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Physiotherapeutic performance in palliative care in the ICU is essential to ensure an integrated and effective approach in the care of terminally ill patients. As a general objective of this research, we sought to analyze the performance of physiotherapy in palliative care in Intensive Care Units, considering its importance in the prevention, treatment of physical complications and relief of patient suffering. This research was carried out through a bibliographic review of works published between 2014 and 2022. The research results were bibliographic and descriptive, addressing works published in the last 10 years. The result of that research pointed out that the performance of physiotherapy in palliative care in intensive care units is of great importance to promote mobility and functionality of patients, improve quality of life and reduce morbidity and mortality. For this, it is necessary that the physiotherapy approach be individualized and humanized, considering the needs and limitations of each patient. [ABSTRACT FROM AUTHOR]

Background: There are some restrictions in Japan regarding end-of-life care. For example, only physicians can legally issue death certificates. By law, ambulance staff members perform cardiopulmonary resuscitation (CPR) for all patients with cardiopulmonary arrest (CPA). Therefore, it is difficult to transport patients to hospitals without CPR, even in cases of terminal patients with do-not-attempt-resuscitation (DNAR) order. Furthermore, there is no 24-hour home care nursing system in our area. Therefore, terminal patients are unable to spend their last moments at their home in the Kuji area. Objective: To design a system in which terminal patients who wish to spend their final moments at their home can be transported to the hospital without CPR after at-home CPA and a system to avoid confusion between ambulance staff and family members using instructions provided by the physician. Setting/Subjects: The subjects were terminal patients with DNAR order who wanted to stay at home. The instruction to not perform CPR after CPA was created as a document by physicians. Patient information was shared with the fire department; patients were transported to our hospital without CPR after at-home CPA. Results: In total, 26 patients died during the study period; eight received emergency transport to the hospital without CPR after CPA. CPR was not performed for any patient. Conclusion: A system transporting terminal patients without CPR after CPA was necessary in our area. This instruction allows terminal patients to spend their last moments where they wish and avoids unwanted CPR and troubles after CPA.

Background: Hospice care (HC) is specialized medical care for terminal patients who are nearing the end of life. Interdisciplinary collaborative hospice care (ICHC) is where experts from different disciplines and patients/caregivers form a treatment team to establish shared patient care goals. However, the ICHC efficacy has not been frequently studied in the terminal geriatric cancer patient (TGCP) population. This study aimed to gain insight into ICHC provided to TGCPs by an ICHC team and identify factors to ameliorate multidimensional HC. Methods: 166 TGCPs were randomized by a computer-generated random number table using an allocation ratio of 1:1. The patients were divided into the ICHC group and life-sustaining treatment (LST) group. The scores of these questionnaires, such as EORTC, QLQ-C30, Hamilton anxiety scale, the median survival time (MST), symptoms improvement, the median average daily cost of drugs (MADDC), the median total cost of drugs (MTDC) in the last 2 days, and medical care satisfaction were observed in both groups. Results: After treatment, the improvement of emotional function and symptoms in the ICHC group were statistically higher than those in the LST group (P < 0.05). The MADDC and the MTDC in the last 2 days were statistically lower in the ICHC group than those in the LSTs group (P < 0.01). In addition, the overall satisfaction situation and the cooperation ability in the ICHC group were statistically higher than those in the LST group (P < 0.01). Conclusion: The ICHC could provide TGCPs with coordinated, comfortable, high-quality, and humanistic care. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic crisis poses a considerable challenge to terminally ill patients. In this paper the use of qualitative research methods and ethnography compares the dignity of everyday life in the nursing hospital and how dignity is achieved before COVID-19 quarantine and during it. The focus is on the main palliative medicine principles – community and support from relatives. Because of quarantine patients could no longer gather and could not communicate with their relatives. This research shows that because of quarantine patients lost their ability to die with dignity. The paper’s methodological basis consists of anthropological and social work research methods such as participant observation, semi-structured interviews, and informal interviews. The main material is from the 2018 Master’s thesis – “Dignity in a nursing hospital. Approaches and experiences of medical staff and patients”. It is updated with five semi-structural interviews from patients and four semi-structural interviews with the medical staff of the hospital conducted in June 2020. The COVID-19 pandemic crisis poses a considerable challenge to terminally ill patients. In this paper the use of qualitative research methods and ethnography compares the dignity of everyday life in the nursing hospital and how dignity is achieved before COVID-19 quarantine and during it. The focus is on the main palliative medicine principles – community and support from relatives. Because of quarantine patients could no longer gather and could not communicate with their relatives. This research shows that because of quarantine patients lost their ability to die with dignity. The paper’s methodological basis consists of anthropological and social work research methods such as participant observation, semi-structured interviews, and informal interviews. The main material is from the 2018 Master’s thesis – “Dignity in a nursing hospital. [...

In South Korea, the legal and cultural environment keeps terminally ill patients from making an informed refusal to a treatment the discontinuation of which can cause death. Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life allows several forms of informed refusal, but it is not enough. There is no explicit guarantee, at least under this law, of the right to refuse a treatment given during a period that has not reached an endof-life process prescribed in the law. Dori, which the family of a terminal patient feels obligated to follow, makes them commit to doing what they believe is right as a family member without asking the patient's intention. Because it reduces the family's motivation to have a difficult talk about death and end-of-life with the patient, the patient is deprived of an opportunity to make a decision based on accurate information. In making a decision for the patient while patient is excluded, the family often ends up choosing a safe decision that puts physical survival first. In conclusion, the culture and the culturally influenced law are making it impractical for terminal patients to make an informed refusal. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Occupational Therapy of University of São Paulo / Revista de Terapia Ocupacional da Universidade de São Paulo is the property of Revista de Terapia Ocupacional da USP and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Music therapy (MT) for terminally ill patients (PT) has been used as a complementary and multidisciplinary palliative treatment, and numerous repercussions may be present in the management of patient treatment. TM aims to relieve physical and emotional symptoms, including reducing pain and improving quality of life. In addition, it can bring support and help in communicating with family members in coping with grief. Being of great importance to individuals to be more comfortable at the end of life. to analyze the evidence in the literature of studies related to the use of music therapy in the management of terminally ill patients. to analyze the evidence in the literature of studies related to the use of music therapy in the management of terminally ill patients. A systematic review was carried out under the PRISMA guidelines, through the databases: PubMed, Cinahl and Cochrane Library CENTRAL and the descriptors found in the Medical Subject Headings (MeSH) and, in the Health Sciences Descriptors (DeCS). Studies containing the descriptors "Palliative care", "Music Therapy" and "Terminal patients" and their cognates were selected, with no restriction regarding languages. A total of 5,836 studies were identified, 12 of which were selected for the review, and only those that described the effects of TM on PT were recruited. In 6 studies it was demonstrated that TM was able to reduce pain, in 5 articles it was identified an increase in well-being. 5 studies identified improvement in QoL through the application of a questionnaire. One study used spirituality as a relevant factor in the effectiveness of TM. Four publications analyzed the effect of TM on pre- and post-intervention discomfort, showing a reduction in discomfort after the intervention. TM proves to be an intervention capable of generating positive responses that correspond to an increase in QoL, with effects on the clinical, physiological and psychological outcomes of individuals in the terminal phase. The use of TM in PT is a cheap and accessible approach, which can bring many benefits to individuals who are in the final stages of life, bringing greater comfort and general well-being. [ABSTRACT FROM AUTHOR]

Objective To gain an in-depth understanding of the motivations,patterns,and related factors in family decision-making regarding the referral of terminal patients in tertiary hospitals. Methods Using purposive sampling,terminal patients and their family members from three tertiary hospitals in Beijing were selected as subjects.Semi-structured interviews were conducted,and the interview data were subjected to thematic analysis. Results Following the saturation principle,a total of 11 patients and 15 family members were included.The interview data were organized and analyzed,yielding six major themes:decision premises,decision patterns,family support,support from the referring hospital's medical team,referral channel conditions,and involvement of volunteer teams and social support.Based on these findings,a flowchart illustrating the family decision-making process for the referral of terminal patients was constructed. Conclusions The study provides a comprehensive analysis of various factors influencing family decision-making in the referral of terminal patients in tertiary hospitals.The results underscore the significance of internal and external factors,emphasizing the integrated impact of decision patterns,family support,medical team support,referral channel conditions,and the involvement of volunteer teams and social support.The research offers profound insights into improving the referral process for terminal patients and enhancing the quality of family decision-making.It provides valuable recommendations for future improvements in medical services and decision support.

Copyright of Social Work. Experience & Methods / Socialinis Darbas: Patirtis ir Metodai is the property of Vytautas Magnus University, Faculty of Social Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A contemporary view of death is characterized by a sequence of uncertain and difficult questions arising from the clinical context, out of the legal and bioethical domains of taking difficult existential decisions related to the last moments of human life. This step requires a full rationality of free autonomy, which can be significantly disturbed by the loss of mental ability, conditioned by certain illnesses in certain moments. Therefore, patients should have a legislative opportunity to clearly state their wishes regarding the required treatment or the withdrawal in previously prepared guidelines of anticipated medical dispositions of the biological testaments for (non) treatment or the appointment of a surrogate representative of treatment choice at the terminal phase, in case of limited decision-making ability. The signed biological will could greatly contribute to a dignified mode of dying, consistent with the choice of autonomous patient's end-of-life care values, which can often enter into collision from a heteronomous perspective of a surrogate decision-maker. With the biological will we could overwhelmingly overcome the difficulties of the clinical dilemma of existential decisions: Physicians would be more reliant on choosing care in urgent health care plans in crisis situations, the patients could provide the assurance of their self-determination while the surrogate rulers could be largely released from the pressure of responsibility. [ABSTRACT FROM AUTHOR]

The lie is considered a moral flaw, always has a negative connotation. Nevertheless its use is very extended from the biological point of view as mechanism of survival and in the human being, even from the point of view of social integration. Self-deception, considered a supreme manifestation of the human use of lies, is closely related to the generation of optimism and hope, people with problems to integrate self-deception have more frequently pathological alterations in mood, especially depression. The advantages and disadvantages of the use of lying to promote self-deception in patients with terminal illness are analyzed from some ethical-philosophical points of view. [ABSTRACT FROM AUTHOR]

Respect for human life is central to medicine. In terminal patients, refractory symptoms are a niche of palliative sedation. This paper identifies, based on scientific evidence, the survival in patients who received palliative sedation as compared to those who didn’t. We conducted a search for systematic reviews from 2000 to 2016, which were methodologically analyzed, and the results were then compared. For methodological reasons, meta-analysis could not be performed. It is concluded that terminal palliative sedation does not shorten patients’ lives. The implementation of the principle of double effect related to the possible shortening of life was reformulated; the unwanted evil is the loss of consciousness. [ABSTRACT FROM AUTHOR]

Copyright of Agora de Enfermeria is the property of Agora de Enfermeria SRL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The analysis of problems and alarms of the patient’s relatives served in hospices and the services rendered to it.Materials and Methods: Questioning of 190 members of the personnel, 216 relatives and the close patients who were in 29 hospices and 5 branches of the palliative help of Bulgaria in 2008.Results: There is no practice of granting conditions for stay of relatives and maintenance of contacts to relatives after death of the patient in the Bulgarian hospices. Relatives underline absence of free from work of a member of a family and impossibility of reception of long holiday for service of the patient as the basic problems. The basic alarms are connected with a condition of the patient and necessary measures for its service.Summary: Wide informing of the population on various forms hospice’s help and a special attention of the medical personnel to problems of health of relatives are necessary.

Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care. This multicenter, retrospective cohort study enrolled terminal patients from a representative sample of nursing homes. Health care costs included fixed nursing home costs, medical fees, pharmacy charges, other charges, and eventual hospitalization costs. Data sources consisted of accountancy and invoice data. The analysis calculated costs per patient during the final month of life at 2007/2008 prices. Nineteen nursing homes participated in the study, generating a total of 181 patients. Total mean nursing home costs amounted to 3,243 € per patient during the final month of life. Total mean nursing home costs per patient of 3,822 € for patients receiving usual care were higher than costs of 2,456 € for patients receiving palliative care ( p = 0.068). Higher costs of usual care were driven by higher hospitalization costs ( p < 0.001). This study suggests that palliative care models in nursing homes need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. [ABSTRACT FROM AUTHOR]

Breaking bad news is considered one of a physician's most difficult duties. Discomfort and uncertainty associated with breaking bad news, along with a lack of proper training, may lead physicians to emotionally disengage from patients. The aims of this study were to evaluate he patients' beliefs of bad news and heir perception and attitude towards breaking bad news. A cross sectional community based survey was conducted in Riyadh city during the month of April, 2009. A representative sample was selected using a stratified random sampling technique. A validated self administrative questionnaire in Arabic language was designed and used for data collection. Chi Square test was used to find the association between two qualitative variables. P- Value was set to be < 0.05 throughout the study. The study included 1086 participants. Half of the samples were male and 46% of them were between 30-39 years old. Almost 75% of them defined bad news as related to the diseases that are highly fatal. Only 50% of the participants had a satisfactory experience in the method of breaking bad news. Around 81% of participants insist on being informed about any news related to their health. Educational level seems to be one of the influencing factors (p<0.001). Most of the participants (71.1%) want detailed information about the disease. Most of the patients (i.e. 88.2%) appreciates more those who tell them the truth. The study gave an overview of Saudi Citizens' perceptions towards breaking bad news. In general, participants had a good understanding of the situation and respect honesty. Medical professionals are urged to learn more about the importance and the techniques of breaking bad news to gain patient's satisfaction and build sound doctor-patient relationships. [ABSTRACT FROM AUTHOR]

Root metaphor analysis as a category of representations of palliative care. In December 2009, thirty four medical majors enrolled at the School of Medicine of the Instituto Politécnico Nacional (National Polytechnic Institute) were surveyed to find out about their mental images on palliative care. All of them were already attending classes on Medicine and Healthcare taught by an algologist working at the Clinic for pain and palliative care at the Hospital General de México. This article's intention is to underline the importance and necessity of using qualitative research methodology to gather in-depth understanding that leads to core medical beliefs regarding pain and suffering. This opens up the possibility of establishing metaphorical categories for analysis. The results show the need to develop appropriate strategies to educate both medical doctors and interns regarding their beliefs, thus providing new meanings to their mental representations so as to provide better treatment(s) to their terminal patients when dealing with suffering and pain. A strategy that could also be extended to the patients' next of kin. [ABSTRACT FROM AUTHOR]

Abstract: Context: Cancer patients have impaired humoral and cellular immunity, and are more susceptible to infections; their immunological response is expected to be less effective than that of healthy people. Objectives: To assess the immune response to influenza vaccine in terminally ill cancer patients in a home palliative care unit. Methods: During the fall of 2000–2001, 2005–2006, and 2006–2007, terminally ill cancer patients treated by our home palliative care unit were vaccinated against influenza with Vaxigrip®. Blood samples were taken before and four weeks after vaccination. Influenza immunological response parameters accepted in the literature were calculated. Results: Eighteen terminal cancer patients were vaccinated against influenza strains predicted for that year; 13 completed the study. The other five patients died within less than a month from the time of vaccination. The serum protection rate increased from 15.4% before to 61.5% after vaccination, and the serum response rate was 53.8% for all the three strains of vaccination. Mean-fold increase was 24.9 for influenza A-H1N1, 15.4 for influenza A-H3N2, and 2.8 for influenza B. Geometric mean titer was increased for influenza A-H3N2 from 8.3 before vaccination to 159.4 after vaccination; for influenza A-H1N1 from 5.2 to 124.3, and for influenza B from 5.7 to 44.6. Conclusion: The results indicate that influenza vaccination is probably effective and can be offered to terminally ill cancer patients with a life expectancy of about three months in a home care palliative care unit. [Copyright &y& Elsevier]

Abstract: Context: In addition to the effectiveness of terminal care, policy makers and health care payers are concerned about the costs of treating terminal patients in a context of spiraling health care costs and limited resources. Objectives: This article aims to review the international literature on the costs of treating terminal patients. Methods: Studies were identified by searching PubMed, Centre for Reviews and Dissemination databases, Cochrane Database, and EconLit, up to April 2009. Studies were included that contrasted costs in different health care settings and that compared palliative care with alternative therapeutic approaches for terminal patients. Results: The few studies that focused on treatment of terminal patients across health care settings showed that hospitalization costs represent the principal component of palliative care costs. In the hospital setting, palliative care tends to be cheaper than usual care or care delivered in units other than the palliative care unit. Palliative care costs depend on patient characteristics, such as diagnosis, status of disease, and age. Also, different care models appear to target different patient groups and offer varied packages of services. Finally, there is some evidence pointing to cost advantages of palliative care at home as compared with alternative care models, although this needs to be corroborated by further research. Conclusion: Different approaches to deliver palliative care are not substitutes of each other and, thus, have different costs. From a cost perspective, hospitals need to pay attention to admitting patients to the palliative care unit at the right time. [Copyright &y& Elsevier]

In present days we face specific care requirements to patients with advanced, chronic-degenerative or terminal diseases. Its prevalence has increased in last two decades, mainly in geriatric population. Palliative care to patients in terminal phase concept fights for insert in public and private care systems. Independently of its clinical characteristics and care needs, its ubiquity in every area of every nation's health care system is one of its major aspects; if there aren't specific measures to respond, health care resources use (mostly in hospital) will increase, and economic, family and institutional costs will be so high without giving patients a better quality of life. These force health care systems to implement coverage and service programs to correctly give palliative care assistance to terminal patients. [ABSTRACT FROM AUTHOR]

End-of-life care can be delivered in a variety of settings, whereby the majority of terminally-ill cancer patients prefer to die at home. The aim of our study is to evaluate health services utilisation during the last year of life, and to compare terminally ill patients who have received home-specialised palliative care services (HSPCS) with patients who died receiving home non-specialised palliative care services. The study included 120 and 515 patients, respectively, who died between 1999-2000. Age and gender distribution were similar in both groups. During the last year of life, mean health services cost per person among the HSPCS group was lower by more then 30% ( P<0.005). The median cost per patient was as low as one-fifth in the last month. Men and the older age group of 65 and above, cost significantly less compared with women and younger patients, respectively, regardless of provider setting. The main differences in health services utilisation were in hospitalisations and oncology treatments ( P < 0.01 and P < 0.05, respectively). [ABSTRACT FROM AUTHOR]

In the last five to ten years there has been increasing debate on terminal sedation, a medical practice that is difficult to place between other decisions at the end of life, like alleviating pain, withholding treatment, and (in jurisdictions where this is allowed) euthanasia or physician-assisted suicide. Terminal sedation is the administration of sedative drugs with the aim to reduce the consciousness of a terminal patient in order to relieve distress. It is frequently accompanied by the withdrawal (or withholding) of life-sustaining interventions, such as hydration and nutrition. It is typically a measure of the last resort, to be considered in situations where all other measures to reduce pain and suffering have failed. While similar to palliative measures as far as the sedation itself is concerned, withholding of hydration and nutrition brings terminal sedation into the realm of non treatment decisions. At the same time, to the extent that the combination of these two measures may shorten the patient's life, the practice may be easily associated with euthanasia. It is no surprise therefore, that terminal sedation has been called (and has been disqualified as) 'slow euthanasia' or 'backdoor euthanasia'. This paper addresses the question how terminal sedation may be looked upon from a legal point of view. Is it indeed a disguised form of euthanasia, or should it be considered as a practice in its own right? In the latter case, what does it imply in legal terms, and under which conditions and safeguards could it be legally justified? To answer these questions, I will look first at the different clinical realities that may be brought under the heading 'terminal sedation'. Then I will deal with its two components -- sedation on the one hand, and withholding artificial feeding on the other -- in a legal perspective. The paper ends with conclusions on terminal sedation as a whole. [ABSTRACT FROM AUTHOR]

Abstract: To describe how patients die in hospital, 370 patients (age >18 years; in hospital for>24 hours) who died on the general wards of 40 Italian hospitals were assessed. Differences between patients whose death was expected and patients whose death was unexpected were evaluated. Data on treatments and care in proximity of death were collected after interviewing the nurse responsible for the patient within 72 hours of the patient''s death, and from clinical and nursing records. For 58% of patients, death was highly expected. Symptom control was inadequate for the most severely ill patients: 75% experienced at least one “severe” symptom (42% pain and 45% dyspnea). Nurses tended to judge patients'' global care as “good” or “very good” (76%), in spite of the persistence of symptoms and the scant use of analgesics. Despite some encouraging signs of sensitivity to end-of-life problems, acute inpatient institutions in Italy still deal inadequately with the needs of dying persons. [Copyright &y& Elsevier]

A previous survey of patients treated by our palliative care service showed that most patients with advanced cancer wished to be cared for at home. This is in contrast with the fact that these patients were increasingly frequently hospitalized because of their belief that a hospital, in spite of its shortcomings, is the place where medical and nursing care are more advanced.A prospective survey was carried out on 120 advanced cancer patients under the palliative care service of the Cremona Hospital, Italy. The survey recorded all the inadequacies of their care from the time patients were seen until death occurred. Five times as many inadequacies occurred in hospital than at home (an average of 4.4 ± 5.0 every 100 days against 0.8 ± 2.0 every 100 days; p < 10E -6). The most frequent inadequacies of care at home were caused by both narcotic and drug misuse, and unjustified alterations in the therapy; in the hospital they were related to therapeutic regimes and failure to report new symptoms. These data support the view that general hospital care in Italy today does not necessarily provide the best solutions to the problems of the terminally ill patient. A palliative care programme should include the option of organized home care. [ABSTRACT FROM PUBLISHER]

Background: There are some restrictions in Japan regarding end-of-life care. For example, only physicians can legally issue death certificates. By law, ambulance staff members perform cardiopulmonary resuscitation (CPR) for all patients with cardiopulmonary arrest (CPA). Therefore, it is difficult to transport patients to hospitals without CPR, even in cases of terminal patients with do-not-attempt-resuscitation (DNAR) order. Furthermore, there is no 24-hour home care nursing system in our area. Therefore, terminal patients are unable to spend their last moments at their home in the Kuji area. Objective: To design a system in which terminal patients who wish to spend their final moments at their home can be transported to the hospital without CPR after at-home CPA and a system to avoid confusion between ambulance staff and family members using instructions provided by the physician. Setting/Subjects: The subjects were terminal patients with DNAR order who wanted to stay at home. The instruction to not perform CPR after CPA was created as a document by physicians. Patient information was shared with the fire department; patients were transported to our hospital without CPR after at-home CPA. Results: In total, 26 patients died during the study period; eight received emergency transport to the hospital without CPR after CPA. CPR was not performed for any patient. Conclusion: A system transporting terminal patients without CPR after CPA was necessary in our area. This instruction allows terminal patients to spend their last moments where they wish and avoids unwanted CPR and troubles after CPA., Competing Interests: No competing financial or any other interests exist. This article has not been published and will not be submitted elsewhere for publication while being considered by the Journal of Palliative Medicine., (© Mizunori Yaegashi et al., 2021; Published by Mary Ann Liebert, Inc.)

Visando minimizar o sofrimento psicológico de pacientes Fora de Possibilidade de Cura e promover Qualidade de Vida na Dor Simbólica da Morte, representada pela Dor Psíquica e Dor Espiritual, desenvolveu - se um método integrando - se as técnicas de Relaxamento Mental e Visualização de Imagens Mentais com o conceito de Espiritualidade, o qual foi estruturado a partir de pesquisas que descrevem os relatos de pacientes que passaram por uma Experiência de Quase Morte (E.Q.M.), e voltaram a viver normalmente. Neste artigo discorremos sobre os dados que estruturam o conceito de Espiritualidade na composição do método proposto, para re-significar a Dor Simbólica da Morte de pacientes terminais.