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Psychiatric aspects of chronic palliative care: Waiting for death

Published online by Cambridge University Press:  22 March 2012

François Sirois
François Sirois*
Affiliation:
Department of Psychiatry, Laval University and Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec, Canada
*
Address correspondence and reprint requests to: François Sirois, Institut Universitaire de Cardiologie et Pneumologie de Québec, 2725, Chemin Sainte-Foy, Quebec, Qc, GiV 4G5, Canada. E-mail: sirois.rondeau@sympatico.ca
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Abstract

This article emphasizes the shifting paradigm of palliative care from cancer patients to vital organ failure in chronic diseases. It offers a view about a type of palliative care for patients reaching the pre-terminal phase of a chronic illness. Unlike cancer patients, time is not as sharply delineated and physical pain is not a major factor, but psychological distress is often a major component of the clinical condition. Starting from the perspective of a psychiatric consultant on medical and surgical wards, I present short clinical vignettes to introduce a discussion about psychological manifestations in patients with chronic vital organ failure. The objective is to help patients find meaning to the last stage of their life. To that effect, four key sensitive areas are presented for clinicians to assess end-of-life coping: pressure on character organization, the management of hope, mourning problems, and ill health as a screen for psychological distress.

Keywords

Chronic diseasesPalliative careEnd-of-life coping
Type
Review Articles
Information
Palliative & Supportive Care , Volume 10 , Issue 3 , September 2012 , pp. 205 - 211
Copyright
Copyright © Cambridge University Press 2012

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