Terminal patients may experience depression or anxiety associated with impending death, and family and caregivers may struggle with psychological burdens.
[7] Accurately identifying the start of terminal status is important because it usually occasions a review of treatment goals.
[8] Most terminally ill people are not distressed by being told that they are likely to die sooner rather than later,[7] and they usually value knowing whether their realistic lifespan is likely to be "weeks", "months", or "years", even if more specific estimates are unavailable.
[7] To avoid admitting that the person will inevitably die from an incurable condition, they may withhold information or, if pressed, give overly optimistic answers.
[8] They may feel pressure from family members to give pleasant news or to preserve the false appearance of hope.
[11] Some terminally ill patients stop all debilitating treatments to reduce unwanted side effects.
Caregivers can help patients receive medications to reduce pain and control symptoms of nausea or vomiting.
Palliative care can also help patients make decisions and come to understand what they want regarding their treatment goals and quality of life.
[21] Palliative care is an attempt to improve patients' quality-of-life and comfort, and also provide support for family members and carers.
[21][29] For patients with end stage kidney failure, studies have shown that transplants increase the quality of life and decreases mortality in this population.
Model for End Stage Liver Disease (MELD) is often used to help providers decide and prioritize candidates for transplant.
In this section of the article, it will be referred to as PAS for the sake of consistency with the pre-existing Wikipedia page: Assisted Suicide.
[37] While some groups believe in personal choice over death, others raise concerns regarding insurance policies and potential for abuse.
For example, the Death with Dignity Act in Oregon includes waiting periods, multiple requests for lethal drugs, a psychiatric evaluation in the case of possible depression influencing decisions, and the patient personally swallowing the pills to ensure voluntary decision.
While terminal condition prognosis is often a grave matter, doctors do not wish to quash all hope, for it could unnecessarily harm the patient's mental state and have unintended consequences.
However, being overly optimistic about outcomes can leave patients and families devastated when negative results arise, as is often the case with terminal illness.
Similarly, a patient with a slowly progressing disease, such as AIDS, may not be considered terminally ill if the best estimate of longevity is greater than six months.
[48] While there are often claims about "disproportionate" spending of money and resources on end-of-life patients, data have not proven this type of correlation.
[50] Many recent studies have shown that palliative care and hospice options as an alternative are much less expensive for end-of-life patients.
For example, a person who finds strength in denial may never reach a point of acceptance or accommodation and may react negatively to any statement that threatens this defense mechanism.
Different forms of psychotherapy and psychosocial intervention, which can be offered with palliative care, may also help patients think about and overcome their feelings.
If not well equipped to face the reality of their loved one's illness, family members may develop depressive symptoms and even have increased mortality.
Many report feeling as if they have to "do it all" by balancing caring for their chronically ill child, limiting absence from work, and supporting their family members.
In taking on the burden of caring for their sick parent and assuming the responsibilities they can no longer accomplish, many children also experience significant declines in academic performance.
[54] Discussing the anticipated loss and planning for the future may help family members accept and prepare for the patient's death.
Upon the death of someone who is terminally ill, many family members that served as caregivers are likely to experience declines in their mental health.
Although it may be a difficult subject to broach, it is important to discuss the patient's plans for how far to continue treatment should they become unable to decide.
[57] It is highly recommended by many research studies and meta-analyses for patients to discuss and create an advance directive with their doctors and families.
This is the patient's choice to make and can depend on a variety of reasons, whether based on personal beliefs or medical concerns.
[61] Patients, healthcare workers, and recently bereaved family members often describe a "good death" in terms of effective choices made in a few areas:[62] In the last hours of life, palliative sedation may be recommended by a doctor or requested by the patient to ease the symptoms of death until they die.