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Terminal illness care

What Is Terminal Illness Care?

A study published in the Journal of Pain and Symptom Management defines Terminal Illness as a life-limiting disease with irreversible decline, and survival is expected to be in terms of several months or less. This means that the illness has a very low chance of being cured and will result in death.

The Medicare hospice benefit has defined people who are terminally ill to be those who have a life expectancy of six months or less if the life-limiting illness runs its normal course. A life expectancy of six months or less is one of the eligibility criteria for a hospice grant from Medicare. Medicare requires a certification from both the hospice doctor and the patient’s medical doctor that the patient is terminally ill and is expected to live for six months or less.


What Are Examples Of Terminal Illnesses?

Examples of terminal illnesses include advanced cancer, dementia, Alzheimer’s disease, motor neuron disease (MND), lung disease, neurological diseases like Parkinson’s disease, advanced heart disease, kidney failure, and chronic obstructive pulmonary disease.

The World Health Organization (WHO) has enumerated several diseases based on the need for palliative care services for the majority of adults. 38.5% of adults with chronic cardiovascular diseases need palliative care. Palliative care is also required by 34% of adults with cancer. 10.3% of adults with chronic respiratory diseases are also in demand of palliative care. Palliative care is also needed by 5.7% of adults with Acquired Immunodeficiency Syndrome (AIDS) and 4.8% of adults with diabetes. WHO also states other medical conditions that need palliative care, such as:

  • kidney failure,
  • chronic liver disease,
  • multiple sclerosis,
  • Parkinson’s disease,
  • rheumatoid arthritis,
  • neurological disease,
  • congenital anomalies, and
  • drug-resistant tuberculosis.


How Long Will Someone With A Terminal Illness Live?

A study published in the Journal of Pain and Symptom Management analyzed the remaining lifetime of patients who received an assessment from their physicians that they were terminally ill. The median remaining lifetime for patients included in the study was 55 days, and 37% of them died in the first month. Patients with a noncancer disease had the shortest remaining lifetime of 17 days compared to patients with cancer, with a remaining lifetime of 59 days. Among cancer patients, patients with prostate cancer had the longest remaining lifetime of 76 days, while patients with hematologic cancer were the shortest remaining lifetime of 41 days.

Medicare defines a patient with a terminal illness as someone who is expected to survive in six months or less. This definition is used as one of the bases of Medicare to shoulder the hospice care costs of their beneficiaries.

A patient with a terminal illness’s life expectancy depends on several factors, such as the type of terminal disease, overall health, and the presence of other health conditions. Medical doctors and researchers have developed guidelines to help palliative or hospice doctors to compute the patient’s life expectancy realistically. The first guideline is the Karnofsky performance scale. The Karnofsky performance scale assists physicians in evaluating the patient’s overall level of functioning, such as the ability to do daily activities and take care of oneself. The score is provided as a percentage score, with lower percentage scores meaning shorter life expectancy.

The other guideline used by physicians and palliative doctors is the Palliative prognostic score. The Palliative prognostic score combines the patient’s Karnofsky performance scale, white blood cell and lymphocyte counts, and other factors in order to produce a score ranging from 0 to 17.5, with higher scores meaning shorter life expectancy.


Can A Person With A Terminal Illness Get Better?

Yes, a person with a terminal illness diagnosis can get better in terms of the management of pain and symptoms and the improvement of the quality of life. However, when it comes to medical treatment, a person with a terminal illness has a low chance of getting better. That is why physicians have certified that a patient is terminally ill and has six months or less to live.

Physicians may recommend chemotherapy or radiation to prolong the life expectancy of the patient with a terminal illness. Patients with terminal illnesses diagnosis may also opt to participate in clinical trials of a new drug or treatment option. Other alternative options are acupuncture, massage therapy, and relaxation techniques. These alternative treatments are aimed at bringing symptom relief and lessening the pain and discomfort brought on by the terminal illness.

A person with a terminal illness can get better in terms of pain and physical symptom management through hospice care (end-of-life care) and palliative care. Hospice care (end-of-life care) and palliative care both provide care, comfort, and quality of life for patients with terminal illnesses as well as their families. Patients can experience a holistic improvement in their daily lives because hospice care (end-of-life care) and palliative care focus not only on the physical aspect but also on the psychological, social, and spiritual areas.


Coping With A Terminal Illness

Impact On Patient

Coping with a terminal illness can be difficult for both the patient and the family members. Patients can experience various emotions, such as shock, fear, anger, resentment, denial, helplessness, sadness, frustration, relief, and acceptance. The feeling of isolation or being alone is also what patients with terminal illnesses experience, even if they are with their loved ones.

A study published in the Journal of Advanced Nursing highlighted the effects of terminal illness on patients. The study states that many of the terminally ill have experienced the process of dying as very slow, distressing, and painful. This also includes the serious limitations on their lifestyle because of the sickness.

Impact On Family

Family members can also have difficulty dealing with their loved one’s terminal illness. The difficulty lies in the process of offering support and dealing with grief. The feeling of anxiety is also a common reaction of family members when one of them is diagnosed with a terminal illness or an incurable illness.

Family members may also have different roles to play in assisting their loved one with a life-threatening illness. The most typical role is being their loved one’s caregiver. Being a caregiver can be really stressful physically and emotionally because of the demand. A study published in the Aging & Mental Health Journal assessed the impacts of caregiving on family members. 41% of the respondents reported that they have been providing caregiving duties, such as bathing, mobility, dressing and undressing, toileting, and assistance at night, for their terminally ill loved one for over a year. According to them, the physical demands from doing caregiving duties increased substantially during the last three months of their loved one’s life.

Hospice care and palliative care offer grief counseling and bereavement counseling to help hospice patients and their families deal with this challenge in their lives. The hospice team are composed of professionals like doctors, nurses, chaplains, religious ministers, spiritual advisors, and bereavement counselors who can provide physical, emotional, psychological, and spiritual support.

For more information on Terminal Illness Care contact the team at Specialized Home Care today.