Religion, communication and control take precedence over physical symptoms and functioning at the end of life for some terminally ill patients, Yale researchers suggest in a new book, which examines the complex issues surrounding death and dying.
"Our review proposes that quality of life is dynamic at the end of life and the components that make up quality of life may shift, making some more important than others, depending on how close one is to death," says Elizabeth Bradley, assistant professor in the Department of Epidemiology and Public Health at the School of Medicine.
The research results are published as a chapter in "Focus on the End of Life: Scientific and Social Issues" by M. Powell Lawton. The book is part of a prestigious series by the Annual Review of Gerontology and Geriatrics, which examines and appraises current progress in research, clinical practice and program development across disciplines -- from psychology, biology and medicine to social issues and public policy.
The volume brings together the latest research on issues around death and dying; life's attributes as it nears death; planning and preparing for death; and care- and intervention-related issues.
"By focusing on quality of life at the end of life, the book re-orients us to the life, rather than the death, of terminally ill individuals," says Bradley. "Our chapter highlights some of the components of quality of life -- such as religiosity, communication and control -- that have been less studied than physical symptoms and functioning, but may be particularly important as death becomes imminent."
Bradley says much of the discourse concerning death and dying focuses on the relief of the pain and suffering associated with death, rather than the broader idea of quality of life in the end of life. She says more research is needed on quality of life.
"Future research could be used to design interventions to promote better quality of life during the different stages of terminal illness," says Bradley. "Interventions may include new clinical practices and/or enhanced recognition and use of community-based resources to promote effective physical, emotional, social and spiritual support of individuals in the end of life."
In the chapter, Bradley and her colleagues note that much of the literature about religiousness and spirituality at the end of life implies that religious beliefs provide comfort, meaning, a sense of continuity and a better quality of life for terminally ill individuals. Recent efforts in the United States to improve the care of the dying invariably call for increased attention to the spiritual needs of patients.
"Efforts to provide answers to fundamental questions surrounding quality of life, can help further shape clinical practice and research to benefit terminally ill patients and their families in the future," says Bradley.
Bradley's coauthors on the chapter include Dr. Terri R. Fried and Stanislav V. Kasl at Yale, and Ellen Idler at Rutgers
-- By Karen Peart
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