Here are some common fears of dying and how to help patients and their loved ones address them.
The process of dying
• Will death be painful?
• How will I get through this?
Make sure patients know they will experience little or no pain (unless they choose to). Staff members at hospice facilities are trained to interpret what patients need using verbal and nonverbal cues, and they will discuss the benefits and drawbacks of each option with patients and their families.
Loss of control
• Must I give up independence?
• Can I cope with being dependent on others?
Encourage patients to live a normal lifestyle for as long as possible. When it becomes clear they will need to accept care from others, arrange for them to meet and get to know caregivers in advance. Becoming acquainted with them before accepting their services can alleviate discomfort and fear.
Loss of loved ones
• What is going to happen to them?
• How will they manage without me?
Only the patient’s loved ones can alleviate this fear. Loved ones should be willing to frankly discuss what will happen to everyone when he or she dies. If children or dependent adults are involved, ensure the patient has help formulating a detailed plan for their future care.
• What if I see fear in the eyes of others?
• How do I respond to differences in their body language?
Explain to patients’ loved ones that it’s natural to feel fear and sadness when faced with the loss of a loved one, but after the initial shock has worn off, they should try to behave normally. A loved one should ensure that all caregivers and visitors are told in advance what to expect. This way, displays of shock or fear can be avoided.
• What if my visits with health care professionals and friends decrease?
• Will I die alone?
A loved one should ensure that regular visits with close friends, family members, and other volunteers are scheduled, especially if medical appointments have decreased because a cure is no longer possible. Hospice care or church ministries can visit when the patient lives far from friends and loved ones. End-of-life care from these establishments includes comprehensive pain management and dramatically increases quality of life.
• What can I expect?
• Will there be life after death?
Everyone, even self-professed skeptics, wonders what will happen to them after they take their last breaths. Addressing this concern has physical, emotional, and spiritual implications. Even if your patient is not religious, consider asking the patient if he or she would like to talk to a priest, rabbi, minister, pastor, or monk. Outside resources such as these can present a gift of peace, regardless of past doubts and skepticism.
That life was meaningless
• What did I accomplish during my life?
• Did I have a positive impact on the world?
People who are leaving this world need to hear that they are valued and that they won’t be forgotten. Loved ones should be encouraged not to miss the chance to tell patients how much they love them, and remind them of all the good they did. Patients need reassurance their lives had purpose and meaning.
Adapted from Donna Authers’ A Sacred Walk: Dispelling the Fear of Death and Caring for the Dying (A&A Publishing, 2008).
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
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