Nurses’ positivity can alleviate end-of-life suffering

By Joanna Lyford, Senior medwireNews Reporter

The psychologic response to terminal illness can be summarized as the realization that life is short, say Spanish researchers.

They say that their qualitative research into the psychology of terminally ill patients will be useful in helping nurses to alleviate suffering at the end of life.

The government-funded research aimed to identify the psychologic responses that terminally ill patients use to face up to the demands of the end of life. Rafael Montoya-Juarez (University of Granada) and colleagues recruited 24 patients who were terminally ill but without cognitive impairment or uncontrollable symptoms.

Each patient underwent a semistructured interview that comprised seven questions, formulated using a phenomologic approach.

"Phenomenology is the appropriate theoretical approach to the study of suffering," the researchers state. "Because we assume a model of suffering based on the response to threats, we have transcended the purely descriptive approach by interpreting the data in light of this model."

Analysis of the interviews revealed a single principle - "that life is short" - report Montoya-Juarez and team in the International Journal of Nursing Studies. This concept is the main threat to patients, they state, but is also the starting point for developing psychologic responses through which they may reduce their suffering.

One such response to the threat is "re-evaluating life" - some patients felt reassured because they believe they have accomplished their life goals; other patients felt helpless and frustrated because of tasks left unfinished or the desire to "settle scores."

Another response is the "opportunity for growth" - patients may interpret their situation as a signal to change their attitudes toward life and to rethink relationships with those around them.

A third response is "resignation and acceptance," typified by a very negative view of the future, although some patients display resignation to their situation with declarations such as "it is time."

Further analysis found that men typically showed concern about the loss of their employment status, social relationships, and physical function, whereas women expressed longing for their homes, normal routines, and children. Also, women more often than men talked about religious beliefs.

Finally, oncologic patients tended to consider their disease as "untimely" or "treacherous" whereas nononcologic patients were more likely to lament their progressive loss of independence and autonomy.

Summarizing their findings, the authors write: "The analysis revealed that the patients interviewed in this study develop a series of psychological responses as they face the end of life. These coping mechanisms begin by the patients positioning themselves to face the real threat associated with the finite nature of life based on their realization that life is short."

They recommend that nurses "must seek to alleviate the emotional impact of terminal illnesses on their patients not only by controlling the physical symptoms but also by encouraging the patients' psychological responses."

They conclude: "It is essential [for nurses] to ascribe a positive meaning to the potentially harmful experiences that occur during terminal illnesses. By doing so, we can alleviate the suffering of terminally ill patients at the end of life."

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