Suicide versus Hospice Care, comment


Many patients receive the diagnosis of cancer as a death sentence, even though advances in cancer therapy are occurring almost daily. Cancer is a disease that is non-selective in its victims, striking all ages, all nationalities and all socioeconomic areas. When a patient receives a diagnosis of cancer, it causes him to face his mortality – and often brings regrets of previous life choices. What can we as nurses do to help our patients receive a cancer diagnosis with hope and courage, rather than doom? First, we can teach; prior to diagnosis, each patient in our care should receive teaching on preventive measures to reduce cancer risk – diet, exercise, smoking cessation, screenings, etc. Second, when the physician tells the patient he has cancer, we can reinforce and teach on the interventions recommended by the doctor. This would include encouraging the patient to express his fears and concerns, and through patient teaching helping to reduce them. If the physician recommends surgery (tumor excision, debulking or palliative) we must address the concerns of anesthesia and pain management, both typical areas of patient fear. If chemotherapy is recommended, sometimes the fear might be as basic as alopecia or nausea and vomiting secondary to chemotherapy. We can assist the patient in choosing a hair piece prior to hair loss, and explain the regimen of combination antiemetics (i.e. aprepitant, dexamethesome and ondansetron) prior to the start of chemotherapy. When the patient is admitted to the hospital for chemotherapy, we must administer medications on the exact time schedule ordered by the physician, especially important in cytotoxic agents which act in a specific phase in the cell cycle. Cancer therapy can be extremely complicated, and nurses must teach the basics in terms that are both understandable and gentle, by choosing our words carefully. Thirdly, we must teach on the decision to treat (or not treat). Most patients perceive chemotherapy as highly toxic and damaging, and fear what it might do to normal cells. The patient must be given an idea of projected benefits versus risks – i.e. cure, palliation or extending a life that’s functional though not cancer free. If they are diagnosed with a highly responsive cancer, we must encourage them to treat, but the ultimate decision is theirs. If the patient decides against treatment, and Hospice is recommended, we must teach about Hospice care and approaching death with dignity. Most Hospice agencies have printed literature outlining pain management and services offered by Hospice (counseling, social services, pastoral care, etc.) for both the patient and the family. With a cancer diagnosis, comes the stages of grief. Nurses have a great responsibility to help the patient move through the stages of grief to acceptance,in a way that is empathic and supportive, but never encourages the option of suicide.

Original Post
April 10, 2010
Title: Suicide versus Hospice Care
What does it say for us as health care providers when a patient who receives a diagnosis of cancer commits suicide? The thought of enduring treatments without cure, suffering physical pain and medication side effects, not to mention facing one’s own mortality, can sometimes push even an individual over the edge. I have to wonder whether we are truly meeting the needs of our patients when I hear that someone has committed suicide because they couldn’t deal with the thought of dying a difficult death. And why does any death need to be "difficult"? It is sad that people perceive hospice as "The Grim Reaper coming through the door with a sickle and shroud to kill you with their morphine". Sadly, this perception is not limited to patients. Medical professionals are in serious need of education about end of life care and pain management and symptom management for a family to hear "you have to give up everything in order to be eligible for hospice" or "hospice means you’re dying" from a medical professional feeds the fears and stigma associated with the very term. Suicide should never be a mechanism in which to manage a life limiting illness. Should people choose to hear, they would learn that hospice can provide them excellent symptom management, allow for life closure, and place their needs at the center of care. Death can be peaceful, serene, and dignified. It is only difficult when fueled by ignorance.

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