Wednesday, September 16, 2009

End-of-Life Counseling is here.

A new hybrid form of counseling called “End-of-Life Counseling” has been developed in recent years to help the elderly deal with death. The topic of “End-of-Life Counseling” has also been linked with President Obama’s health insurance reform; one of the provisions of the current bill includes paying a nurse to talk to the elderly patient about living wills, hospices, estate planning, and dealing with death.

Conservatives are critical of this part of the bill and refer to end-of-life counseling as “death panels.”

In a new study published in the Journal of the American Medical Association, trained nurses did the end-of-life counseling, mostly by phone, with patients and family caregivers using a model based on national guidelines. All the patients in the study had been diagnosed with terminal cancer. Half were assigned to receive usual care. The other had received usual care plus counseling about managing symptoms, communicating with health care providers and finding hospice care.

Patients in the study also attended 90-minute group meetings with a doctor and nurse to discuss problems related to their imminent death. Patients who got the counseling scored higher on quality of life and mood measures than patients who got no counseling. The patients who got the counseling also lived longer, by more than five months on average.

Actually death counseling has been around for some time as one of the forms of psychotherapy available to seniors. Elizabeth Kubler-Ross pointed to the need for this kind of counseling in her seminal book, On Death and Dying. In that book she observed a group of terminally ill patients in a hospital and noted that they went through stages of dealing with death and dying.

Their first reaction to being told they had cancer was denial. (“Those can’t be my x-rays!) Their second reaction was anger. (“Why did it have to be me?) Their third reaction was bargaining. (“God, if you’ll let me get well, I’ll give all my money to the church.”) The fourth reaction was depression. (“Of course, everything bad happens to me.”) And finally there was acceptance. (“Death is a normal part of life, accept it.”)

An end-of-life counselor can help people go through these stages as well as dealing with other end-of-life issues. People tend to get stuck in one of these stages—for example, the anger stage. They are angry at themselves, angry at their loved ones, angry at nurses, and angry at doctors. They feel everybody else is smug and gleeful because they get to live. They want to assail everybody and make them share their misery.

Death is the ultimate obstacle and the final stressor with which one has to cope. End-of-life counseling can’t make it go away. But it can get death to wipe the smirk off its face and be more sympathetic to this great human dilemma.