Learning Objective
Explain the principles of end-of-life care, including advance directives, patient communication, hospice care, and the stages of psychological adjustment in terminal illness.
End-of-Life Care
Advance Directives
Ask patients about DNR status
A living will or healthcare power of attorney ensures the patient’s wishes are followed if they cannot decide
Communication Principles
Provide honest information; do not give false hope
• Recognize that hope may focus on quality of life, less pain, or a painless death
• Allow discussion of feelings, encourage social engagement
Kübler-Ross Stages
Denial → Anger → Bargaining → Depression → Acceptance
Stages may not occur in order, and patients can cycle between stages
Activity
Hospice Care
For terminal illness, life expectancy ≤6 months
- Provides medical, psychological, and spiritual support
- Can be delivered at home or specialized facilities
- Payment may come from Medicare, Medicaid, or private insurance
