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Dear Medical/Health Reporter:

When a family member is terminally ill and all hope is gone, where does one turn? Hospice is a concept of care designed to provide comfort and support to patients and their families when an illness no longer responds to cure-oriented treatments. Introduced in the U.S. in the mid-1970s, hospice helps improve the quality of a patient's last days by offering comfort and dignity.

Terminally ill patients experience a broad range of emotions throughout the cycle of their illness. It can be emotionally exhausting for the patient. Hospice provides supportive social, emotional, and spiritual services to the patient as well as to their families. Most Americans have not yet learned how to confront and discuss the topic of death and dying. November is National Hospice Month, and it encourages each of us to give some thought to the inevitable.

For people near the end of their lives, the depression and other psychological problems (and interpersonal issues) sometimes affects their decision-making ability, as well as their physical well-being. As many as 15 to 20 percent of terminally ill patients are in serious emotional distress about their illness, but only a fraction are referred to mental health treatment, according to Barry Rosenfeld, PhD, of Fordham University. Many physicians are unable to accurately identify depression, terror of dying, and all the other complex emotional issues, and those who do identify the dying person’s emotional distress either see it as a normal reaction not necessitating care or are reluctant to burden patients with additional medication or psychological treatment.

Depression may result in hasty decisions by patients to refuse palliative care (treatment to provide the reduction of pain and other symptoms, rather than treatment aimed at cure) that can improve quality of life as they go through the dying process. Even patients who are not clinically depressed can benefit from ventilating feelings with a professional as they progress through the stages of death and face fluctuating levels of anxiety, anger and frustration. Families of terminally ill patients also may become exhausted and suffer physically and emotionally. A licensed psychologist can assess patients' ability to identify options, make informed choices and help patients and their families follow through on their own decisions. Psychologists can help the patients and family through the emotional and difficult issues surrounding living wills, power of attorney, and the transition from the utilization of heroic measures to comfort measures.

As a service to your community, the Psychologists in Independent Practice, a Division of the American Psychological Association, would like to offer a psychologist in your area to speak with you on the subject of end-of-life issues. He/She would be able to discuss how they can help guide patients and their families through the anxiety of their illness and enhance communication between patient, partner, children, family members, and clergy. Your readers can call toll-free 1 (877) 603-4000 for a free brochure called ?Serious Illness.?

APA’s Psychologists in Independent Practice represents independent psychologists, each of whom is a doctoral level professional licensed by his or her particular state. When you need to talk to someone who can help, you need an experienced, licensed psychologist. I look forward to speaking with you.

Sincerely,