Addressing a Terminally Ill Patient's Fear of Impending Doom

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I understand how challenging it can be for terminally ill patients to cope with their fear of impending death. It is crucial for both healthcare providers and family members to take these feelings seriously and respond with compassion and understanding. In this article, we will explore the importance of acknowledging a patient’s fear of impending doom and discuss actions that families can take to provide peace and comfort during this grim time.

Understanding the Fear of Impending Doom

When someone is very sick and knows they will die soon, they may have many different feelings. One of these feelings is fear of impending doom. This means they are scared of what will happen when they die. There are many reasons why someone might feel this way. Here are some of them:

Uncertainty about the Future: Nobody knows for sure what happens after we die. Some people believe in heaven or other places where our souls go. Some people think there is nothing after death. Some people are not sure what they believe. This can make them feel afraid and worried.
Loss of Control: When someone is very sick, they may not be able to do the things they used to do. They may need help from others to eat, drink, move, or go to the bathroom. They may not be able to make their own decisions about their care. They may feel like they have no power over their situation. This can make them feel more scared.
Existential Concerns: When someone is close to dying, they may wonder about the meaning and purpose of their life. They may ask themselves questions like: Why am I here? What have I done with my life? What will I leave behind? How will I be remembered? These questions can be hard to answer and can make them feel sad or confused.
Leaving Loved Ones: When someone is dying, they may think about their family and friends. They may worry about how they will cope without them. They may feel guilty for causing them pain or trouble. They may feel sad for missing out on their future. They may want to say goodbye and express their love. This can make them feel very emotional.
Physical Symptoms: When someone is dying, their body may change in many ways. They may feel pain, nausea, fatigue, or other discomforts. They may have trouble breathing, sleeping, or eating. They may lose weight, hair, or skin color. They may see or hear things that are not there. These symptoms can make them feel worse and more afraid.

In my experience as a hospice nurse, when a loved one states their death is coming shortly, believe them and I cannot stress enough the steps listed below.

Taking Patients’ Statements Seriously

It is essential to acknowledge and validate a terminally ill patient’s feelings and statements when they express their fear of impending doom or belief that their time is near. By taking these expressions seriously, we can offer the necessary support and comfort. Here are some steps to consider:

Listen Actively: Let the person talk about their fears and worries. Do not interrupt them or tell them they are wrong. Just listen and show that you care. You can nod your head, say “uh-huh” or “I see”, or ask questions to show that you are paying attention.
Empathize with Their Feelings: Tell the person that you understand how they feel. Do not say things like “don’t be afraid” or “everything will be okay”. This might make them feel like you are not taking them seriously. Instead, say things like “I know this is hard” or “I’m here for you”. Give them a hug or hold their hand if they want.
Provide Reassurance: Remind the person that they are not alone. Tell them that you will be with them as much as you can. Tell them that you love them and that you are proud of them. Tell them that they have done many good things in their life and that they have made a difference.
Clarify Goals of Care: Ask the person what they want to do with their remaining time. Do they have any wishes or goals that they want to achieve? Do they have any preferences for their medical care? Do they have any documents that say what they want or who can make decisions for them? These documents are called advanced directives. They include things like POLST, which stands for Physicians Orders for Life Sustaining Treatment. This tells the doctors what kind of treatments the person wants or does not want. Another document is called durable power of attorney for healthcare. This lets the person choose someone who can make medical decisions for them if they cannot. Another document is called living will for healthcare. This tells the doctors what the person wants to happen if they are dying and cannot speak for themselves.
Involve a Chaplain or Spiritual Advisor: Some people have beliefs about what happens after they die. They may believe in God or another higher power. They may have a religion or a faith that gives them comfort. If the person has spiritual beliefs, you can ask them if they want to talk to someone who shares their beliefs. This person is called a chaplain or a spiritual advisor. They can pray with the person, read from a holy book, or do other things that help the person feel closer to their faith.
Encourage Legacy Activities: Some people want to leave something behind for their family and friends. This is called a legacy. A legacy can be anything that shows who the person was and what they cared about. For example, the person can write a letter, make a video, record a message, or create a scrapbook. They can also give away some of their belongings, such as jewelry, books, or photos. These things can help the person feel like they have a purpose and that they will be remembered.
Communicate with Hospice: Hospice is a type of care that helps people who are dying. Hospice workers can come to the person’s home or to a special place called a hospice house. They can help with the person’s physical, emotional, and spiritual needs. They can also help the family and friends who are taking care of the person. If the person is on hospice services, you should tell the hospice nurse what the person said and when they said it. This can help the nurse understand how the person is feeling and what they need. If the person is not on hospice services, you can ask the person’s doctor or nurse if they think hospice would be helpful. You can also call a local hospice provider and ask them for more information.

Actions for Families to Provide Peace and Comfort

When someone you love is very sick and knows they will die soon, you may want to do everything you can to make them feel better. Here are some things you can do to help them feel more comfortable and peaceful:

Be Present: The most important thing you can do is to be with them. Show them that you love them and care about them. You can talk to them, read to them, sing to them, or just sit quietly with them. You can also hug them, hold their hand, or stroke their hair. Sometimes, just being there is enough.
Create a Familiar Environment: You can make the place where they are staying feel more like home. You can bring things that they like or that remind them of good times. For example, you can bring their favorite blanket, pillow, or stuffed animal. You can also bring photos, cards, letters, or drawings from family and friends. You can also play their favorite music or movies.
Encourage Expression: You can let them know that it’s okay to talk about how they feel. You can listen to them without interrupting or judging them. You can also ask them questions to help them express themselves. For example, you can ask them what they are afraid of, what they are hoping for, or what they need. You can also share your own feelings with them but try not to make them feel worse.
Assist with Basic Needs: You can help them feel more comfortable by taking care of their physical needs. You can help them eat, drink, go to the bathroom, or change their clothes. You can also help them with their medicine, oxygen, or other equipment. You can also make sure they are not too hot or cold, and that they have enough light and fresh air.
Maintain Calmness: You can help them feel more peaceful by keeping the environment calm and quiet. You can avoid arguing, yelling, or fighting with other people around them. You can also avoid talking about things that might upset them, such as money, work, or problems. You can also try to stay calm yourself, and not let your emotions overwhelm you.
Connect with Supportive Resources: You can get help from other people who know how to take care of someone who is dying. You can call hospice, which is a type of care that helps people who are dying and their families. Hospice workers can come to your home or to a special place called a hospice house. They can help with the person’s physical, emotional, and spiritual needs. They can also help you and your family cope with your feelings and grief. You can also join a support group, which is a group of people who are going through the same thing as you. You can share your stories, feelings, and tips with each other. You can also get support from your friends, relatives, neighbors, or religious leaders.

Conclusion

When a terminally ill patient expresses fear of impending doom or the belief that their time is near, it is crucial to take their statements seriously and respond with compassion and empathy. Active listening, open communication, and reassurance can help provide comfort and peace during this challenging time. Family members also play an essential role in supporting the patient and creating a nurturing environment.

Remember, every patient’s journey is unique, and providing comfort and care with empathy is the cornerstone of hospice and palliative care.