Changing the Focus from Cure to Comfort
Changing the focus from cure to comfort is NOT giving up. You must weight the benefits versus the risks. The decision is quality of living versus quantity of life. It is a time of clarifying choices. It is a time to look at the plan developed earlier, evaluating the outcomes, and revising the plan for the future. The physician can help with this decision as well as spiritual and cultural leaders. The individual needs reassurance that the physician will still provide care.
Changing focus is changing the goals of treatment. Both the individual and the family have goals. The individual might include the family in the decision to change the focus or make the decision over time. Many people consider the goals of the physician important but they are NOT important. The only important goals are your goals. Many people will involve family and friends in this important decision. It is important to clarify the choices with the family and help them understand the change in focus.
Part of changing focus, is to take the time to change the plan and make decisions that are right for you. Some people are afraid to take that extra time because they see time as more limited. It is OK to STOP, LOOK, and LISTEN before changing the plan.
Palliative Care
Palliative care is treatment that provides comfort and improves the quality of life when hope for a cure has faded. There is no particular treatment and a person can consider all possibilities. In palliative care the individual, physicians, family members, caregivers, and others agree on an expected outcome for the care. It may be relief from distressing symptoms, easing of pain, and/or enhancing the quality of life. The choices and decisions you make are of paramount importance. They include:
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Affirmation of life and seeing dying as a normal process. |
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Provides pain and symptom relief WITHOUT hastening or postponing death. |
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Includes psychological, physical, and spiritual aspects. |
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Offers individual and family support systems. |
Support Networks
While support networks are important throughout life, they become even more important when changing the focus from cure to comfort. The support system gathers close while the members of the network may change. The person may affirm, renew, prioritize, or deepen relationships. Old relationships may end while new relationships develop. This may depend on the ability of the other person to talk about dying. It is an INSULT to NOT talk about dying with a person and the family. It is important to strive for open and honest communication. Personal space is important to everyone for consideration. Large extended families may seem chaotic when they are well organized. Each person must designate whom the caretaker is to talk with.
Spirituality and Value Changes
Your definition of success may change. Spiritual beliefs change and take on new meanings as you face mortality. You may begin questioning faith or God. You may increase your reliance on God and faith while thinking about life after death.
Values may change or the weight given existing values may change. The focus is on the important values while letting go of those that do not provide support to the person.
Complimentary and Alternative Medicine
Complimentary and Alternative Medicine (CAM) provides a large array of treatment options for the individual whose focus is on comfort. Some compliment traditional medicine while others are alternatives to traditional medicine. Examples are herbs, acupuncture, cultural healers, colon enemas, acupressure, massage therapy, aromatherapy, and biofeedback. It is important to notify your physician of other treatments you are taking. Some may cancel out or double the effects of your physician's treatment.
A Good Death
What is a good death? Although each person answers this question in different ways, “dying well” is freedom from avoidable stress and suffering. It is dying in a manner consistent with wishes, spiritual beliefs, and cultural traditions. Try to envision what a good death would look like for yourself.
Managing Symptoms
The greatest gift for an individual and family is being free of pain and misery. You have an active role in comfort management. The primary symptoms of concern to the individual, family, and the caregivers are:
| Pain - the greatest fear of all. |
| Lack of appetite and weight loss. |
| Nausea & Vomiting |
| Constipation - the infrequent passage of stool. |
| Depression |
| Fatigue - constantly feeling tired despite. |
For further discussion on why these symptoms occur and ways to manage them, can be found by clicking on Managing Symptoms.
Home Adaptations
There are many ways to adapt a home to provide comfort care. Some chose to remain in their bedroom while others want to be in the middle of the living area of the home. Standing curtains can provide privacy if a person chooses the living area.
Equipment can include: hospital bed, over-bed table, bedside commode, wheelchair, oxygen tanks and/or concentrator, shower chair, tub transfer benches, hair washing trays, alternating or pressure relief mattress, etc. To see pictures and explanations of how to use the equipment click on Equipment.
Supplies can include: bed protection pads, incontinent pads, gloves, comfort care disposable washcloths, mouth swabs, waterless hair shampoo, special food supplements, etc.
Many things in the home can be adapted for ease of use in care of a person. Many organizations have loan closets for equipment that insurance does not pay for.
Caregiver & Family Support
The family needs support when providing comfort care. You will need support from the physician for medications, symptom relief methods, and visits when the person cannot leave the home, etc. Home Health Care can provide for nursing assessments, answer questions, liaison with physician, obtains supplies and equipment, referrals to other agencies, etc.
There are many things that family and friends can do for someone. Keeping a list of needs handy will help match the need with someone who offers assistance. Some examples are: picking up medications from the pharmacy, grocery shopping, laundry, tending the garden, shoveling snow, reading or visiting, writing letters, etc. The list is endless depending on the situation. There is ALWAYS something everyone in the family can do to provide support. It is important that all involved family and friends have a task. This helps them feel needed and part of the care.
