Editing Terminal illness (section)

== Psychological impact ==
Coping with impending death is a hard topic to digest universally. Patients may experience [[grief]], [[fear]], [[loneliness]], [[Depression (mood)|depression]], and [[anxiety]] among many other possible responses. Terminal illness can also lend patients to become more prone to psychological illness such as [[Depression (differential diagnoses)|depression]] and [[anxiety disorder]]s. [[Insomnia]] is a common symptom of these.<ref name="Block-2006"/>

It is important for loved ones to show their support for the patient during these times and to listen to his or her concerns.<ref name="Mayo-2017">{{Cite news|url=https://www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/grief/art-20047491?pg=1|title=Supporting a terminally ill loved one|work=Mayo Clinic|access-date=2017-11-07}}</ref>

People who are terminally ill may not always come to accept their impending death. For example, a person who finds strength in&nbsp;[[denial]]&nbsp;may never reach a point of acceptance or accommodation and may react negatively to any statement that threatens this&nbsp;[[defense mechanism]].<ref name="Mayo-2017" />

=== Impact on patient ===
[[Depression (differential diagnoses)|Depression]] is relatively common among terminal patients, and the prevalence increases as patients become sicker. Depression causes quality of life to go down, and a sizable portion of patients who request [[assisted suicide]] are depressed. These negative emotions may be heightened by lack of sleep and pain as well. Depression can be treated with [[antidepressant]]s, therapy, or both, but doctors often do not realize the extent of terminal patients' depression.<ref name="Block-2006"/>

Because depression is common among terminal patients, the American College of Physicians recommends regular assessments for depression for this population and appropriate prescription of antidepressants.<ref name="Qaseem-2008"/>

[[Anxiety disorder]]s are also relatively common for terminal patients as they face their mortality. Patients may feel distressed when thinking about what the future may hold, especially when considering the future of their families as well. It is important to note, however, that some palliative medications may facilitate anxiety.<ref name="Block-2006"/>

=== Coping for patients ===
Caregivers may listen to the concerns of terminal patients to help them reflect on their emotions. Different forms of [[psychotherapy]] and psychosocial intervention, which can be offered with palliative care, may also help patients think about and overcome their feelings. According to Block, "most terminally ill patients benefit from an approach that combines emotional support, flexibility, appreciation of the patient's strengths, a warm and genuine relationship with the therapist, elements of life-review, and exploration of fears and concerns."<ref name="Block-2006"/>

=== Impact on family ===
Terminal patients' families often also suffer psychological consequences. If not well equipped to face the reality of their loved one's illness, family members may develop depressive symptoms and even have increased mortality. Taking care of sick family members may also cause stress, grief, and worry. Additionally, financial burden from medical treatment may be a source of stress.<ref name="Lima-2016b">{{Cite journal |last1=Lima |first1=Liliana De |last2=Pastrana |first2=Tania |year=2016 |title=Opportunities for Palliative Care in Public Health |journal=Annual Review of Public Health |volume=37 |issue=1 |pages=357–374 |doi=10.1146/annurev-publhealth-032315-021448 |pmid=26989831 |doi-access=free}}</ref> Parents of terminally ill children also face additional challenges in addition to mental health stressors including difficulty balancing caregiving and maintaining employment. Many report feeling as if they have to "do it all" by balancing caring for their chronically ill child, limiting absence from work, and supporting their family members.<ref>{{Cite journal |last1=Kish |first1=A. M. |last2=Newcombe |first2=P. A. |last3=Haslam |first3=D. M. |date=May 2018 |title=Working and caring for a child with chronic illness: A review of current literature |url=https://onlinelibrary.wiley.com/doi/10.1111/cch.12546 |journal=Child: Care, Health and Development |language=en |volume=44 |issue=3 |pages=343–354 |doi=10.1111/cch.12546|pmid=29341191 |s2cid=4754378 |url-access=subscription }}</ref> Children of terminally ill parents often experience a role reversal in which they become the caretakers of their adult parents. In taking on the burden of caring for their sick parent and assuming the responsibilities they can no longer accomplish, many children also experience significant declines in academic performance. <ref>{{Cite journal |last=Chen |first=Cliff Yung-Chi |date=June 2017 |title=Effects of Parental Chronic Illness on Children's Psychosocial and Educational Functioning: a Literature Review |url=http://link.springer.com/10.1007/s40688-016-0109-7 |journal=Contemporary School Psychology |language=en |volume=21 |issue=2 |pages=166–176 |doi=10.1007/s40688-016-0109-7 |s2cid=256432947 |issn=2159-2020|url-access=subscription }}</ref>

=== Coping for family ===
Discussing the anticipated loss and planning for the future may help family members accept and prepare for the patient's death. [[Intervention (counseling)|Interventions]] may also be offered for [[anticipatory grief]]. In the case of more serious consequences such as [[Major depressive disorder|depression]], a more serious [[Intervention (counseling)|intervention]] or [[therapy]] is recommended. Upon the death of someone who is terminally ill, many family members that served as caregivers are likely to experience declines in their mental health.<ref>{{Cite journal |last1=Aoun |first1=Samar M |last2=Bentley |first2=Brenda |last3=Funk |first3=Laura |last4=Toye |first4=Chris |last5=Grande |first5=Gunn |last6=Stajduhar |first6=Kelli J |date=May 2013 |title=A 10-year literature review of family caregiving for motor neurone disease: Moving from caregiver burden studies to palliative care interventions |url=http://journals.sagepub.com/doi/10.1177/0269216312455729 |journal=Palliative Medicine |language=en |volume=27 |issue=5 |pages=437–446 |doi=10.1177/0269216312455729 |pmid=22907948 |s2cid=34463161 |issn=0269-2163|hdl=20.500.11937/34995 |hdl-access=free }}</ref>  Grief counseling and grief therapy may also be recommended for family members after a loved one's death.<ref name="NCI-2007b">{{Cite web |date=2007-12-18 |title=Last Days of Life |url=https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/last-days-pdq#section/all |access-date=2017-11-26 |website=National Cancer Institute}}</ref>