This article describes a systematic approach to understanding the needs of the terminally ill who are also subject to serious mental health problems. A compilation of potential issues that could arise is provided along with specific techniques that could be useful to staff and volunteers who encounter them. Vignettes from clinical experience are used to provide a framework for understanding the unique aspects of cognitively impaired patients and for enhancing confidence in helpers. This article will give serious consideration to dispelling some misconceptions and to detailing resources for helpful interventions in difficult cases.

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