While studying psychology in my undergraduate career, I volunteered with a hospice organization for three years. During this time, I realized the importance of supporting individuals at the end of their lives. Although I was a stranger to the individuals I saw on a weekly basis, the presence of another human being was valuable in ensuring that they knew that they were not alone. Many of my friends over the years could never understand how I was able to volunteer with hospice, as they deemed it to be a depressing experience. I believe that my strong religious beliefs, and my thoughts on the circle of life gave me the ability to compartmentalize the saddening portions of the experience, and to remember that we will all reach that part of life where we need extra support and love.
In the research study, “Patients with cancer. Is there a role for chiropractic?” chiropractors were asked what chiropractic care can offer individuals with a cancer diagnosis. Many of the practicing physicians explained that chiropractic care could help a patient with cancer in terms of their pain relief, empathy, mobility, energy levels, quality of life, sleeping patterns and function. Cancer patients who utilized chiropractic care perceived their benefits to be pain relief, sleep pattern improvement, immune system improvement, an increase in well-being, higher energy levels and psychological reinforcement. Clinical practice guidelines developed by the chiropractic profession include referral to mental health professionals in the presence of mental health concerns. Many individuals with a terminal illness will have mental health complications. Screening for these comorbidities by a chiropractic physician does not need to be complicated or require extensive knowledge. Having a good working relationship with mental health providers is crucial for co-management of individuals with terminal illnesses.
There are many end-of-life issues with regard to the patient, the family and the physician. Open communication and empathy are crucial characteristics for the involved physician to embody. The individual’s needs, whether it is physical or psychological, need to be addressed through a multidisciplinary team approach. A chiropractic physician has a large part in the palliative care portion of end-of-life care, as pain management and psychological wellbeing can be improved by chiropractic techniques. When comanaging an individual with a terminal illness in my future practice, I will utilize the SPIKES model to ensure the best communicative techniques.
The SPIKES model consists of the setting of the discussion, the perception of the patient’s set of knowledge, the invitation by the patient to the physician to provide information, the imparting of knowledge, the exploration of emotions, and the strategy and summarization of plans for the future. I will also pull from my past experiences with hospice, as it is important to attempt to separate my emotions from the patient’s emotions and experience. Separating my emotions and realizing that I am there to benefit the patient’s symptoms, will be my most important strategy for not only terminal patients, but all patients. The literature shows chiropractic physicians as being greatly beneficial in palliative care, and that is how I see myself as a future practicing physician.
Last, the end-of-life issues regarding the family are complex, as there are many emotions involved. Maintaining open communication with both the family and patient, and allowing grace and empathy for the individual, will allow them to live out the end of their life to the fullest.