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Coastal Palliative Care

Supportive care, Palliative care and Hospice services for Coastal


What is stress?
A life-threatening illness can bring a lot of additional stress into the life of a patient and his or her family. Stress appears in various ways. Your body may feel full of anxiety or nervous tension. Physically you may experience a faster and stronger heartbeat; muscle tension particularly around your jaw, neck, or back; headache; upset stomach; shortness of breath; sweaty palms; and dizziness. Emotionally you may feel very anxious, edgy, irritable, constantly worried, or feel depressed. New tensions may arise in your relationships with family members or friends. Hassles with care providers may erupt unexpectedly.
Stress does not occur only in times of illness; it is a challenging and stimulating part of life. Often stress helps you to find creative responses to life’s problems and to discover abilities you did not know you had. Stress helps you develop coping abilities and resiliency for facing life’s difficulties. Take time to remember how you have coped with stress at other points in life. It may provide ideas for responding to your present situation.
When stress starts to overwhelm and distress you, it is no longer positive. Distress occurs when you feel you have no options or resources for coping with your situation. You may feel helpless, and that may threaten your sense of well-being. As distress mounts, you may feel you are losing touch with who you are and with the usual ways you have lived your life. These are very normal experiences, but they may make you feel very abnormal.
This article will help you to understand possible sources of stress, how to evaluate your stress and identify some strategies to help reduce stress.


Sources of stress
The physical problems that may accompany a life-threatening illness are the most obvious sources of stress. However, the stress related to the illness may often be increased by practical and emotional problems and by family and spiritual or religious concerns.

These are common physical problems that may contribute to increased stress:
• changes in physical appearance or in body functions resulting from the illness;
• changes in energy or wellness level;
• difficulty in getting around;
• changes in sleeping pattern;
• changes in eating pattern or level of interest in food;
• effect of diagnostic and treatment procedures, which may cause uncomfortable or painful side effects or cause worry, and also disrupt personal schedules.

Life-threatening illness may bring new and sometimes overwhelming stress through its impact on the practical aspects of life. You and your family may find it difficult to maintain routine and normalcy in your daily life. Frequently patients and their families experience difficulties and stress in the following areas:
• responsibilities in providing care
• finances or housing
• transportation
• work or education
• legal matters
• availability of medical care and support in the home
• access to medications

The emotional pain that arises when you anticipate the end of your life or the death of a loved one may be more intense and harder to cope with than the physical pain or discomfort. The emotional pain is personal and unique to the person who experiences it. Frequently, however, one or more of the following is a source of such pain:
• fear of dying or of the unknown
• guilt about specific events or relationships
• sadness about separating from one’s family or friends
• sense of helplessness and loss
• diminished sense of self-worth
• disappointment over failed treatment leading to hopelessness
• worry, anxiety, nervousness, or panic
• difficulty making plans
• anger or frustration

The stress that arises from a life-threatening illness usually affects relationships with family members and others close to you. You may experience stress in relationships with your children, your partner, other relatives, friends, or care providers. These are common sources of stress in such relationships:
• fear of being abandoned
• concern about becoming a burden
• loss of family and social roles
• sexual concerns
• conflict
• mistrust
• estrangement or withholding of forgiveness
• care that seems to lack compassion
• social isolation

Spiritual pain is often intense and overwhelming. It arises from threats to your assumptions about yourself and life. Spiritual pain and concerns may be related to any of these factors:
• loss of meaning or purpose in life;
• spiritual emptiness or loss of faith;
• regret about the past or feelings of failure;
• questions about the justice or fairness of life;
• feeling a loss of the presence or protection of a higher power;
• fear of punishment;
• isolation from spiritual supports

Coping with stress

The stressors in facing a life-threatening illness are challenging to cope with. Your personal history of coping, or what has worked for you in the past may or may not be enough to support you now. All people cope in their own way, and the following suggestions are not intended to mean that there is a right or wrong way to cope with stress. Among these ideas, you may find some that are helpful to you.

Recognize what you can and cannot change
It is important to distinguish between sources of stress that can be changed from those that cannot be changed. For example, if the main stressor is identified as something that can be changed (e.g. pain control, tension within family relationships) then you can reduce the stress by managing the cause. If the source of the stress is unchangeable (e.g. disappointment about failed treatment or inability to fulfill a dream or goal because of illness), you may find it helpful to identify resources to help you develop your coping skills to deal with the stress. Questions for helping you decide which stressors you can and cannot change:
• Can something be done about the experience that is distressing you?
• If yes, can you picture changes that would reduce the amount of stress it gives you?
• Does the source of your distress seem unchangeable?
• If yes, what would help you to cope with it?

Ask for help
Many friends and extended family members are more than willing to help out when a family is facing a life-threatening illness, but they may not know what they can do. If you can identify areas in which you need help, and provide some concrete suggestions, people often welcome the opportunity to help. You can call upon friends or family members to provide help in these areas:
• practical support – doing tasks like washing dishes, running errands, mowing the lawn;
• emotional support – simply listening, or providing a shoulder to cry on;
• spiritual support – providing a supportive presence, praying;
• physical support – helping with tasks such as using a toilet, or turning in bed.
Some families find that some form of schedule works well, so that supportive family and friends aren’t with you all at the same time (as this can cause additional stress). That way you or your family member will know when to expect help to be available. Having friends or family members available on “on call” may also be very helpful.

Professional support (medical) Often when we feel unwell, the first person we seek help from is our family doctor. Our family doctor can be helpful in offering counseling support and/or connecting us with other health team members for emotional support or practical assistance.
Professional support (emotional).
Your health care team can refer you to social workers, counselors, spiritual care providers, volunteers, and group programs that offer counseling, emotional support, education (e.g. relaxation techniques), practical suggestions, and information (e.g. regarding financial benefits).   A counselor, social worker or spiritual leader may be able to provide you with unbiased support as you discuss your fears, your hopes and your concerns. Some people worry that seeking outside help from a professional may feel like one more burden, especially when struggling to balance all the other pieces of life. Think of it another way: seeing a professional is a way of taking care of yourself – a way of making sure that you can sustain the energy you need to enjoy life. Sometimes, speaking with someone who is outside your situation can help to normalize what you are going through. Sorting through your feelings with another person may also give you a new perspective and ideas about how to cope with all the changes you are experiencing.
Professional support (practical).
The health care team can also help with referrals for in-home services, such as nursing visits, assistance with personal care and/or household tasks. At times,  a health care aide to help with practical tasks such as bathing, dressing, eating and toileting may help to reduce the stressors that the family is facing. Some people with life-threatening illnesses hire home support workers or others to do tasks such as cleaning the house or walking pets. If you are at home, visiting nurses can be a tremendous support for symptom management and as an additional coping resource.

Develop ways to reduce stress
Some general stress reduction techniques may help to reduce the distress you are feeling. For example, you can focus on taking some deep breaths to help you to feel more relaxed. You also could use any of the following activities to reduce some of the distress you are feeling:
• yoga
• meditation
• guided imagery
• listening to music
• progressive muscle relaxation
• massage
• exercise (if possible)
• having a bath
• putting on scented lotion
• watching a funny TV show or movie
• spending time with nature or pets
• taking time to be by yourself
• finding a way to be creative
• writing your thoughts in a journal
• creating a less stressful environment

Not all of these techniques will be helpful for all people. Choose what you think will help you to reduce the stress you feel, or think of your own. Questions for reflecting on ways to reduce stress:
• What do I enjoy doing?
• What are some ways that I have coped with stress in the past?
• What do I feel would help me right now?