Most of us don’t like to think about it or talk about it.
“It” is how to approach the final days on life.
“It’s the elephant in the room that can hold entire families hostage,” said Dr. Phyllis Hayes-Reams of Kaiser Permanente in southern California told the National Pain Report.
Part of Dr. Hayes-Reams’ work is palliative hospice care and treating pain for people at the end of their lives.
“It’s not just physical pain that we treat,” she said. “The suffering is not just physical but also can be psychological, spiritual and sociological in nature.”
The National Hospice and Palliative Care Organization estimates 1.2 million dying Americans and their families are helped each year. That number is much bigger when you consider hospitals, nursing facilities and home health care agencies are also dealing with patients at the end of their lives and the issues that cause physical or emotional pain or suffering.
“It is critical that the family be involved in these discussions and decisions on how to approach the end of a loved one’s life,” Dr. Hayes-Reams emphasized. “It is important for the physician and care givers to understand that no situation is exactly the same. There are many choices to make.”
The American Psychological Association talks about those choices on its website. Basic decisions need to be made like what kind of caregiver help they want or need and whether to receive care at home or in an institutional treatment setting.
Dying persons may have to make choices about the desired degree of family involvement in care giving and decision-making. They frequently make legal decisions about wills, advanced directives, and durable powers of attorney. They may make choices about how to use their limited time and energy. Some may want to reflect on the meaning of life, and some may decide to do a final life review or to deal with psychologically unfinished business. Some may want to participate in planning rituals before or after death. In some religious traditions, confession of sins, preparation to “meet one’s maker,” or asking forgiveness from those who may have been wronged can be part of end-of-life concerns.
“We have to demystify this process and have these discussions long before the end of one’s life,” said Dr. Hayes-Reams.
She notes there is an increasing trend of patients and their families being prepared. She emphasized that advanced directives, especially in hospice, make it so much easier for everyone involved.
Dr. Hayes-Reams who is board certified in internal medicine, geriatrics and palliative/hospice care, says the work that she does is humbling.
“Palliative care and hospice care are a process for the patient and his or her family, part of life’s journey. It is an awesome responsibility.”