By p 26 Patient Control

We need to provide options to patients so they can actively participate in their care and feel a sense of control.

Terminally ill patients have a need to believe that they are still in control of their affairs as much as possible, even though they have lost control of their bodies. They should be given the freedom to make choices and assume responsibility over as many aspects of their existence as possible. For many individuals, this is an essential part of living, and its loss may destroy their motivation to live. A terminally ill patient should be helped to focus on and cope with the realities of daily living, because these problems remain very real and can serve as a diversion from constant preoccupation with the prospect of death. When patients have understanding and insight into the treatment and feel they still have some control over the decision-making process regarding their lives, they are more likely to cooperate with prescribed treatment regimens.

It is often fear of the unknown that makes a patient suspicious and resistant to therapy. Patients also should be given the opportunity to settle their affairs. Studies have shown that 40% of terminally ill patients are most concerned about being a burden to their family and friends, and that 40% of the families of cancer patients become impoverished as a result of providing care for a family member (Emanuel et al., 2003). Concentration on financial business and putting the house in order is a pragmatic approach to active participation in the decision-making process. Some patients may have a burning desire to complete a cherished project, reconcile an estranged relationship, or visit particular places before they die. Positive motivation can be maintained by assisting them to focus on and deal with these issues.

A sense of control is more possible for the patient if pain is controlled and the patient is made comfortable. Sleep should not be forced with medication, because some patients resist going to sleep, fearing they may never awaken, while others frequently have terrifying dreams.

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