Accounts By Health Care Providers Religious And Family Support

An extensive review of the English language literature written by health professionals engaged in caring for dying cancer patients identified that there has been a number of transitions over the last 30 years which recognized improvements in palliative care and greater awareness of the benefits of hospice programs.60 There was also greater acknowledgment of the psychological needs of patients and an interest in providing care within the context of multiprofessional teams rather than merely from medical or nursing perspectives. As evidence for this trend, there have been emerging accounts written by social workers, physical and psychological therapists, chaplains, and complementary therapists since the 1990s. However, physicians remain the most productive and dominant "voice" in professional accounts and serve to the shape practice and policy in this area. Analysis of the content of the written accounts reveals that professionals identify a wide range of needs for people with advanced cancer and particularly in North America tend to emphasize patient autonomy, control, and choice. These writings also reveal a growing prioritization of psychological aspects of managing advanced cancer, with assumptions that open emotional expression is helpful but emotions should be "positive" and facilitate "acceptance"— drawing upon the popular ideas of Kubler Ross,52 rather than emotional expressions ofanger, disruption, and guilt. There are therefore interesting tensions been the professional discourses of patient autonomy and choice and clear expectations about the "right" ways to deal psychologically with cancer which may limit permitted options for patients.

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