End-of-Life Issues, Grief, and Bereavement

A practical overview of clinical issues related to end-of-life care, including grief and bereavement

The needs of individuals with life-limiting or terminal illness and those caring for them are well documented. However, meeting these needs can be challenging, particularly in the absence of a well-established evidence base about how best to help. In this informative guide, editors Sara Qualls and Julia Kasl-Godley have brought together a notable team of international contributors to produce a clear structure offering mental health professionals a framework for developing the competencies needed to work with end-of-life care issues, challenges, concerns, and opportunities.

Part of the Wiley Series in Clinical Geropsychology, this thorough and up-to-date guide answers complex questions often asked by patients, their families and caregivers, and helping professionals as well, including:

• How does dying occur, and how does it vary across illnesses?
• What are the spiritual issues that are visible in end-of-life care?
• How are families engaged in end-of-life care, and what services and support can mental health clinicians provide them?
• How should providers address mental disorders that appear at the end of life?
• What are the tools and strategies involved in advanced care planning, and how do they play out during end-of-life care?

Sensitively addressing the issues that arise in the clinical care of the actively dying, this timely book is filled with clinical illustrations, guidance, tips for practice, and encouragement. Written to equip mental health professionals with the information they need to guide families and others caring for the needs of individuals with life-threatening and terminal illnesses, End-of-Life Issues, Grief, and Bereavement presents a rich resource for caregivers for the psychological, sociocultural, interpersonal, and spiritual aspects of care at the end of life.

Contributors v

Preface vii

1 Introduction to End-of-Life Care for Mental Health Professionals 1
Julia E. Kasl-Godley

2 Trajectories of Chronic Illnesses 26
Michelle S. Gabriel

3 The Cultural Context of Spirituality and Meaning 43
E. Alessandra Strada

4 Working With Family Caregivers of Persons With Terminal Illness 64
David B. Feldman and Jasmin Llamas

5 Serious Mental Illness 85
Julia E. Kasl-Godley

6 Advance Care Planning 116
Michelle S. Gabriel and Sheila Kennedy

7 Pharmacologic Management of Pain 128
W. Nat Timmins

8 Nonpharmacological Approaches to Pain and Symptom Management 148
Stephanie C. Wallio and Robert K. Twillman

9 Grief and Bereavement Care 168
Shirley Otis-Green

10 Complicated Grief 181
E. Alessandra Strada

11 Health-Care Teams 201
Julia E. Kasl-Godley and Donna Kwilosz

12 End-of-Life Care in Long-Term Care Settings 229
Mary M. Lewis

13 Advocating for Policy Change: The Role of Mental Health Providers 252
Robert K. Twillman and Mary M. Lewis

14 Physician-Assisted Suicide in the United States: Issues, Challenges, Roles, and Implications for Clinicians 263
Silvia Sara Canetto

15 Creating Ethics Conversations in Community 285
Malham M. Wakin

16 Professional Self-Care 294
E. Alessandra Strada

17 Embracing the Existential Invitation to Examine Care at the End of Life 310
Shirley Otis-Green

Author Index 325

Subject Index 335

SARA H. QUALLS, PHD, is Professor of Psychology, Director of Clinical Training in Geropsychology, and Director of the Gerontology Center at the University of Colorado at Colorado Springs. She has twenty years of academic, clinical, and continuing education training experience and is the co-chair of the Adult Development and Aging Division of the American Psychological Association (APA).

JULIA E. KASL-GODLEY, PHD, is Coordinator of Psychology Training at the Palo Alto Veterans Affairs Interprofessional Palliative Care Fellowship Program in California. She has published on interventions for anticipatory grief and end-of-life care and is the recipient of the APA's 2003 Theodore Blau Early Career Award for Outstanding Contribution to Professional Clinical Psychology.

A practical overview of clinical issues related to end-of-life care, including grief and bereavement

The needs of individuals with life-limiting or terminal illness and those caring for them are well documented. However, meeting these needs can be challenging, particularly in the absence of a well-established evidence base about how best to help. In this informative guide, editors Sara Qualls and Julia Kasl-Godley have brought together a notable team of international contributors to produce a clear structure offering mental health professionals a framework for developing the competencies needed to work with end-of-life care issues, challenges, concerns, and opportunities.

Part of the Wiley Series in Clinical Geropsychology, this thorough and up-to-date guide answers complex questions often asked by patients, their families and caregivers, and helping professionals as well, including:

• How does dying occur, and how does it vary across illnesses?
• What are the spiritual issues that are visible in end-of-life care?
• How are families engaged in end-of-life care, and what services and support can mental health clinicians provide them?
• How should providers address mental disorders that appear at the end of life?
• What are the tools and strategies involved in advanced care planning, and how do they play out during end-of-life care?

Sensitively addressing the issues that arise in the clinical care of the actively dying, this timely book is filled with clinical illustrations, guidance, tips for practice, and encouragement. Written to equip mental health professionals with the information they need to guide families and others caring for the needs of individuals with life-threatening and terminal illnesses, End-of-Life Issues, Grief, and Bereavement presents a rich resource for caregivers for the psychological, sociocultural, interpersonal, and spiritual aspects of care at the end of life.

Also in the Wiley Series in Clinical Geropsychology

• Psychotherapy for Depression in Older Adults
• Changes in Decision-Making Capacity in Older Adults: Assessment and Intervention
• Aging Families and Caregiving