Coping with Death

1
Coping with Death

• How do we face our own mortality?

2
Coping Definition

• Constantly changing (dynamic) cognitive and
  behavioral efforts to manage demands exceeding
  the resources of the person.
• This emphasizes that coping behaviors go beyond
  routine, adaptive behaviors.

3
Domains of Coping

• The task of coping can be divided into 3 domains,
  each of which involves different skills.
• (1) Appraisal Focused Coping how one understands
  a stressful situation.
• Logical analysis and mental preparation
• Cognitive redefinition accept the basic reality
  of a situation but restructure it to find
  something favorable.
• Cognitive avoidance or denial deny or minimize
  the crisis.

4
Domains of Coping

• (2) Problem Focused Coping what one does about
  the problem.
• Seeking information and support.
• Taking problem solving action.
• Identifying alternative rewards.
• (3) Emotion focused coping
• Affective regulation trying to maintain hope
  and control emotions.
• Emotional discharge venting, gallows humor.
• Resigned acceptance.

5
Factors that influence coping

• Dying trajectories
• How might the shape and duration of a persons
  death trajectory influence coping?
• Awareness contexts
• The interactions among those who are coping with
  dying with an emphasis on the levels of openness
  and honesty between them.
• 4 types of awareness (these are not stages)

6
Awareness Contexts

• Closed Awareness
• Dying person does not know. Is this fair? How
  long can it be maintained?
• Suspected Awareness
• Ill person suspects that they havent received
  the full story. Undermines trust.
• Mutual Pretense
• Both parties know, but do not discuss. Requires
  constant vigilance and is very draining.
• Open Awareness
• Free and open communication.

7
Stage Based Approaches

• Elisabeth Kubler-Ross Based her model on
  interviews. Stages can occur out of order and/or
  simultaneously.
• Denial It cant be true!
• Anger resentment of the non-dying, dehumanizing
  treatment.
• Bargaining acknowledgement that death is
  coming, but asks for more time.
• Depression active mourning process.
• Acceptance calm recognition and readiness.

8
Critiques of Kubler-Ross Model

• Although important, there is much debate about
  her theory.
• No research support
• Line is blurred between description and
  prescription
• Misused by public and medical community
• Complexity of environment is ignored

9
Corrs Task Based Approach

• Corrs model moves away from stages to an
  investigation of the things that a dying person
  needs to do.
• Physical Dimensions to satisfy bodily needs and
  minimize physical distress in ways that are
  consistent with other values. Physical comfort
  and symptom relief. Pain control.
• Psychological Dimensions to maximize
  psychological security, autonomy, and richness in
  living. Thus, person is respected as a fully
  living person, maintains independence and
  control, is helped to enjoy life.

10
Corrs Task Based Approach

• Social Dimension To sustain and enhance those
  interpersonal attachments significant to the
  person and to address the social implications of
  dying.
• Patient is not abandoned or isolated
• There is private time to share with loved ones
• Connections with larger social groups
• Positive relationships with healthcare workers
• Resolve unfinished business

11
Corrs Task Based Approach

• Spiritual Dimension to identify, develop, or
  reaffirm sources of spiritual energy and in so
  doing foster hope.
• Religious needs
• Life review (e.g., Eriksons idea of ego
  integrity vs. despair)
• Provide opportunity for aesthetic involvement

12
Living with a life threatening illness

• Doka provided a 5 phase model of facing a
  potentially fatal illness.
• Prediagnostic phase initial indicators of
  illness and disease. What do I do?
• Acute phase tasks that occur with a serious, but
  treatable condition. Learning, changing
  lifestyle, express feelings.
• Chronic phase living with a life threatening
  illness. Managing symptoms and side effects,
  dealing with financial concerns, preserving
  self-concept.

13
Dokas 5 Phase Model

• Recovery Phase
• Deal with after effects, anxiety about
  reoccurrence, reformulating of ones lifestyle.
• Terminal Phase
• Trying to find meaning from experience
• Saying goodbye
• Deciding what kind of care to have
• Dealing with caretakers.