Made available in DSpace on 2014-12-17T15:38:51Z (GMT). No. of bitstreams: 1 ChristineMFCL_DISSERT.pdf: 730945 bytes, checksum: bf93983fe44a7b2aa210f3ebe005c785 (MD5) Previous issue date: 2011-03-31 / It is undeniable that all the extraordinary technological advances in contemporary society have increased the severe patients expectation and quality of life, especially cancer patients. On the other hand, it is easily verifiable by many researches that it was not possible to advance in the same proportion in caring for the human experience of death. Much is said about the anguish of a man facing death, of cancer patients in terminal stage, about their families, and very little about the feelings, anxieties and ways of coping with the medical professional who deals with this situation, specifically the clinical oncologist. Little is known about the experience of the doctor who has learned to take death as an enemy to be defeated, and increasingly is compelled to live at length with his advertisement. However, we started to watch in recent years a growing interest of researchers in this issue. This study seeks to add to this interest in order to understand the experience of clinical oncologists that accompany dying patients, the meanings they attach to death, ways of coping and the implications for providing care. This is a qualitative study in which was used as a tool for data collection an in-depth interview with the projective using script and scenes. Gadameriana Hermeneutics was used for analysis and interpretation of narratives. The subjects were 10 clinical oncologists who work at two institutions from cancer treatments in the state of Rio Grande do Norte, chosen from a variation in the time working in the specialty (minimum of one year, even old ones). However, you can bring some initial results for the dialogue. It was found that the death is still a topic that causes many difficulties in the daily lives of these professionals, the choice for oncology involves dealing with death without preparation in medical education; being close to the patient in the final moment, supporting the family, coping with own pain of loss and the inability to heal. These are central elements of the narratives. We also have investment in medical training and continuing education in setting up a demand that permeates the discourse of participants. Being able to listen to the subjective world of clinical oncologists will support the work not only for them as other professionals who deal with patients with advanced cancer, providing evidence to understand to what extent the meanings attributed to its know-how before patients on the verge of death interfere with the production of care and allow identify coping strategies in everyday life of these professionals that hinder or facilitate coping with death, promote or preclude the care with others and with themselves. It is hoped that research can contribute to the field of knowledge about the know-how in clinical oncology and their terminal-care-death oncologist-patient relationships, bringing runways capable of promoting a better quality of care in the production of all involved in this process: professionals, patients and families / Na contemporaneidade muito se fala das ang?stias do homem frente ? morte, dos pacientes com c?ncer em estado terminal, e, muito pouco dos sentimentos, e formas de enfrentamento do profissional da medicina que lida com essa situa??o, especificamente o oncologista cl?nico. Este estudo tem como objetivo compreender a viv?ncia de oncologistas cl?nicos que acompanham pacientes terminais. Foi realizada uma pesquisa qualitativa, utilizando como estrat?gia metodol?gica a entrevista em profundidade, com roteiro e uso de cenas projetivas. Para an?lise e interpreta??o das narrativas recorremos ? Hermen?utica Gadameriana. Os sujeitos desta pesquisa foram 10 oncologistas cl?nicos que trabalham em duas institui??es de refer?ncia em tratamentos oncol?gicos no estado do Rio Grande do Norte, escolhidos a partir de uma varia??o quanto ao tempo de atua??o na especialidade. A an?lise dos dados permitiu identificar as motiva??es dos entrevistados quanto ? escolha profissional aos significados atribu?dos por eles ao ser oncologista a busca pelo t?cnico/cient?fico e o humano. Suas concep??es sobre morte real?am os aspectos existenciais e transcedentais, como sofrimento, descanso e religi?o. Os pap?is desejados para o enfrentamento do processo de morte de um paciente elencados foram: evitar ao m?ximo a chegada da morte; promover qualidade de vida/morte e suporte emocional, estabelecendo uma comunica??o eficiente e cuidar do paciente at? o fim. Por sua vez o cotidiano com a morte os desafiam a lidarem com as dificuldades do n?o curar, do comunicar a noticia ruim, e com o desejo de cuidar at? o fim de seus pacientes. Por fim, ressalta-se a necessidade do cuidado com a dor desses profissionais, por entender que a maneira como eles lidam com a morte pode interferir na produ??o de cuidado ao paciente. Espera-se que este estudo possibilite pistas capazes de promover uma melhor qualidade na produ??o do cuidado de todos os envolvidos nesse processo: profissionais, pacientes e familiares

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-29T19:09:09Z No. of bitstreams: 1 WildobertoBatistaGurgel.pdf: 4265404 bytes, checksum: 93f54cf301884ac30c2b5a2e3d930f58 (MD5) / Made available in DSpace on 2017-05-29T19:09:09Z (GMT). No. of bitstreams: 1 WildobertoBatistaGurgel.pdf: 4265404 bytes, checksum: 93f54cf301884ac30c2b5a2e3d930f58 (MD5) Previous issue date: 2008-05-21 / This is an analysis if public policies on death and dying under the control of the contemporary capitalism state. I investigate government action on the forms of death and dying with the transference of control from the state to the market place in the consumer society. I assume the existence of an organic relationship between the forms of death and types of state, which can be demonstrated by the analysis of the policies of assistance to the dying both in the social state as well as in the neoliberal state. I use the hermeneutic-dialectic method to investigate this relationship, as at the same time I use other more contemporary political theories. I understand that they way people die today is both a continuity and a rupture in the capitalist program of social control over bodies. This continuity/rupture is associated to forms of assistance to the dying, starting at the more state-controlled assistance to the the more marketoriented industry of death. The connection between one and the other are the mechanisms of social insertion of the dying in the consumer society, so that they can consume their own assistance. I conclude that the assistance policies through the concession of social rights -- lead the state to look after both the interests of the industry of death and also the will of the dying of not perishing without specialized assistance. / Análise das políticas públicas voltadas para a morte e o morrer sob a tutela do Estado capitalista contemporâneo. Pretendese investigar a ação estatal sobre as formas de morte e morrer na sociedade capitalista contemporânea com a passagem da morte sob a tutela do Estado para a morte sob a tutela do mercado na sociedade de consumo. Pressupõese a existência de uma relação orgânica entre as formas de morte e as formas de Estado, que pode ser demonstrada por meio da análise das políticas de assistência aos moribundos, seja no âmbito do Estado social, seja no do Estado neoliberal. Aplicase o método hermenêuticodialético para a investigação dessa relação, ao mesmo tempo que lança mão de outras teorias políticas mais contemporâneas. Compreendese que a forma como as pessoas morrem nos dias de hoje é uma continuidade e uma ruptura dentro do programa de controle social sobre os corpos do capitalismo. Essa continuidade/ruptura está associada às formas de assistência aos moribundos, indo desde a assistência mais estatizada, até àquela mais mercantilizada, sob o controle direto da indústria da morte. A mediação entre uma e outra são os mecanismos de inserção social dos moribundos na sociedade de consumo, para que eles possam consumir a sua própria assistência. Concluise que as políticas de assistência aos moribundos, por meio da concessão de direitos sociais, levam o Estado a atender tanto aos interesses da indústria da morte, quanto aos desejos dos moribundos de não morrerem sem assistência especializada.

abstract: Advocacy groups work across many aspects of “death with dignity” practice and treatment, and provide insight across multiple aspects of “death with dignity”. This study argues that key advocacy groups in the American death with dignity movement influenced the broader conceptualization of death with dignity in a way that makes patients more able to achieve it. This influence has been a dynamic process across different periods of practice starting the discussion of “death with dignity” in 1985 through today, although this thesis extends only to 2011. The question in this study is how do the three main historical advocacy groups in the US: the Hemlock Society, Compassion in Dying, and Compassion and Choices, conceptualize death with dignity with regards to patient and doctor relationship, legal and policy factors, and medical technologies and protocols? This study found that the Hemlock Society (1980-2005) characterized death with dignity as a terminally ill patient being able to “self-deliver” from suffering via autoeuthanasia regardless of medical community approval or legality. Compassion in Dying (1993-2007) characterized death with dignity as involved advocacy work with terminal patients and their communities to pursue palliative care and hospice up to the point of assisted death. This organization was also involved in the passing of Oregon Death with Dignity Act. Compassion and Choices (2007-present) characterized death with dignity similarly to Compassion in Dying but also advocated for adequate management of pain and suffering symptoms in palliative care to prevent people from desiring death over the illness. Conceptualizing death with dignity is important for understanding why patients want death with dignity and better accommodating their end of life needs when they are suffering with terminal illness. / Dissertation/Thesis / Masters Thesis Biology 2019

This study focuses on how terminal diagnoses impact individuals and families within the Hispanic/Latino community. Hispanic/Latino hospice caregivers, Hispanic/Latino non-hospice caregivers and physicians participated in the study, which explores the utilization of hospice by Hispanic/Latino terminally ill individuals. The data collected from 30 semi-structured interviews, ethnographic participant observations, and archival data were analyzed using structured and statistical analysis. Verbatim transcripts were examined through a combination of ethnographic and content analysis. Barriers related to language and culture, as well as immigration, are critical themes that impact access to healthcare. The physicians' discourses relate patients' responses to terminal diagnoses, including the Hispanic/Latino patients' perceptions of hospice services. My research also ascertains how caregivers of Hispanic/Latino hospice patients cope with their loved ones' terminal diagnoses, structural organizational barriers to hospice utilization as well as cultural factors that contribute to the under-utilization of hospice services by this population. The findings indicate that higher incomes, higher education, and fewer years in the United States mainland directly affect healthcare decisions and treatment choices at end of life. Female gender and identity also directly impact access to health care, especially hospice services, at the end of life.

This paper reviews literature on the topic of death anxiety and therapy. The author conducted a study examining potential clients' perceptions of two different therapeutic approaches for working with terminally ill clients with death anxiety. A review of literature relevant to this topic indicates that death anxiety is correlated with many psychological problems; however, there are no clinical studies focused primarily on the treatment of death anxiety among clients with a terminal illness. In this study, potential clients were randomly assigned to watched either a short video of a cognitive behavioral therapy session or a short video of an acceptance and commitment therapy session focused on treating a terminal ill person's death anxiety. After watching the video, potential clients rated the session impact of the therapy approach using the Session Evaluation Questionnaire. In addition, participant's views of seeking psychotherapy were assessed with the Attitudes Toward Seeking Professional Psychology Help measure. No differences in ratings of session impact were found between participants who viewed the cognitive behavioral therapy session and the acceptance and commitment therapy session. However, participants' attitudes toward seeking therapy were positively associated with their views of the therapist and session depth. Consistent with past literature, women reported more death anxiety than men. In regards to potential clients' views of session impact variables, their view of postsession positivity was positively related to their view of session smoothness. Additionally, a positive correlation was found between potential clients' views of the therapist and session depth. Implications and conclusions are discussed.

<p>Syftet med denna litteraturstudie var att beskriva hur sjuksköterskor kan samtala om döden och döendet med barn som har livshotande sjukdomar. Litteratursökningen genomfördes i databaserna Medline (via PubMed) och Cinahl samt via manuell sökning. Tio artiklar som mötte inklusionskriterierna granskades. Resultatet bearbetades och presenterades utifrån de nio grundelementen i professionell, omvårdnadsorienterad kommunikation. Resultatet visade att en förutsättning för att sjuksköterskor ska kunna samtala om döden och döendet med barn är att de visar <em>empati</em>, har <em>yrkeskunskap</em> samt <em>ett mål</em> för samtalet. Relationen mellan sjuksköterskor och barnet måste bygga på <em>känslor</em>, <em>förnuftigt tänkande</em> samt en <em>etiskt reflekterande </em>vård. Sjuksköterskor måste se på <em>nuet</em> samtidigt som de har barnets <em>förflutna</em> i åtanke och föreställer sig hur barnets <em>framtid</em> kan gestalta sig. Genom att använda teckningar som kommunikationshjälpmedel kan sjuksköterskor åskådliggöra barnets känslor, tankar, drömmar och frågor samt förstå barnets livsupplevelser. Slutsatsen är att det finns stöd för att samtalet om döden och döendet med barn som har livshotande sjukdomar kan bygga på de nio grundelementen i professionell, omvårdnadsorienterad kommunikation.</p> / <p>The aim of the present literature review was to describe how nurses can talk about death and dying with children who have life-threatening diseases. A literature search was conducted in the databases Medline (through PubMed) and Cinahl, and through manual search. Ten articles that met the inclusion criteria were reviewed. The results were processed and presented on the basis of the nine basic elements of professional, caring-oriented communications. The result showed that a condition for nurses to be able to talk about death and dying with children is that they show <em>empathy</em>, have <em>professional knowledge</em> and <em>a target</em> for the conversation. The relationship between nurses and the child must be based on <em>emotions</em>, <em>rational thinking</em> and an <em>ethically reflective</em> care. Nurses must look at the <em>present moment</em>, while they have the child's <em>past</em> in mind and imagine how the child's <em>future</em> can turn out. To use drawings as a communication tool can help nurses to visualize the child's feelings, thoughts, dreams and questions, as well as understand the child's life experiences. The conclusion is that there is evidence for that conversation about death and dying with children who have life-threatening diseases could be based on the nine basic elements of professional, caring-oriented communications.</p>

This dissertation will support full ethical endorsement of terminal sedation for those most urgently in crisis and need of beneficence, those who are dying and in the final hours or days and suffering. To clarify the practice I first detail ethical differences between euthanasia, physician assisted suicide and terminal sedation. Moreover, I identify new areas where harms and benefits need to be evaluated as affecting not only patients, but also families and caregivers. I evaluate the current practice to allow the development of ethical guidelines and greater consensus on deciding the hard cases. This work may also serve to assist those looking to enlarge the practice in the future with ETS for those with debilitating diseases or disability, but they are not my primary goal. Below is the standard I propose for moral allowability for the use of terminal sedation. I will refer to it often in the pages that follow simply as my standard . Terminal sedation is the appropriate and intentional use of medications (benzodiazepines and/or narcotics) to produce ongoing, deep unconsciousness upon 1) a terminal patient’s (or surrogates) request due to 2) suffering intractable pain or other distressing clinical symptoms intolerable to the patient when 3) death is expected within hours or days (less than two weeks) due to the terminal illness, injury, or disease. I offer two versions of initial guidelines for development of hospital policy. The first version outlines minimal guidelines that ought to be utilized to allow TS for patients who fit my standard. The minimal guideline is based upon the recommendations of the American Medical Association with some modifications. The guideline is admittedly restrictive in hopes of gaining wider societal support for a currently controversial practice. Secondly, I offer more moderate guidelines for policy that could become a standard in the future. It maintains the restrictive focus of the minimal guidelines and offers additional education and support to others which has yet to be broadly provided. The moderate guidelines would mark an important step forward for allowing more choices in dying and offering additional supports to those involved with dying patients.

In wireless networks, communication links may be subject to random fatal impacts: for example, sensor networks under sudden power losses or cognitive radio networks with unpredictable primary user spectrum occupancy. Under such circumstances, it is critical to quantify how fast and reliably the information can be collected over attacked links. For a single point-to-point channel subject to a random attack, named as a dying channel, we model it as a block-fading (BF) channel with a finite and random channel length. First, we study the outage probability when the coding length K is fixed and uniform power allocation is assumed. Furthermore, we discuss the optimization over K and the power allocation vector PK to minimize the outage probability. In addition, we extend the single point to-point dying channel case to the parallel multi-channel case where each sub-channel is a dying channel, and investigate the corresponding asymptotic behavior of the overall outage probability with two different attack models: the independent-attack case and the m-dependent-attack case. It can be shown that the overall outage probability diminishes to zero for both cases as the number of sub-channels increases if the rate per unit cost is less than a certain threshold. The outage exponents are also studied to reveal how fast the outage probability improves over the number of sub-channels. Besides the information-theoretical results, we also study a practical coding scheme for the dying binary erasure channel (DBEC), which is a binary erasure channel (BEC) subject to a random fatal failure. We consider the rateless codes and optimize the degree distribution to maximize the average recovery probability. In particular, we first study the upper bound of the average recovery probability, based on which we define the objective function as the gap between the upper bound and the average recovery probability achieved by a particular degree distribution. We then seek the optimal degree distribution by minimizing the objective function. A simple and heuristic approach is also proposed to provide a suboptimal but good degree distribution.

The overall aim of this thesis is to illuminate and describe bodily changes and problems in incurable cancer, with focus on prostate cancer, from the patient’s perspective. The thesis consists of four papers, each of which illuminates various aspects of the phenomenon studied. The study population consisted of 24 participants, three women with different cancer diagnoses in the palliative phase, and 21 men with hormone refractory prostate cancer (HRPC) and skeletal metastases. Data are based on interviews (papers I–IV) and a quality of life questionnaire (paper I). The study design is cross-sectional (papers I–III) and longitudinal (paper IV). Qualitative description, descriptive statistics, phenomenological hermeneutics, and analysis of discourse were used to analyze data. The findings of study I show that the dominating symptoms for the men with HRPC (n=20) were pain and fatigue, and three different variants of each problem were described. The men said that changes in their sex life were not an extensive problem, even if it was scored as such. The symptoms differed in occurrence, extent, and meaning between the men, and were not necessarily experienced as problems. In study II, pain and fatigue were again the most prominent problems in men with HRPC (n=18), but pain and fatigue were seen to have different meanings. Pain was seen as synonymous with cancer. Pain can be alleviated, but it is a threat, both now and in the future, and symbolizes a painful death. Fatigue was viewed as a hindrance in the present. It was experienced as less threatening than pain, but as something that cannot really be changed. Fatigue represents the natural course death will take, as eventually sleep into death. An important finding of study II is that one meaning of bodily problems is to live in a cyclical movement of losing and reclaiming wellness. Understanding, and, to some extent, being in control of, bodily problems makes it possible to experience wellness. When the bodily problems increase or change, or when new problems appear or become a hindrance in the daily life, the experience of being ill returns. The findings of study III show that one meaning of fatigue in patients with cancer in the palliative phase (n=4) is a lived bodily experience of approaching death. This can be understood through the paradox of struggling against fatigue, and hoping to overcome it, yet expecting failure. The body, through fatigue, signals to the person that death is approaching, but the person is not yet “ready”. Paper IV shows that the way two of the men with HRPC talked about the past, present, and future changed during the disease trajectory. In the first interview, the men were open towards both the past and the future, while just before death, their narration was totally dominated by the concrete experience of the illness. The past became the past in the illness and not in life, and the present was flooded with extensive bodily changes. Also, the future had shrunk, although it also had been transferred to beyond death. Pain, fatigue, nausea, and other bodily problems figured largely in this change. This thesis provides important insights into the phenomenon of bodily changes when living with incurable cancer, with focus on prostate cancer. The thesis shows the connection between bodily changes and time, where different bodily changes have different meanings, and meanings seem to change during the illness trajectory (papers I–IV); and bodily changes close to death seem to take “all” time; what is left is the present filled with problems (paper IV). Further, it shows that bodily changes have a great influence on the cyclical movement between losing and reclaiming wellness in incurable cancer (paper II). The clinical implications of the thesis are that alleviation of pain and other bodily problems must be based on the meaning the patient gives the bodily changes taking place. That is, alleviation with the purpose to free time and to facilitate living in wellness as death is approaching.

The overall aim of the thesis was to describe caregivers’ experiences of caring for women with breast cancer on a surgical ward. The study was based on interviews with narrative parts and tape-recorded clinical supervision sessions. The interviews and clinical supervision sessions were transcribed verbatim, and analysed by content analysis. Nurses (n=10) described life for women with breast cancer as either having freedom or not having freedom, with both physical and existential suffering. Dying occurred either naturally in patients’ own home or unnaturally in hospital. The nurses felt that it is possible to alleviate suffering during dying through providing adequate pain relief but also, through listening, providing information and changing the caring atmosphere (I). Breast cancer as an illness was described from a dark point of view by caregivers (n=37). The descriptions focused on loss of breasts and control, progression of the illness and annihilation. The illness seemed, in the caregivers’ mind, to often end with a painful death. Caregivers who had the opportunity to follow the total care process described a lighter viewpoint (II). According to nurses (=31) the most important needs among women, their relatives and nurses themselves were the needs to talk and receive information. There was a discrepancy between what was described as important needs and the descriptions of how these needs were provided for. Nurses, whose own needs for support were sometimes unsatisfactorily met (III), seemed almost to be unaware of the needs among women and their relatives. In the clinical supervision sessions caregivers reflected on difficult care situations related to women’s, relatives’, and most often caregivers’ feelings (n=38). The care situations were described as evoking feelings of discomfort, powerlessness and reduced self-esteem. These feelings were described by caregivers as arising in connection with caring for especially women with advanced breast cancer in a changing organisation (IV). Caregivers’ descriptions of caring for women with breast cancer show a lot of negative experiences of powerlessness and frustration. They met women and their relatives who suffered in various ways and had considerable need for support. Caregivers often found themselves unable to meet these needs due to organisational obstacles e.g. lack of time and lack of knowledge about other caregivers’ responsibility in the care.