Tuesday, March 7, 2006
Two recent articles about psychosocial and spiritual aspects of dying, both by Canadians.
HM Chochinov has a tour de force of a review article (free full-text appears to be available) on psychosocial & spiritual aspects of death and dying in the journal CA. It is a thorough, eloquent, narrative review on the topic, covering spirituality and existential suffering and meaning at the end of life, hopelessness, psychiatric problems, dignity, etc. It has a strong practical focus, referring to Chochinov's own dignity therapy work among other things. It came for me at the end of a long, exhausting day today, when I was finally able to sit down with a patient whose care had been causing a lot of conflict and angst amongst his primary medical team. I sat down and found a terrified, frustrated man, pissed off about dying young who had been sensing that his docs had no clue what to do with him other than watch him die (this was mostly accurate). He talked to me about what he was afraid of and angry about. He told me about his job and the devastation of losing it because of his illness. We parted, me commiserating with him, wishing I had either good news or answers to his questions (I had neither). But damn I walked out of there feeling the best I had all day. All of this is to say I wonder to what extent 'dignity therapy' (apologies here to Dr. Chochinov) is a two-way street, and gives us 'care providers' the sustenance we need to witness so much suffering.
Anyway, a good article to stick in the teaching file.
The Canadian Medical Association Journal has published a study on what patients and families think is important regarding their care at the end of life. Nothing surprising here--trust in docs, symptoms addressed, avoiding burdensome care, etc.