Oman doctor gives tips on how to cope with terminal illness

Muscat: In this article, I will try to show some of the psychological processes and ideas that shape the way people come to terms and cope with dying from an incurable or terminal illness. This article is dedicated to Prof William Jeans.
Many readers will be familiar with the work of the American psychologist, Elizabeth Kubler-Ross, who described five stages in the process of dying from an incurable disease.
Initially, there is a denial of the illness (“this isn’t happening to me, maybe there’s a mistake, perhaps the test was wrong”) and feeling isolated; then, a feeling of anger at being the one with the illness (“why me?”); bargaining with oneself to try and get cured (e.g. stopping smoking, leading a healthier life), depression about dying; and finally, acceptance of the illness and its consequences.
Another way of looking at dying is as a series of tasks that have to be accomplished as a way of coping with dying.
These tasks include responding to the physical fact of having an incurable illness and understanding the illness. For instance, some people try to gain as much information as possible whereas others don’t want to think too much about their illness.
Taking steps to cope with the reality of the disease and how it will affect your life, such as having to go to hospital appointments, periods of inpatient treatment or taking medicines that have unpleasant side effects.
Other tasks include maintaining friendships and relationships whilst also dealing with issues about one’s own life, such as regrets for things not done or mistakes made, not being able to see your children growing up or attending their marriages.
These general models of how people come to terms with dying are flexible and people can move backwards as well as forwards though the stages.
Individual differences in health behaviour can be predicted by how a person perceives his illness (e.g. cancer) and the threat it represents, their own coping style (which might include active approaches, such as seeking medical attention, or passive strategies, such as avoidance and denial) and appraisal in which the person judges the effectiveness of his coping strategy (for example, avoidance and denial of cancer may mean missing hospital appointments and, thus, not getting proper treatment).
Finally, work in patients with breast cancer has identified coping styles such as a fighting spirit (being optimistic about the outcome and feeling in control), helplessness-hopelessness (giving up hope once you know you have cancer), anxious preoccupation (e.g. constantly checking for signs of recurrence), avoidance and denial.
Individuals with a fighting spirit who are optimistic and have a determination to cope with the situation have less depression and anxiety than those following other coping styles.
This article shows how people faced with an advanced illness go through different stages but usually come to an acceptance of dying. Clearly, some ways of coping are better than others.
People who become anxious, preoccupied, depressed or remain in denial may need help and guidance to move on to an acceptance of death with the opportunity to have time to deal with their affairs and say goodbye to loved ones.
Friends, family, nurses, social workers and doctors may all have a part to play that can help in this process. Home based patient centred palliative care helps patients retain their dignity at the end of life.
Last year, the Times of Oman had ran a campaign on palliative care together with Maggie Jeans, a British expat and a long term resident of Oman. This article, titled ‘Coming to terms with terminal illness,’ is the second part of the series of articles on this subject