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.