Abstract
Multiple randomized clinical trials have demonstrated that palliative care improves
the quality of life of individuals with serious medical illness. Research also suggests
that in patients with advanced cancer, palliative care's focus on symptom management,
coping with illness, goals of care, and treatment decisions may be associated with
improved patient quality of life in part by increasing patients' use of active (vs.
passive) and approach-oriented (vs. avoidant) coping strategies. However, without
a framework outlining the process that individuals with serious medical illness and
their loved ones undergo, it is challenging to discern exactly where, how, and why
palliative care may affect the serious medical illness experience. To address this
gap, we propose a clinically applicable framework, derived from existing theory and
research in the social and behavioral sciences. This framework, called the Integrative
Framework of Appraisal and Adaptation in Serious Medical Illness, describes how patients
and their loved ones cognitively and emotionally process the various events that may
occur as they navigate serious medical illness and the end of life. The framework
also describes how individuals and their loved ones use that event processing to determine
next steps, while considering the impact of their surrounding external environment,
their individual social roles, and their connections on this decision making. The
framework presented in this article is intended to improve our ability to understand
and care for individuals with serious medical illness and their loved ones, while
stimulating further discussion and research to test and refine these ideas.
Key Words
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Article info
Publication history
Published online: May 20, 2020
Accepted:
May 11,
2020
Identification
Copyright
Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
