(Adapted from End of Life Care)
WHAT are some ways to provide emotional support to a person who is living with and dying of cancer?
Everyone has different needs, but some worries are common to most dying patients. Two of these concerns are fear of abandonment and fear of being a burden. People who are dying also have concerns about loss of dignity and loss of control. Some ways caregivers can provide comfort to a person with these worries are listed below:
Keep the person company. Talk, watch movies, read, or just be with him or her.
Allow the person to express fears and concerns about dying, such as leaving family and friends behind. Be prepared to listen.
Be willing to reminisce about the person's life.
Avoid withholding difficult information. Most patients prefer to be included in discussions about issues that concern them.
Reassure the patient that you will honor advance directives, such as living wills.
Ask if there is anything you can do.
Respect the person's need for privacy.
Support the person’s spirituality. Let them talk about what has meaning for them, pray with them if they’d like, and arrange visits by spiritual leaders and church members, if appropriate. Keep objects that are meaningful to the person close at hand.
What other issues should caregivers be aware of?
It’s just as important for caregivers to take care of their own health at this time. Family caregivers are affected by their loved one’s health more than they realize. Taking care of a sick person often causes physical and emotional fatigue, stress, depression and anxiety.
Because of this, it’s important for caregivers to take care of their own body, mind and spirit. Helping themselves will give them more energy, help them cope with stress, and cause them to be better caregivers as a result.
The caregiver should know they can seek help from a physician as well. If you feel like you are having a hard time sleeping, a sleeping pill can be prescribed. It is quite normal to be depressed and anxious. It is expected from someone that is grieving. The caregiver should seek an appointment himself or herself with a healthcare provider if the feeling of being burnt out is overwhelming.
Medical therapy for insomnia and depression are effective and may make a huge difference. In times of stress, taking a multivitamin and omega-3 helps avoid mental exhaustion. Please make sure to consult with your doctor as to which supplements are appropriate.
It’s also helpful if caregivers ask for support from friends and family members. Don't feel bad in asking – one may feel ashamed or bad about asking. Again, death is a family if not a community event, so ask away. Such help is important to help lessen the many tasks involved in taking care of a loved one who is sick or dying.
What are some topics patients and family members can talk about?
For many people, it’s hard to know what to say to someone at the end of life. Sometimes the silence is the best option. There is nothing wrong in dwelling in meaningful periods of silence. If you don't know what to say, don't say anything. Word is silver but silence is gold. The fact that you are offering your presence and company speaks volumes.
People sometimes feel uncomfortable with certain subjects. It is a delicate balance between talking about what is important and making sure we are not forcing a subject that is painful or awkward. Body language/nonverbal cues may indicate when the subject at hand is to be avoided. Watch carefully how the person positions the body either leaning in or turning away, the position of the hands and feet – either relaxed or tightly clasped/pointing away; and the expression of the eyes – angry, glazing, tuning out versus mellow, sad, or happy. Treading carefully and slowly is probably the best. Be sure to have tissue paper at hand, as it is a nice gesture of sympathy to offer it if tears come about.
It’s normal to want to be upbeat and positive, rather than talk about death. And yet, it’s important to be realistic about how sick the person may be. Caregivers can encourage their loved one without giving false hope. Although it can be a time for grieving and accepting loss, the end of life can also be a time for looking for meaning and rethinking what’s important.
During this period, many people tend to look back and reflect on life, work and family, legacies created through work or family life, contributions to society and to the community, and loved ones who will be left behind. People may want to make videos and recording, take pictures, write a journal, or write letters or Skype long-lost relatives and friends. This is all important and acceptable for end of life.
Some questions to explore with a patient at the end of life are the following: What are the happiest and saddest times we have shared together? What are the defining or most important moments of our life together? What are we most proud of? What have we taught each other?
Patients with serious, life-threatening illness have stated that being positive or adding humor remains an important outlet for them. Even at this challenging moment, laughter may still be the best medicine. It is important to be tactful when using humor. Not all death-related situations need to be somber and serious. Humor can be appropriate and it's balsam for the soul of everyone involved when applied in the correct manner.
We have more to follow, stay tuned!