Medical Family Therapy in Palliative and Hospice Care

Chapter
Part of the Focused Issues in Family Therapy book series (FIFT)

Abstract

Contemporary advancements in health care and medical technology are allowing patients to live longer now than they ever have before. We are seeing these trends in longer life across all age groups—from increased survival during childhood from illnesses that were heretofore rapidly fatal to combating normative age-related declines (and thereby prolonging senescence) in the elderly. With these trends come marked increases in the likelihood of being diagnosed with a serious or terminal illness during one’s lifetime (Centers for Disease Control and Prevention [CDC], 2011). Such illnesses and their unique health trajectories are generally treated under the medical specialties of Palliative and Hospice Care (CDC, 2010; Meier, 2011). Providers engaged in these treatment teams must attend to patients’ physical functioning within a context where getting better is not presumed. Treatment teams must thereby attend to foci like quality of life, emotional suffering, loss, meaning making, and spirituality as part of everyday practice.

Notes

Glossary of Important Terms in Palliative and Hospice Care

Advanced care planning

A process of communication between individuals and their healthcare agents to express wishes and preferences regarding care in the event they are unable to make their own decisions or speak for themselves (Waldrop & Meeker, 2012). MedFTs can help patients and family members engage in advance care planning that can help prevent unnecessary suffering and improve quality of life toward the end of life and can aid caregivers in better understanding what the patient prefers (Houben, Spruit, Groenen, Wouters, & Janssen, 2014). Several documents and resources scan assist in this process and are listed at the end of this chapter. The decisions made in advanced care planning are reflected in an advance directive.

Advance directive

A legal document that states your preferences regarding healthcare decisions in the event you are unable to speak for yourself. There are three main categories of advanced directives: “power of attorney,” “healthcare proxy,” and “living will.”

Allow natural death (AND)

A more recent terminology that can replace the DNR order. While a DNR /DNAR relates to CPR, an AND instructs that only comfort measures be taken to manage symptoms without interfering with the natural dying process.

Death with dignity

A term commonly used to describe a physician-assisted death, physician-assisted dying, aid-in-dying, or medical aid-in-dying. It includes a process that allows for certain terminally ill patients (adults) to legally consult and request a lethal dose of medication from their primary care providers. Patients receive said medication from a pharmacist and then take it themselves (or have a family member administer it) in order to end life in a peaceful and dignified manner. This option is only available in certain areas (see Death with Dignity, 2016).

Do not resuscitate (DNR)/Do not allow resuscitation (DNAR)

A medical order written by a primary care provider (Breault, 2011). It instructs healthcare providers not to do cardiopulmonary resuscitation (CPR) if a patient stops breathing or if his or her heart stops beating. The primary care provider writes the order only after talking about it with the patient (if possible), the proxy, or with the patient’s family.

Healthcare proxy

Designates an individual to make medical decisions on a patient’s behalf if they are unable.

Living will

Documents a patient’s desired wishes about medical treatment at the end of life in the event they are unable to communicate. It can also be called a “directive,” “healthcare declaration,” or “medical directive.”

Physician order for life-sustaining treatment (POLST)

A more recent form developed to improve communication about goals of care, quality of life, diagnosis, prognosis, and treatment options between seriously ill or frail patients and healthcare professionals about wishes pertaining to life-sustaining treatments. (Polst Organization, 2016).

Power of attorney

Authorizes an individual to make decisions on a patient’s behalf in the event they become disabled or incapacitated. A medical power of attorney authorizes an individual to make medical decisions for a patient in the event he or she becomes unconscious or mentally incapable of decision-making.

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Behavioral Health, Loma Linda UniversityLoma LindaUSA
  2. 2.Department of Family Social ScienceUniversity of MinnesotaSaint PaulUSA

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