Academic journal article Journal for the Study of Religions and Ideologies

Arguments in Favor of a Religious Coping Pattern in Terminally Ill Patients

Academic journal article Journal for the Study of Religions and Ideologies

Arguments in Favor of a Religious Coping Pattern in Terminally Ill Patients

Article excerpt

Abstract: A patient suffering from a severe illness that is entering its terminal stage is forced to develop a coping process. Of all the coping patterns, the religious one stands out as being a psychological resource available to all patients regardless of culture, learning, and any age. Religious coping interacts with other values or practices of society, for example the model of a society that takes care of it's elder members among family or in an institutionalized environment or the way the health system offers or not psychological support for a terminally ill patient. Health care providers should have at least some psychological coping patterns training because not all patterns of religious coping are equally effective, and some have been described as increasing the level of stress or producing other negative psychological effects on the patient. This article aims to review the complex models of religious coping that are unanimously accepted in psychooncology, arguments in favor of religious coping, the types of patients that use this model, ethical dilemmas that could be reinterpreted using religious arguments. Finally, we will also discuss the need of Romanian patients to embrace a religious coping in case of an incurable illness, and also the support that they can receive from both curative and palliative health care providers.

Key Words: coping, religious coping, spirituality, palliative care, terminally ill patients, cancer, spiritual needs, decision making at the end of life

Psychological adjustment of a terminal patient

The clinical approach for individuals facing a crisis (terminal illness) implies his analysis in a social, cultural, domestic and also religious context1. The psychological and spiritual support given to patients facing a life-changing crisis such as reaching the terminal phase of an illness is based on the analysis and streamlining of his psychological adjustment as well as supporting the patient when they are faced with decisions regarding his clinical situation (deciding to start a palliative treatment, or to discontinue a treatment considered ineffective, or not treating a symptom and finding a meaning in suffering, even determining the place where the patients might desire to spend their final days). This moment, when faced with decision making in the terminal stage of an illness is where medicine, psychology and bioethics overlap; this is where controversies and dilemmas are born. But before we analyze these dilemmas we need to present, in brief, the main patterns of psychological adjustment as well as the multitude of bio-psycho-social problems caused by severe illness (near-terminal phase) in patients' lives, towards which the patient must develop a psychological adjustment process.

According to the common psychooncologic point of view, coping is a sum of behaviors and cognitive activities that appear in response to a "predicament", an overwhelming event of life, with the aim of overcoming that event. These "response behaviors" developed by the patient following the disclosure of the diagnosis/prognosis arise as a subconscious means of psychologically fighting. These psychological answers' aim is to minimize the disturbance in the life of patients produced either by the disclosure of the diagnosis and beginning of treatment or the overwhelming news that there is no cure, just palliative treatment. By effectiveness in alleviating the negative psychological consequences, coping can be functional (efficient, adaptative, effective), lowering levels of stress, anxiety and depression or disfunctional (inefficient, not adaptative, ineffective), which is associated with unfavorable evolution of disease and an elevated level of stress2.

The effective coping patterns for terminal patients are accepting the prognosis/diagnosis, positive thinking, engaging the "unseen enemy", represented by disease, in combat, accepting support from peers, taking into account every possibility for evolution of the disease, identifying their own resources and using them, reinterpretation of the disease as having positive connotations (cognitive reconstruction), reacquisition of religious valences at the start of the terminal stage, and the search for support in religion/spirituality. …

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