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Caring Tips >Psychosocial Support

About Psychosocial Support

    Palliative care not only focuses on the physical conditions of patients but also their psychosocial needs. Given the changes in condition of patients, communication between the patient, their family and the medical team plays an important part in psychosocial support for the patient.

    There is no universal language or method that fits all situations. If necessary, contact your social worker for follow up.

Communication

Communicating with the patient – facing death

  • When the patient is facing a terminal condition, it is important to communicate with them about the progression of the disease, medical procedures and the topic of death
  • Starting a conversation:
    • Before bringing up any topic, ask for the patient’s consent. Make sure you ask them before elaborating on any topic. This can show your respect and prepare the patient mentally for the discussion
    • Many relatives and family members find themselves not knowing what to say to comfort patients with life-threatening and life-limiting diseases. However, the key to starting a conversation is not to say the right thing but to be a good listener. In fact, active listening allows us to understand what the patient needs the most at that moment, so that we can cater to their needs
  • Hiding their condition from the patient?
    • Many relatives and friends avoid talking about the condition of the illness with the patients, or even just tell them good news because they are afraid it will affect the patients’ mood. However, if the relatives and friends decide not to tell the patients, they will have to cover up the truth. Meanwhile, since they may be afraid of saying the wrong thing, they cannot freely communicate with the patients during the precious time together; some may even feel uncomfortable, which in turn makes the patients feel isolated. Moreover, patients may panic and feel confused if they sense the deterioration of their condition without getting any proper explanation
    • Each case is unique, and we need to manage it according to the individual needs of the patient. After being informed about their condition, patients can plan their remaining time properly, make medical decisions, fulfil their wishes and convey their thoughts on the funeral, which would allow them to face the last stage of life in a calmer way
  • Unable to communicate with the patient?
    • Some patients are unable to carry out normal communication due to cognitive or functional limitations. We can talk to them in simpler language, or through touch, such as body massage

Communication amongst family members – (i)Stress of carers

  • The process of caring for the patient may cause stress to carers including physical, financial and psychological pressure. Carers can alleviate stress through stress reduction activities and taking proper rest
  • When facing the stress of caring for the patient, you can:
    • Seek the necessary help
      • Reach out to the practical support available around you or in the community. Bear in mind that you do not have to face everything on your own. You can refer to the section on Community Resources in our website when necessary
    • Seek spiritual support
      • Find a friend, family member, social worker or someone you trust to share your situation with
    • Spend time taking care of yourself
      • As a carer, there is no problem in taking care of yourself. Giving yourself time to rest and adjust will enable you to take better care of your loved one

Consult your social worker in case of any questions.

Communication amongst family members – (ii)Family relations

  • Since everyone has their own personal experience, personality and ideas, sometimes family members may encounter varying difficulties when talking about issues related to life and death, and this may even affect the family relations
  • Here are some tips:
    • In these situations, first try to sort out your own views about life and death, the last stage in life and funeral arrangements before discussing with the family
    • Find a suitable time and place for discussion, such as when change of health condition, after meeting with the doctor and when in a quiet environment
    • Respect the differing pace of family members; try to first listen and understand their views
    • Even if there are different opinions, you can explain the reasons behind your ideas. Different family members may have different preferences, but they are all seeking to safeguard the well-being of the patient for the most part
Consult your social worker in case of any questions.

Communication amongst family members – (iii)Bereavement and grief

  • Please refer to the “Bereavement and grief” section below

Communication between patient and family members –(iv)Family relations

  • Please refer to the “Communication between the family - Family relations” section above

Communication between patient and family members –(v)Communication before passing

  • Please refer to the “Communicating with patients—facing death” section above

Communicating with the medical team

  • Patients, their families and the medical team are important partners in palliative care. Effective communication with the medical team is the key to ease the worries of patients and their families. Generally speaking, communication with the medical team comprises the following three areas: explaining patient’s condition, treatment plans, advance directive / Do-Not-Attempt Cardiopulmonary Resuscitation
  • Patients and family can make good use of the consultation time to better understand their condition and needs

Consult your social worker in case of any questions.

Bereavement and Grief

  • Birth, ageing, sickness and death are all inevitable stages of life. When we lose our loved ones, it is natural to react with grief. People have different personalities and express grief in different ways

Disease progression – take care of the patient

  • Grief does not only occur after the death of the patient. For patients, they may have experienced various forms of grief due to the tangible and intangible losses caused by the illness. Therefore, the carers cannot ignore the importance of caring for the patient. You can refer to the following points as you take care of the patient:
    • The section about “Communicating with patients—facing death” above

Consult your social worker in case of any questions.

Disease progression – take care of the family

  • As patients have suffered tangible and intangible losses due to illness, such as mobility and cognitive ability, their family will gradually develop the grieving reactions too. In fact, it is normal for the family to have such reactions even before the passing of the patient. The key is to acknowledge your grief and find suitable support

Consult your social worker in case of any questions.

Parting – common situations

  • As the disease progresses, family and relatives can learn about the possible situations they may face and prepare themselves for it. If conditions allow, relatives and friends can consult the medical team before visiting the patients
  • Here are some common conditions of patients that may be encountered:
    • Haggard body and face
    • Slow response
    • Being connected to tubes (for oxygen/injection)

Consult your social worker in case of any questions.

Parting – common reactions

  • Showing a haggard face
  • Showing mental cloudiness
  • Avoiding social contact
  • Being depressed/uneasy
  • Having insomnia or waking early
  • Having weight loss
  • Using negative languages
  • Being irrational (e.g. suddenly shouting)
  • Being indifferent
  • Feeling down

Consult your social worker in case of any questions.

After the patient has passed – adaptations of children

  • Like adults, children will experience grief and reactions to the death of a close family member. Based on the level of cognitive development at different ages, children will show slightly different understanding of the passing of their loved ones. However, even younger children will have the need to mourn and grieve over the loss. Therefore, we can help them face their loss in the following ways:
    • Sincere communication
      • Simply use words such as “dead” and “death” to break the news to children about the passing of loved ones; avoid using vague expressions such as “asleep”, “gone travelling” or “going somewhere faraway” to avoid misunderstanding and fear of sleep or travel
      • Approach death with an honest attitude, as our attitude is the object of imitation by our children. We can let our children know that grief is a natural response to the death of a loved one, and the most important thing is to deal with the emotions in a positive way
      • Directly explain to the children the cause of the death of the loved one; let them know that the death is not their fault
    • Give them choices
      • Explain the funeral to the children and let them decide whether to attend or be involved in some part of the process
      • Children may not actively seek help for handling grief. Let them choose when to express. We can observe and seize the opportunity to show our care
      • Everyone expresses and deals with grief differently. Even within the family, there may be different ways to handle it. We should respect the response of the children
    • Encourage them to express their feelings
      • Although children may not express their grief, it does not mean that they are not grieving. On the contrary, they need our understanding and consideration
      • Use different forms or media of expression, such as photos, videos or drawing/painting, instead of restricting to verbal expression

You are not alone when helping your children. If you need further suggestions or help, consult your healthcare professionals or social workers.

Reference

After the patient has passed – adaptations of adults

  • Principles for handling personal grief
    • Let the grief out; do not suppress it
    • Try to talk to someone you trust
    • Accept your own limitations and that you may not be able to solve all the problems
    • Time heals but it may not make every problem fade
    • Think about the positive perspectives of the bereavement, which can become a strength and motivation, such as learning to treasure the people around you
    • Give yourself some quiet space/contact with nature
    • Learn to relax, do not put everything on your shoulders
    • Find the way to give yourself support in your daily life and reorganise your life
    • Seek help from a professional when necessary
  • What the bereaved need
    • Talking with others
    • Companionship/ quiet space for grieving
    • Practical support (care, financial difficulties, everyday errands)
    • Advice (such as the arrangement of the funeral and inheritance)

Consult your social worker in case of any questions.

After the patient has passed – adaptations of elders

  • Even with more life experiences, elders do experience grief and reactions with bereavement. It is also important to help them adapt to the passing of those around them
  • Apart from general ways to support and care for elders, we also need to pay attention to the following:
    • Cognitive ability: Use language and words that match their cognitive ability; try to keep it simple, concise and clear, and ask questions to confirm their understanding
    • Avoidance: Elders tend not to be working or have active social lives. After experiencing bereavement, you should take the initiative to show your care and reduce the chance of social avoidance after the passing of their spouse

Consult your social worker in case of any questions.

Emotion Management

Are you satisfied with your current life?

When you encounter something unhappy, if you take a step back and re-evaluate, can you view the situation differently?

Occupational Lifestyle Re-design

Develop a balanced and healthy lifestyle based on one’s own ability.

Plan your daily routine on a 7-day basis.

When you have energy, engage in some interesting and meaningful activities.

Five elements of a positive life

To help patients to overcome physical, psychological and environmental barriers, active participation in meaningful activities can restore the sense of achievement and joy. With this we hope to ultimately improve the patient’s motivation and quality of life. Five ways include: Connect with other people, Be physically active, Learn new skills, Give to others, Pay attention to the present moment.

Occupational Lifestyle Re-design – try mind body exercise, such as Health Qigong.