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1 -1- ( ) , , -2- , 12345-3-1) , , , , , (holistic care)1. , -4-2) WHO .1. , .. , , .-5-3) 1. , Curative/remissive therapyPresentationDeathPalliative CareHospiceRelieving suffering -6-4) 1. , 6 : , , , to alleviate(disease) withoutcuring Hospice care is end of lifeoriented Palliative care is goal oriented-10-1) (WHO) : : ( ), ( ), , : (1989) : , 2.

2 -11-2) , (1968) 5 .2. (Denial) (Anger) (Bargaining) (Depression) (Acceptance) (Hope)-12-3) .2. , - ( ) . , . , , . , , , - -13-4) Pattison(1974)2. , , , , , , , , -14-1) 3. 2 . , , . -15-1) 3. 6.

3 - ( , ) , - ( , 6 .)-16-2) ( ) 3. Medicare 6 .Medicare , . 7 , 6 .-17-2) ( ) 3.. , , .-18-3) .3. , ( , , , )-19-4) : .3.

4 -20-5) 1 24 1 7 , . 3. , , , . , , , , 1 24 1 7 . 1 24 1 7 ..-21-6) 1 ..3. ( ) .( ) .( ) , .( ) .-22-7) 3.. -23-7) 3.

5 2001 2002 -24-3. ( ) : . > , , : , , , . ( , Death with dignity) : ..-25-3. ( , Euthanasia) : . (active euthanasia) (physician assisted suicide) (Advance Directive) : . , , , . : , , -26-7) 3.

6 (Informed consent) .. (withholding) (withdrawing) , , , , . (Futile Management) .-27-7) 3. (Do-Not-Attempt-Resuscitation, DNAR) -28-8) 3. / : / / : / -29-9) 3.

7 -30-10) 3. , , , . , . , , , , .-31-1) 4. : (%)1 Pain67( )2 Family coping31( )3 Elimination: Bowel22( )4 Psycho-spiritual distress 15( )5 Dyspnea15( )6 Skin integrity10( ) (%)7 Nausea, vomiting9( )8 Ascites8( )9 Edema6( )10 Urinary problem5( )11 Oral mucosal integrity 3( ) : (2000).. , 3(1), ) 4. Twycross Model (%) (Somatic source) (Cancer)47( ) (Non cancer pathology)42( )Symptom of debility37( ) (Side effect of therapy)16( )-33-4. (%) (Depression) 30( ) (Sense of helplessness)23( ) 23( ) (Loneliness)20( ) 12( ) (Disfigurement)8( ) 7( ) 7( )Twycross Model -34-4.

8 (%) (Anger) Anger with relationship*14( ) (Perceived neglect from family*)12( ) (Therapeutic failure)9( ) (Anger at God*)3( ) (Unavailable doctors)1( ) (Friends who do notvisit)1( )Twycross Model -35-4. (%) (Anxiety) (Fear of death)34( ) (Fear of pain)30( ) (Uncertainty aboutfuture)27( ) (Worry about family)22( ) (Spiritual unrest), (guilty)17( ) (Family finances)14( ) (Loss ofdignity and bodily control)12( ) (Fear of hospital)1( )Twycross Model -36-4. 1) , - : , , , , , - : , , , , , , , , , , -37-4.

9 1) , , , : , , : : , , -38-4. 2) (Needs) (Rights) , ( honest answers) , , , , , , . Victoria Hospice Society(2004) .Psychosocial care of the dying and bereaved. -39-4. 2) , , , -40-4.

10 3) .. , ( ), , , . , , .. , , . -41-5. Degner (1991) 7 10 . -42-5. Debratz(1990) 4.