Model of Life-threatening Illness
Although several models attempt to account for how individuals cope with a life-threatening illness, the
task-based approach is the model most commonly used.[1] Several significant, limiting factors have been ascribed to the older model, a
stage theory based on the original work of Elizabeth Kubler-Ross,[2] including the actual
existence of these five stages (denial, anger, bargaining, depression, and
acceptance). There is no evidence that all individuals experience
these stages or that movement from one stage to another occurs sequentially. Further, the sole analysis of this theory was flawed by
limitations in the research methodology.[1]
The task-based model does not imply any order or sequence and is therefore viewed
as a more flexible, fluid model that helps to empower the patient and his or
her family and significant others. Four phases, or segments, of a
life-threatening illness have been identified: prediagnostic, acute, chronic, and recovery or death. A task-based concept has been
applied to explain how individuals confront each phase.[3]
The prediagnostic phase of a life-threatening illness is the time before the diagnosis of illness during which an individual recognizes symptoms
or risk factors that make him or her prone to illness and during which diagnostic studies are performed. This is not a
single moment but may culminate in one moment when the diagnosis is first
spoken.
The acute phase centers on the crisis of diagnosis in which a person is forced
to understand the diagnosis and make a series of decisions regarding his or her
medical care.
The chronic phase of an illness is the period of time between the
diagnosis and outcome.[3] Individuals attempt to cope with the demands of life
while simultaneously striving to comply with treatments and deal with side
effects. Until recently, the period between a cancer diagnosis and death was
typically measured in months, most of which were spent in the hospital. Today
people can live for years after the diagnosis of cancer.
Persons may experience recovery from their disease and thus deal with the
psychological, social, physical, spiritual, and financial after-effects of
cancer.
Other individuals encounter a final phase, or terminal phase, of illness when death
is no longer just possible but is inevitable. At this time, medical goals change from
curing illness or prolonging life to providing comfort and focusing on
palliative care. The tasks during this final phase reflect this transition and
often focus on spiritual and existential concerns.
References
-
Corr CA, Nabe CM, Corr DM: Death and Dying, Life and Living. 2nd ed. Pacific Grove, Calif: Brooks/Cole Publishing Company, 1997.
-
Kubler-Ross E: On Death and Dying. New York: Macmillan Publishing Company Inc.,1969.
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Doka KJ: Living with Life-Threatening Illness: A Guide for Patients, Their Families, and Caregivers. New York: Lexington Books, 1993.
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