Please be aware - this information is for healthcare professionals
As a person approaches the end of their life, they and their family may be more aware of their thoughts and fears. This is a natural part of the grieving process, but it can be difficult for others to understand. In these circumstances, your professional skill may be required to ease possible tensions.
What types of emotions are the patient and their family likely to be feeling?
It’s common for feelings of loss to emerge as part of the grieving process, for both the patient and their family. This sense of loss may be about the future, their role in the family, their dignity or loss of control. There may be a feeling of overwhelming sadness that the patient can’t explain. It’s natural to have fears around death and dying, pain and the unknown. The patient may experience fears about what will happen to their family after they die and how they will cope. There may also be regrets about things they never had a chance to do, and other unresolved issues.
The patient or their family may be in denial about what is happening, and they may not want to talk to you. Denial may also cause conflict within the family. You should always be guided by the patient, so try not to force them to acknowledge the situation if they aren’t ready to accept the reality of their condition.
Tension and high emotions may also be caused by a difficult family history that has re-emerged and hasn’t been resolved. We have more information about the thoughts and feelings a person approaching the end of life might have on our page about talking to someone with a terminal illness about death.
What should I do if I’m asked to withhold information?
You may find that the patient or their family ask you to withhold information from one another, avoid certain conversations about their illness or want you to give the patient false hope or reassurance. This is known as collusion.
In situations like this, it’s important to remember that collusion is usually driven by someone’s desire to protect the patient. Often, the patient and their family will both be fully aware of what is happening, but do not want to discuss this together. It may also be due to cultural or religious beliefs about accepting that the person is going to die soon.
It is important to remember that the patient has a right to confidentiality and this should be respected. While you may acknowledge reasons for withholding information, you should let the person and their relatives know that you have to answer honestly when they ask you questions. It is often helpful to try to explore why the patient or family want you to collude and sensitively discuss the benefits of being open and honest.
Offering to support the patient and their family when they start these difficult conversations together can relieve some of the anxiety. Engaging in collusion will not be productive and may compromise the work of other professionals involved in the person’s care.
You may need to read more or do further training to deal with this type of situation. If you would like more information on guidance and policies relating to collusion, you should speak to your line manager or contact the regulatory body for your profession, and ask for the Code of Conduct.
How can I help a patient with their psychological needs?
Sometimes you may find that an offer to help is rejected. This may be because the patient doesn’t recognise that they are struggling or simply because they wish to be left alone with their thoughts and feelings. Remember, this is a natural reaction.
There are however, some things that you can suggest, such as attending a hospice day centre for activities like art and music therapy, group work or peer support. Talking and listening therapy may be beneficial and counselling is normally available as well. Sometimes, preparing a memory box or making a video can be therapeutic.
If you feel it’s appropriate, offer a listening ear to the patient and their family. You may not be able to resolve every issue, but you may be able to make suggestions that help them decide how to move forward. It’s important to actively listen and give the patient or their family the space to open up.
The family are angry, what should I do?
Anger is one of many stages of grief. Not everyone will be angry at the same time or about the same things, and there is no hard and fast rule about the order of the stages of grief. Sometimes anger subsides only to return again later on. Some people may not feel angry at all.
Always remember that although the patient or their family or friends may appear to be angry at you, they are more likely to be angry at the situation. Try not to say that you understand, even if you have had a similar life experience. This is their experience and it will be unique. The best tools you have are your listening skills. Let them talk or shout if necessary. Try to avoid interrupting or sympathising excessively, as this may be perceived as patronising.
It is important to be aware that anger can be a sign that you are at risk of violence. If the person who is angry is known to suffer from a severe mental illness such as psychosis, or is known to be psychopathic or sociopathic, their anger may not be controllable.
This could also be the case if the person who is angry is under the influence of drugs or alcohol, or if they have a history of criminal violence. Under these circumstances it is important to stay safe. You should leave the scene, find a safe place and report the incident to your manager.
I’m finding that feelings I thought I had dealt with are resurfacing. What should I do?
Sometimes, a stressful or emotional situation can be similar to an experience you’ve had in your personal or professional life, causing memories to resurface unexpectedly. See our page on caring for someone in their last days and hours for more information on dealing with your own feelings at this time.
Death and dying can also make you more aware of your own mortality. It‘s important to acknowledge these thoughts and feelings. You may find that clinical supervision or reflection helps you to make sense of them.
Who else should I talk to?
- A specialist palliative care social worker
- The patient’s GP
- The district nurse
Points to remember
- Not all psychological issues can be fixed.
- Learn how to listen effectively, avoiding interruption or excessive sympathy.
- Not everyone believes that they need to be helped.
- People may have issues that can’t always be resolved.
- You can suggest solutions or ways of addressing them, but you can’t force them to be taken up.
- Be aware of support services provided locally for both the person and yourself.
- Look after yourself and be aware of any issues that might reappear from your own life experiences.
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