Emotions and cognitions
Psychological aspects of care
The presence of psychiatric morbidity in terminally ill patients and the fact that it is often not diagnosed is well recognized (Rodin and Voshart 1986; Kathol et al. 1990; Pirl and Roth 1999; Murray et al. 2002). Nursing staff have an important role in identifying patients who may have psychiatric symptoms (Valentine and Saunders 1989; McVey 1998). Nurses spend more time in direct patient contact, enabling them to observe behaviour more closely, and the nature of intimate nursing tasks may provide an opportunity for patients to express any psychological distress. Sadness and depression exist along a continuum. In this chapter, I explore how patients can be supported in coping with their feelings when confronted with a terminal illness, focusing in particular on depression and anxiety and the difficulties involved in diagnosis. Brief case histories will be used to illustrate the issues discussed; all names and details have been changed to protect anonymity.
Andrew was 46 years old, worked in an office and was the proud father of three small children. He noticed he was passing some blood mixed with the stool and after presenting to the GP was referred for barium enema and colonoscopy that revealed a cancer of the rectum. Andrew was told his diagnosis at the outpatient clinic with, as he recounted later, 'the world and his wife also there'. He was told that the surgery would probably mean a stoma and was admitted a week later for surgery. This was followed by 20 fractions of radiotherapy and chemotherapy. He found the stoma difficult to accept, but returned to work after finishing his treatment. Eighteen months later he developed a series of chest infections, which were resistant to antibiotic treatment. An X-ray revealed that he had multiple pulmonary metastases and an abdominal ultrasound revealed liver metastases. This