CA: A Cancer Journal for Clinicians, Vol 15, 105-111, Copyright
© 1965 by American Cancer Society
Communication with the Fatally III
Adriaan Verwoerdt M.D.1
1 Assistant Professor of Psychiatry at Duke University School of Medicine, Durham, North Carolina.
In fatally ill patients, the knowledge about imminent death can interfere with the usual processes of anticipation and hope. This stress combined with the impact of the illness can lead to a regression with a concomitant change in the patient's time scale. A regressive time scale is protective in the sense that day-by-day living again affords good prospects and hope. In informing patients about their condition, the real issue is not whether to tell or not to tell, but rather how much to tell and in what manner. This depends on an assessment of the patient's ego strength and age; the presence of denial mechanisms; the nature and the meaning of the illness; the role of the family; factors pertaining to hospitalization and doctor-patient relationship.
The psychophysiologic significance of hope has been discussed. Hopelessness and helplessness can be managed by the therapeutic use of regression; continued palliative treatment; counteracting the adverse effects of hospitalization; anticipating the patient's needs; and finally, by providing an "ego prosthesis."
