
Main goal of coping is to establish a sense of control
Mostly psychological
Emotion-focused: regulates distress levels
Helps regulate distress levels
Reframing a situation into positive light to reduce sense of threat
Distancing self from situation
Problem-focused: manages distressful problem
Pursuit of personally meaningful goals
Associated with greater sense of control
E.g. seeking out information about a diagnosis and taking an active role in medical decision-
making
Meaning-focused: maintains perspective and sense of positive well-being
Use of spiritual beliefs to find insight, meaning, and benefits in distressing situations
E.g. giving up goals that are no longer achievable and formulating new ones, making sense of
what is happening, etc.
Treatment Options and Issues
Phenomenon of specialists referring to other specialists without coordination, resulting in:
Confused messages
Increased anxiety
More referrals
More hospitalizations
Deterioration in health care
Typical cancer treatment options:
Radiation therapy
Chemotherapy
Surgery
Alternative therapies
Expectations of the Ill
Regular assessment/treatment of pain and symptoms
Clearly and simply stated condition/treatment information
Care coordinated between visits and physicians/health programs involved
Crises prevent when possible and emergency management plans
Enough nurses/aides to provide safe and high-quality care
Support for families in caregiving and grieving
Chochinov on dignity: the quality or state of being worthy, honored, or esteemed
Provides framework for determining objectives and therapeutic considerations
Dignity is a cultural-laden concept, but still (according to Hong Kong studies), palliative care:
Focuses predominantly on pain and symptom control
Holistic care and familial support are limited
Chemotherapy
Leading curer of cancer
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