Skip to main content
SpringerLink
Log in

End-of-Life, Grief, and Bereavement: Strategies to Provide Comfort?

  • Chapter
  • First Online:
Supportive Care Strategies

  • 286 Accesses

Abstract

Patients facing life-threatening illnesses often have questions about what their last days and hours will look like. There is an equal concern from patients about effective symptom control at the end of life and the fear of becoming a burden on loved ones. Communication during the dying phase is incredibly important. This chapter will identify methods used in patient–doctor communication that can assist clinicians when discussing end-of-life issues. In addition, clinicians will have a greater understanding of common signs and symptoms at the end of life, so they can effectively manage them. Key issues in the transition to hospice and advance care planning are discussed. Clinicians will also learn to identify grief and understand what causes it to be prolonged or complicated in nature.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Agrawal M, Grady C, Fairclough DL, Meropol NJ, Maynard K, Emanuel EJ (2006) Patients’ decision-making process regarding participation in phase I oncology research. J Clin Oncol 24:4479–4484

    PubMed  Google Scholar 

  • Brown E, Bennett M (2007) Survey of blood transfusion practice for palliative care patients in Yorkshire: implications for clinical care. J Palliat Med 10:919–922

    PubMed  Google Scholar 

  • Bruera E, Bush SH, Willey J et al (2009) Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer 115(9):2004–2012

    PubMed  Google Scholar 

  • Buss MK, Vanderwerker LC, Inouye SK, Zhang B, Block SD, Prigerson HD (2007) Associations between caregiver-perceived delirium in cancer patients and generalized anxiety in their caregivers. J Palliat Med 10(5):1083–1092

    PubMed  Google Scholar 

  • Cartoni C, Brunetti GA, D’Elia GM, Breccia M, Niscola P, Marini MG et al (2007) Cost analysis of a domiciliary program of supportive and palliative care for patients with hematologic malignancies. Haematologica 92:666–673

    PubMed  Google Scholar 

  • Cook I (2004) Guideline watch: practice guideline for the treatment of patients with delirium. American Psychiatric Association, Arlington, VA, pp 24–25

    Google Scholar 

  • Doyle-Brown M (2000) The transitional phase: the closing journey for patients and family caregivers. Am J Hosp Palliat Care 17(5):354–357

    CAS  PubMed  Google Scholar 

  • Duffy M, Wild J (2017) A cognitive approach to persistent complex bereavement disorder (PCBD). Cogn Behav Ther 10:e16

    Google Scholar 

  • Dvelin JW, Roberts RJ, Fong JJ et al (2010) Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 38(2):419–427

    Google Scholar 

  • End of Life Online Curriculum Project (2012) Prevalence of dyspnea. End of life curriculum project: a joint project of the US Veterans Administration and SUMMIT. Stanford University Medical School. http://endoflife.stanford.edu. Accessed 9 Sept

  • Hugel H, Ellershaw J, Gambles M (2006) Respiratory tract secretions in the dying patient: a comparison between glycopyrronium and hyoscine hydrobromide. J Palliat Care Med 9:279–284

    Google Scholar 

  • Iestra JA, Fibbe WE, Zwinderman AH, van Staveren WA, Kromhout D (2002) Body weight recovery, eating difficulties and compliance with dietary advice in the first year after stem cell transplantation: a prospective study. Bone Marrow Transplant 29:417–424

    CAS  PubMed  Google Scholar 

  • Inouye SK, Bogardus ST Jr, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340(9):669–676

    CAS  PubMed  Google Scholar 

  • Koedoot CG, Oort FJ, de Haan RJ, Bakker PJ, de Graeff A, de Haes JC (2004) The content and amount of information given by medical oncologists when telling patients with advanced cancer what their treatment options are: palliative chemotherapy and watchful-waiting. Eur J Cancer 40:225–235

    CAS  PubMed  Google Scholar 

  • Lee SJ, Fairclough D, Antin JH, Weeks JC (2001) Discrepancies between patient and physician estimates for the success of stem cell transplantation. JAMA 285:1034–1038

    CAS  PubMed  Google Scholar 

  • Lee SJ, Loberiza FR, Rizzo JD, Soiffer RJ, Antin JH, Weeks JC (2003) Optimistic expectations and survival after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 9:389–396

    PubMed  Google Scholar 

  • Longergan E, Britton AM, Luxenberg J, Wyller T (2007) Antipsychotics for delirium. Cochrane Database Syst Rev 2:CD005594

    Google Scholar 

  • Mack JW, Wolfe J, Grier HE, Cleary PD, Weeks JC (2006) Communication about prognosis between parents and physicians of children with cancer: parent preferences and the impact of prognostic information. J Clin Oncol 24:5265–5270

    PubMed  Google Scholar 

  • Macleod AD (2006) The management of terminal delirium. Indian J Palliat Care 12(1):22–28

    Google Scholar 

  • Matsuyama R, Reddy S, Smith TJ (2006) Why do patients choose chemotherapy near the end of life? A review of the perspective of those facing death from cancer. J Clin Oncol 24:3490–3496

    PubMed  Google Scholar 

  • McCann R, Hall W, Groth-Juncker A (1994) Comfort care for terminally ill patients: the appropriate use of nutrition and hydration. JAMA 272(16):1263–1266

    CAS  PubMed  Google Scholar 

  • Monti M, Castellani L, Berlusconi A, Cunietti E (1996) Use of red blood cell transfusions in terminally ill cancer patients admitted to a palliative care unit. J Pain Symptom Manag 12:18–22

    CAS  Google Scholar 

  • Morita T, Hiral K, Sakaguchi Y, Tsuneto S, Shima Y (2004) Family-perceived distress from delirium-related symptoms of terminally ill cancer patients. Psychosomatics 45(2):107–113

    PubMed  Google Scholar 

  • Moyer D (2011) Terminal delirium in geriatric patients with cancer at the end of life. Am J Hosp Palliat Med 28:44–51

    Google Scholar 

  • Portenoy RK (1986) Continuous infusion of opioid drugs in the treatment of cancer: guidelines for use. J Pain Symptom Manag 1:223–228

    CAS  Google Scholar 

  • Prendergast TJ, Luce JM (1997) Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Crit Care Med 155(1):15–20

    CAS  Google Scholar 

  • Prigerson HG, Frank E, Kasl SV et al (1995) Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses. Am J Psychiatry 152(1):22–30

    CAS  PubMed  Google Scholar 

  • Prigerson HG, Horowitz MJ, Jacobs SC et al (2009) Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med 6(8):e1000121

    PubMed  PubMed Central  Google Scholar 

  • Puchalski CM, Romer AL (2000) Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med 3(1):129–137

    CAS  PubMed  Google Scholar 

  • Ray A, Block SD, Friedlander RJ, Zhang B, Maciejewski PK, Prigerson HG (2006) Peaceful awareness in patients with advanced cancer. J Palliat Med 9:1359–1368

    PubMed  Google Scholar 

  • Sullivan AM, Lakoma MD, Matsuyama RK, Rosenblatt L, Arnold RM, Block SD (2007) Diagnosing and discussing imminent death in the hospital: a secondary analysis of physician interviews. J Palliat Med 10:882–893

    PubMed  Google Scholar 

  • Twycross RG, Lack S (1983) Symptom control in far-advanced cancer: pain relief. Pitman, London, p 305

    Google Scholar 

  • Ulep R, Malhotra S (2017) Palliative medicine: management of serious illness. In: Conrad K (ed) Clinical approaches to hospital medicine. Springer, Chennai

    Google Scholar 

  • Wee B, Hillier R (2008) Interventions for noisy breathing in patients near to death. Cochrane Database Syst Rev 1:CD005177. https://doi.org/10.1002/14651858.CD005177.pub2

    Article  Google Scholar 

  • Weeks JC, Cook EF, O’Day SJ, Peterson LM, Wenger N, Reding D et al (1998) Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA 279:1709–1714

    CAS  PubMed  Google Scholar 

  • Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T et al (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300:1665–1673

    CAS  PubMed  PubMed Central  Google Scholar 

Further Reading

  • Acute Pain Management Guideline Panel (n.d.) Acute pain management: operative or medical procedures and trauma clinical practice guideline. AHCPR Publication No. 92-0032. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.32241

  • American Pain Society (2003) Principles of analgesic use in the treatment of acute and chronic cancer pain. 5th edn. American Pain Society, Glenview, IL. http://www.ampainsoc.org/pub/principles.htm

  • Chung HM, Lyckholm LJ, Smith TJ (2009) Palliative care in BMT. Bone Marrow Transplant 43:265–273

    CAS  PubMed  Google Scholar 

  • Cobb JL, Glantz MJ, Nicholas PK et al (2000) Delirium in patients with cancer at the end of life. Cancer Pract 8(4):172–177

    CAS  PubMed  Google Scholar 

  • Detering KM, Hancock AD, Reade MC et al (2010) The impact of advance care planning on end of life care in elderly patients: randomized controlled trial. BMJ 340:c1345

    PubMed  PubMed Central  Google Scholar 

  • Goldstein NE, Morrison RS (2013) Evidence-based practice of palliative medicine. Elsevier Saunders, Philadelphia

    Google Scholar 

  • Johnston SC, Pfeifer MP, McNutt R (1995) The discussion about advance directives: patient and physician opinions regarding when and how it should be conducted. End of Life Study Group. Arch Intern Med 155(10):1025–1030

    CAS  PubMed  Google Scholar 

  • Levy M (1996) Pharmacologic treatment of cancer pain. N Engl J Med 335:1124–1132

    CAS  PubMed  Google Scholar 

  • Mack JW, Wolfe J, Cook EF, Grier HE, Cleary PD, Weeks JC (2007) Hope and prognostic disclosure. J Clin Oncol 25:5636–5642

    PubMed  Google Scholar 

  • Management of cancer pain: adults (1994) Clin Pract Guideline Quick Ref Guide Clin. (9):1–29. http://www.ncbi.nlm.nih.gov/pubmed/7509686?dept=Abstract

  • Reports of a WHO Expert Committee (1990) Cancer pain relief and palliative care. World Health Organ Tech Rep Ser. 804:1–75

    Google Scholar 

  • Tulsky JA (2005) Beyond advance directives: importance of communication skills at the end of life. JAMA 294(3):359–365

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Palliative Medicine and Supportive Care, University Medical Center, New Orleans, LA, USA

    Sonia Malhotra

  2. Section of General Internal Medicine and Geriatrics, John W Deming Department of Medicine/Tulane University School of Medicine, New Orleans, LA, USA

    Sonia Malhotra

Authors
  1. Sonia Malhotra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sonia Malhotra .

Editor information

Editors and Affiliations

  1. Hematology, Oncology, and Bone Marrow Transplant, Ochsner Health, New Orleans, LA, USA

    Laura Finn

  2. Palliative Medicine and Comprehensive Care, Inova Health System, Falls Church, VA, USA

    Alva R. Roche Green

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Malhotra, S. (2020). End-of-Life, Grief, and Bereavement: Strategies to Provide Comfort?. In: Finn, L., Roche Green, A.R. (eds) Supportive Care Strategies. Advances and Controversies in Hematopoietic Transplantation and Cell Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-59014-1_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-59014-1_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59013-4

  • Online ISBN: 978-3-319-59014-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation