This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (74)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • End-of-life Care/ Palliative Medicine  • Perspectives on Care at the Close of Life  • Alert me on articles by topic

The Art of the Possible

Susan D. Block, MD

JAMA. 2001;285:2898-2905.

Patients with life-threatening illnesses face great psychological challenges and frequently experience emotional distress. Yet, the end of life also offers opportunities for personal growth and the deepening of relationships. When physical symptoms and suffering are controlled, it is easier to address patients' central concerns—about their families, about their own psychological integrity, and about finding meaning in their lives. Optimal end-of-life care requires a willingness to engage with the patient and family in addressing these distinct domains. In addition to supporting growth of patients and their caregivers, physicians need to recognize the impact of psychiatric disorders such as depression, anxiety, and delirium at the end of life and develop skills in diagnosing and treating these syndromes. Comments of a patient with pancreatic cancer, his son, and his physician help illuminate the potential opportunities presented when coping with life-threatening illness. Enhanced understanding of the common psychological concerns of patients with serious illness can improve not only the clinical care of the patient, but also the physician's sense of satisfaction and meaning in caring for the dying.

Author Affiliations: Department of Adult Psychosocial Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

RELATED ARTICLE

June 13, 2001
JAMA. 2001;285(22):2921-2922.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Death-Talks: Transformative Learning for Physicians
Moon
AM J HOSP PALLIAT CARE 2008;25:271-277.
ABSTRACT  

Horns of a Dilemma
Samuel and Subbannan
JCO 2008;26:2219-2220.
FULL TEXT  

Hope and Prognostic Disclosure
Mack et al.
JCO 2007;25:5636-5642.
ABSTRACT | FULL TEXT  

End-of-Life Care: Issues Relevant to the Geriatric Psychiatrist
Lyness
Focus 2007;5:459-471.
ABSTRACT | FULL TEXT  

The Ethics of Palliative Sedation as a Therapy of Last Resort
National Ethics Committee, Veterans Health Adminis
AM J HOSP PALLIAT CARE 2007;23:483-491.
ABSTRACT  

Palliative and End-of-Life Care for Patients With Cardiopulmonary Diseases: American College of Chest Physicians Position Statement
Selecky et al.
Chest 2005;128:3599-3610.
ABSTRACT | FULL TEXT  

Ethical issues of resuscitation: an American perspective
Marco
Postgrad. Med. J. 2005;81:608-612.
ABSTRACT | FULL TEXT  

Terminal restlessness as perceived by hospice professionals
Head and Faul
AM J HOSP PALLIAT CARE 2005;22:277-282.
ABSTRACT  

On Saying Goodbye: Acknowledging the End of the Patient-Physician Relationship with Patients Who Are Near Death
Back et al.
ANN INTERN MED 2005;142:682-685.
FULL TEXT  

End-of-Life Care: Issues Relevant to the Geriatric Psychiatrist
Lyness
Focus 2005;3:341-353.
ABSTRACT | FULL TEXT  

Caring for the Child With Cancer at the Close of Life: "There Are People Who Make It, and I'm Hoping I'm One of Them"
Hurwitz et al.
JAMA 2004;292:2141-2149.
ABSTRACT | FULL TEXT  

Identifying barriers to psychosocial spiritual care at the end of life: A physician group study
Chibnall et al.
AM J HOSP PALLIAT CARE 2004;21:419-426.
ABSTRACT  

Decision Making at a Time of Crisis Near the End of Life
Weissman
JAMA 2004;292:1738-1743.
ABSTRACT | FULL TEXT  

End-of-Life Care: Issues Relevant to the Geriatric Psychiatrist
Lyness
AJGP 2004;12:457-472.
ABSTRACT | FULL TEXT  

Palliative Care for Patients With Heart Failure
Pantilat and Steimle
JAMA 2004;291:2476-2482.
ABSTRACT | FULL TEXT  

The quality of medical care at the end-of-life in the USA: existing barriers and examples of process and outcome measures
Yabroff et al.
Palliat Med 2004;18:202-216.
ABSTRACT  

Dying with dignity: The good patient versus the good death
Proulx and Jacelon
AM J HOSP PALLIAT CARE 2004;21:116-120.
ABSTRACT  

Advanced cancer at home: caregiving and bereavement
Ferrario et al.
Palliat Med 2004;18:129-136.
ABSTRACT  

Hope and Hopelessness at the End of Life
Sullivan
AJGP 2003;11:393-405.
ABSTRACT | FULL TEXT  

When Your Favorite Patient Relapses: Physician Grief and Well-Being in the Practice of Oncology
Shanafelt et al.
JCO 2003;21:2616-2619.
FULL TEXT  

Simultaneous Care: Disease Treatment and Palliative Care Throughout Illness
Meyers and Linder
JCO 2003;21:1412-1415.
FULL TEXT  

Religion, Spirituality, and Existentialism Near the End of Life: Implications for Assessment and Application
KAUT
American Behavioral Scientist 2002;46:220-234.
ABSTRACT  

Adolescent Grief: "It Never Really Hit Me . . . Until It Actually Happened"
Christ et al.
JAMA 2002;288:1269-1278.
ABSTRACT | FULL TEXT  

Responding to Requests for Physician-Assisted Suicide: "These Are Uncharted Waters for Both of Us. . . ."
Bascom and Tolle
JAMA 2002;288:91-98.
ABSTRACT | FULL TEXT  

Evaluating End-of-Life Care from the Perspective of the Patient's Family
Larson and Larson
Eval Health Prof 2002;25:143-151.
ABSTRACT  

When Does the Responsibility of Our Care End: Bereavement
Penson et al.
The Oncologist 2002;7:251-258.
ABSTRACT | FULL TEXT  

Dignity-Conserving Care--A New Model for Palliative Care: Helping the Patient Feel Valued
Chochinov
JAMA 2002;287:2253-2260.
ABSTRACT | FULL TEXT  

Enhancing Physician-Patient Communication
Lee et al.
ASH Education Book 2002;2002:464-483.
ABSTRACT | FULL TEXT  

Psychological Considerations, Growth, and Transcendence at the End of Life: The Art of the Possible
McPhee and Markowitz
JAMA 2001;286:3002-3002.
FULL TEXT