Barriers to psychological care of the dying

Abstract

Direct observation of doctors and nurses talking with real, stimulated, or role played patients suffering from a terminal illness has shown that they consistently use distancing tactics. These prevent them getting close to their patients' psychological suffering and are used to try to ensure their own emotional survival. Since these tactics discourage patients from disclosing their psychological concerns they are a serious barrier to effective psychological care. If those concerned in terminal care are to risk relinquishing these distancing tactics they will need better selection, more appropriate training, regular psychological support, and real opportunities for taking time out.

KIE: Direct observation by video or audiotape recording of communication between doctors and nurses and real, simulated, and role-played terminally ill patients has shown that health personnel often use tactics such as false reassurance and selective attention to distance themselves from their patients' emotional suffering. The author attributes these tactics to the caregivers' fear of "burnout" caused by the overwhelming psychological problems of their dying patients. He suggests that doctors and nurses who provide terminal care be selected for psychological suitability, be trained in communication, receive adequate ongoing support and definition of their roles, and rotate periodically to less stressful duties.