Support for the Family

Families and close friends of the dying patient also suffer and should be supported. A good policy is for the physician not only to be sensitive to the needs of family members before death, but to follow up with the family after the patient dies, either with a phone call, a letter, or a home visit.

Hospice care is not focused only on the patient; the unit of care is the patient and family. The physical, psychological, and interpersonal needs of both the patient and the family are addressed. After a patient's death, family members may experience increased morbidity and mortality, emphasizing the need for greater family support from the physician. Unfortunately, most physicians do not routinely contact the family after a patient's death, so this need often goes unrecognized.

The "widower effect" is the likelihood that the surviving spouse will die shortly after the death of the partner. However, spouses of partners who received hospice care lived longer than those whose spouse died without the benefit of hospice care, probably because hospice patients impose less stress on the family (Christakis and Iwashyna, 2003).

The hospice team provides follow-up bereavement care to the family up to 1 year after the patient's death. Family members who experience grief after the death of a loved one are more vulnerable to physical and other emotional disturbances than at any other time in their lives. They need help dealing with the grief, guilt, and symptoms associated with this emotional turmoil. The bereavement services of a hospice team can minimize these problems and can help family members cope with the pain of memories that arise from time to time, especially at holidays, birthdays, and other stressful occasions.

A man dying of cancer did not tell family or friends in order to spare them. After his death, some admired his ability to suffer in silence, but many were angry and hurt, believing he did not think they were strong enough to suffer with him. The survivors not only were angry because he did not appear to need them, but also were hurt because he did not even say good-bye (New Age, 1989).

The most remarkable contribution of the hospice movement is not that it provides a special and compassionate setting in which terminally ill persons can die without heroic measures, but that the family becomes involved and comfortable in caring for the ill member. With the rapid increase of scientific and technologic competence in the field of medicine, families feel increasingly incompetent and impotent to deal with dying. The hospice movement has reversed this trend and helps family members work with community support services to provide home care for many of these patients. When symptoms cannot be controlled at home, the hospice inpatient unit can provide medical and nursing expertise in a homelike setting.

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