The paper considers the role of anxiety and depression in provision of care and quality of life of terminally and chronically ill individuals in light of hospice care.
Their soft but veiled with sadness eyes reveal fear and despair, paralyzing unawareness of their own lifespan along with concern about their close people, slowly killing pain, waiting, or wasting moments of spiritual and physical exhaustion. Probably, these are just a few components of overwhelming emotional mix experienced by individuals who are terminally or chronically ill and whose future is limited to six months or less. In addition, defining the exact borders of the group poses a problem. On the one hand, the complexity of measuring the group metrics is linked to a diagnosis. Indeed, there is plethora of illnesses requiring a patient to address hospice care since it is not only cancer that needs such assistance. To illustrate, kidney failure, dementia, chronic obstructive pulmonary disease, and heart failure disease are among the leading determinants for hospice care. Hence, the population impacted by any of the aforementioned health conditions or some health disparities resulting in limited or complete immobility is in constant need of medical assistance.
On the other hand, each of these diseases is blind in terms of race, gender, age, and social or economic position in the society among other patient characteristics. Illness may easily concern any person regardless of his or her multidimensional background. This feature implies another important attribute defining the above-indicated population as an extremely significant group of individuals whose needs should be addressed on permanent and urgent grounds. Therefore, this target population seemingly needs care most of all and prior to any other patient groups. Moreover, for these individuals, commonly known treatment becomes actually care but not cure whereas extension of quality of life as much as possible is what medical personnel should devotedly deliver to such patients.
Apart from a particular diagnosis which enforces chronically or terminally ill patients to refer to hospice care, these people encounter even stronger difficulties which are likely to worsen their health condition and thus make their life even shorter. Specifically, these are the states of anxiety and depression which come along with the disease and impair patients’ emotional balance as a consequence. What is more, anxiety as a less difficult mental health disorder easily transforms into depression, a state of constantly feeling sad, which destroys a person from within and makes him or her approach the end of life in a faster pace than it has been expected. Drawing upon the recent academic research in the field, “clinical depression is highly prevalent yet under-detected and under-treated in palliative care settings” and is “associated with adverse medical and psychological outcomes for patients and their family members”. This evidence demonstrates that the problem exists and its impact is detrimental for a notable number of stakeholders besides the detected target population.
Significance of the Health Disparity
Undoubtedly, human health condition and well-being are thoroughly dependent on one’s physical-to-mental health balance. Due to the fact that one of the sides of these scales of health is already affected, harmfulness of impacting the second factor seems more than evident. Furthermore, both researchers and practitioners have demonstrated this intertwined connection. In particular, the state of physical health is directly dependent on that of mental and vice versa. Being diagnosed with any of the severe chronic, terminally, or life-limiting diseases is already a stress with detrimental consequences for human psyche. What is more, when a diagnosis is multiplied with a short-life sentence, such a psychological trauma is of immense impact on the nervous system and an entire organism.
Besides worsening of the overall health condition in the target population, undiagnosed or untreated anxiety and depression may lead to co-morbidities, especially emotional, such as willingness to die along with fear of death. Additionally, patients may commit suicide attempts. These stressing events are equally destructive for a patient, his or her relatives, friends, and medical staff involved, expanding the scope of potential impact of depression in this context. While families will experience grief because of bereavement, the personnel can face anxiety, burnout, and other psychological, emotional, and spiritual strains.
Contemporary academic research offers a substantial amount of information evidencing a multi-level importance of anxiety and depression in the identified context. To start with, it is necessary to emphasize that prevalence of these two mental health disorders varies across palliative care settings in accordance with different factors. For instance, Plaskota et al. have discovered that from 14% to 26% of patients are involved in hospice care suffer anxiety. In contrast, the Palliative Care Center has reported that 17% of cancer patients experience clinical depression, which is destructive for individuals’ health and well-being. Simultaneously, Hallford et al. have informed that prevalence of depression within the target audience may range from 25% up to 50%, which is quite a shocking factor.
Apart from fluctuating though high depression rates among terminally and chronically ill patients, the significance of addressing the issue is determined by severity of consequences these mental disorders may cause. To illustrate, “factors associated with depression in this population” refer to “increased frequency and intensity of physical symptoms, lower general well-being, increased mortality, and a hastened desire to die”. In addition, sleeping and eating disorders are other co-morbidities related to undiscovered and untreated anxiety modified into depression.
Moreover, certain subgroups of the analyzed population may have higher risks of experiencing severe depression. For example, Holland, Currier, Kirkendall, Keene, and Luna have discovered that veterans of military service are prone to this state in the hospice care encounter. Posttraumatic health disorder symptomatology, excessive alcohol consumption, suicide attempts, and a number of health co-morbidities are among such risk factors in the scope of this subgroup. Hence, while a disease determining the target group does not choose one’s background, the latter may become a sufficient contributing factor to his or her shorter and less qualitative life in such circumstances.
The Position of the American Nurses Association
Following the positioning of nurses’ role with respect to the issue, their responsibility to stay at a patient’s bedside and provide the highest quality of remaining life is obligatory. Moreover, this procedure implies a multifaceted care with relation to human physical state relief along with emotional, existential, and spiritual life-sustaining balance. It follows that discovering an anti-depressant approach towards care delivery to the identified target population is a widely recognized standard of care that should be taken for granted by nursing practitioners along with other healthcare providers. On a similar note, the statistical evidence of high prevailing anxiety and depression rates as important health concerns for terminally and chronically ill patients remain sufficiently high. In this respect, a conclusion can be drawn that “comprehensive and compassionate end-of-life care” as a nursing care standard needs a better articulation to provide more effective outcomes for patients.
My Position Statement
Dr. Steve Maraboli, an academic in behavioral science, the author of bestsellers narrating a necessity of and a path to changes, has aptly noted in his book Unapologetically You, “It’s time to care; it’s time to take responsibility; it’s time to lead; it’s time for a change; it’s time to be true to our greatest self; it’s time to stop blaming others.” I do believe in strength and prophetic character of these words. Nursing practitioners employed in the hospice field indeed can make a difference and help inspire this population to end their life decently, surrounded by sincere and close people.
The statistics demonstrating high depression rates among such patients is high. Nonetheless, many best practices in the field are available to address this huge concern and health disparity effectively. For instance, the scholars have reported about favorable outcomes of behavioral and art therapy, hypnotherapy, and even pharmacological treatment in mitigating detrimental effect of depression. Of course, theory-to-practice bridging does not mean that nurses poorly perform their duties or are inattentive to following the defined standards of care. However, nurses are people as well. They feel empathy, compassion, and sympathy to their patients experiencing acute pain and approaching the end of their lifespan. Although these emotional states are a part of performing their direct responsibilities, they have side effects. Therefore, it may be deduced that the American Nurses Association could have redeveloped the mechanisms of such a care delivery that would be effective for patients and not harmful but productive for nursing practitioners. Finally, nurses should not be alone in this fight with lifespan extension. Hence, “stop blaming others” means that the main others in life of these patients have to be thoroughly involved in the process of care administering, such as families, friends, and just those who care about their care.
The efficacy of healthcare strategies and policies focused on treatment of anxiety and depression has to be multiplied at times, especially in light of thorough and holistic involvement of main stakeholders in individual’s surrounding.
From 14% to at least 50 % of terminally and chronically ill individuals suffer depression as co-morbidity of their disease which decreases their lifespan in many ways. I am a hospice care nurse in Miami who knows the suffering and most common disparities of people with life-limiting diseases from within. From a daily experience and in light of scholarly evidence, I know that anxiety and depression are among the greatest contributors to their short and extremely painful life where quality of remaining lifespan is not even questioned. Permanent sadness, stronger physical symptomatic, eating, and sleeping disorders, constant thoughts about death and suicide attempts are just a few possible consequences of this mental state. Along with the patients, their families and care providers suffer their pain as well.
Undoubtedly, multidimensional care is a primary standard for nurses. However, this factor does not imply that patients’ antidepressant life-sustaining and extending is nurses’ sole proprietorship, so to speak. Policy-makers should reconsider the regulatory mechanisms of a more holistic care delivery with involvement of all relevant stakeholders as a must. A multidimensional paradigm of hospice care will allow quicker and more effective cooperation between the parties. The patient’s surrounding individuals will be responsible for gathering of valuable and holistic information about their beloved. In addition, skills and knowledge of healthcare practitioners, as well as evidence-based database will enable quick, weighted, and informed decision-making and care framework development on an individual basis. Thus, professional-versus-family support will be the most diligent and efficient way to make the patients’ end of life indeed qualitative. Only in this way, all individuals relevant for the field will have an opportunity to admit sincerely that everything possible has been done timely and no one is there to blame.