coping strategies for palliative patients

[zobell]

Hey all,
Just wondering what coping strategies you would advise to patients dealing with a terminal illness. For example, a patient who is having difficulty accepting their prognosis and wishes to enjoy their time (prognosis of 6 months) with loved ones but cannot stop thinking about how she now has a "time limit" on her life. She is receiving WBRT and has an excellant performance status.
Another such patient is dealing with self blame issues, she has brain mets from NSCLC and has been smoking all her life. As we all know smoking is one of the main causes of lung cancer and she is also aware of this and feels incredibly guilty as she feels she is to blame, she feels she deserves no sympathy.
Kind regards

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[smalltownpsych]

Validating and normalizing their experience and reactions. Assessing for existing coping and reinforce the use of those. Spiritual resources can be very helpful for many people. Mindfulness can also be helpful. I think Kabat-Zinn is the guy who has worked with this quite a bit so you can look him up or help patients actively research dependent on what would be more effective. If you have some experience with other patients who have gone through this, then you might consider sharing some of your experiences with that, but tread carefully as you don't want to risk invalidating as each person's situation is unique.

Don't try to make them feel better. Don't offer platitudes. Don't tell them how they should or should not feel. Don't pretend to understand unless you just happen to be dying yourself.

 

[deleted343839]

Hey all,
Just wondering what coping strategies you would advise to patients dealing with a terminal illness. For example, a patient who is having difficulty accepting their prognosis and wishes to enjoy their time (prognosis of 6 months) with loved ones but cannot stop thinking about how she now has a "time limit" on her life. She is receiving WBRT and has an excellant performance status.
Another such patient is dealing with self blame issues, she has brain mets from NSCLC and has been smoking all her life. As we all know smoking is one of the main causes of lung cancer and she is also aware of this and feels incredibly guilty as she feels she is to blame, she feels she deserves no sympathy.
Kind regards

I find strategies from acceptance and commitment therapy to be helpful in these situations. The patient may feel guilty and scared and worried and yet still be able to connect with things that give her life value and meaning. The two need not be mutually exclusive. She's having very normal emotional reactions. You might be able to help her plan and follow through with actions and behaviors that bring her closer to what she wants from whatever time she has.