Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-20T01:49:05.769Z Has data issue: false hasContentIssue false
  • English
  • Français

Living in the face of death: Interviews with 12 terminally ill women on home hospice care

Published online by Cambridge University Press:  29 April 2003

MAREILE M. GRUMANN  and
DAVID SPIEGEL
MAREILE M. GRUMANN
Affiliation:
The Psychosocial Treatment Laboratory, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
DAVID SPIEGEL
Affiliation:
The Psychosocial Treatment Laboratory, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: To determine how home hospice patients deal with their impending death and whether there is a need for greater involvement of mental health professionals in the care of patients dying at home.

Method: In a pilot study, 12 female home hospice patients with advanced cancer and a median survival time of 42 days were assessed using structured interviews and brief questionnaires. Topics of inquiry included facing death, fear of death, pain, fatigue, depression, and anxiety. Three key themes were extracted from the information reported by the women: (1) confronting the issue of death, (2) fear of dying and death and its correlates, and (3) spirituality/religious faith and its role in mitigating fear of death.

Results: First, all subjects reported thinking about their approaching death. For half of them, this thought was bothersome and these women were frequently troubled by unresolved issues and higher anxiety, pain, and fatigue. The majority of the subjects expressed a desire to actively discuss their impending death. Second, more than half of the patients reported being afraid of death and high death anxiety was associated with fear of dying in pain, high peak or usual pain, unresolved issues, and difficulty in parting with family in death. Third, most subjects experienced their religious faith as an important source of comfort and strength.

Significance of results: A substantial subgroup of home hospice patients expressed problems dealing with their approaching death. These problems are amenable to psychological treatment, such as fear of death, unresolved issues, parting with family, and pain. The findings, thus, highlight the need for close collaboration of mental health professionals with home hospice institutions.

Keywords

Home hospice patientsDeath anxietyUnresolved issuesParting with familyReligious faith
Type
Research Article
Information
Palliative & Supportive Care , Volume 1 , Issue 1 , March 2003 , pp. 23 - 32
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Attig, T. (1979). Death, respect and vulnerability. In The Dying Human, de Vries, A. & Carmi, A. (eds.), pp. 3–15. Tel Aviv: Turtledove Publishing.
Breitbart, W. & Payne, D. (2000). Psychiatric aspects of pain management in patients with advanced cancer and AIDS. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 131–59. Oxford, New York: Oxford University Press.
Cassem, E.D. (2000). Care and management of the patient at the end of life. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 13–23. Oxford, New York: Oxford University Press.
Cherny, N.I., Coyle, N., & Foley, K.M. (1994). Suffering in the advanced cancer patient: A definition and taxonomy. Journal of Palliative Care, 10, 57–70.Google Scholar
Chochinov, H.M., Tataryn, D., Clinch, J.J., & Dudgeon, D. (1999). Will to live in the terminally ill. The Lancet, 354, 816–19.CrossRefGoogle Scholar
Cleeland, C.S. (1989). Measurement of pain by subjective report. In Advances in Pain Research and Therapy: Issues of Pain Measurement, Chapman, C.R. & Loeser, J.D. (eds.), pp. 391–403. New York: Raven Press.
Dougherty, K., Templer, D.I., & Brown, R. (1986). Psychological states in terminal cancer patients as measured over time. Journal of Counseling Psychology, 33, 357–359.Google Scholar
Franks, K., Templer, D.I., Cappelletty, G.G., & Kauffman, I. (1990–1991). Exploration of death anxiety as a function of religious variables in gay men with an without AIDS. OMEGA, 22, 43–50.Google Scholar
Gonda, T.A. & Ruark, J.E. (1984). Dying Dignified. The Health Professional's Guide to Care. Menlo Park, CA: Addison Wesley Publishing Company.
Ita, D.J. (1995–1996). Testing of a causal model: Acceptance of death in hospice patients. OMEGA, 32, 81–92.Google Scholar
Kearney, M. & Mount, B. (2000). Spiritual care of the dying patient. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 357–373. Oxford, New York: Oxford University Press.
Mendoza, T.R., Wang, X.S., & Cleeland, C.S. (1999). The rapid assessment of fatigue severity in cancer patients. Use of the Brief Fatigue Inventory. Cancer, 85, 1186–1196.Google Scholar
Morris, J.N., Mor, V., Goldberg, R.J., Sherwood, S., Greer, D.S., & Hiris, J. (1986). The effect of treatment setting and patient characteristics on pain in terminal cancer patients: A report from the national hospice study. Journal of Chronic Diseases, 39, 27–35.CrossRefGoogle Scholar
Reed, P. (1987). Spirituality and well-being in terminally ill hospitalized adults. Research in Nursing & Health, 10, 335–344.Google Scholar
Schachter, S. & Coyle, N. (1998). Palliative home care—impact on families. In Psycho-oncology, Holland, J.C. (ed.), pp. 1004–1015. Oxford, New York: Oxford University Press.
Smith, E.D., Stefanek, M.E., Joseph, M.V., Verdieck, M.J., Zabory, J.R., & Fetting, J.H. (1993). Spiritual awareness, personal perspective on death, and psychosocial distress among cancer patients: An initial investigation. Journal of Psychosocial Oncology, 11, 89–103.Google Scholar
Smith, D.K., Nehemkis, A.M., & Charter, R.A. (1983–1984). Fear of death, death attitudes, and religious conviction in the terminally ill. International Journal of Psychiatry in Medicine, 13, 221–232.Google Scholar
Spiegel, D., Bloom, J.R., & Yalom, I. (1981). Group support for patients with metastatic cancer. A randomized prospective outcome study. Archives of General Psychiatry, 38, 527–533.Google Scholar
Templer, D.I. (1970). The construction and validation of a death anxiety scale. Journal of General Psychology, 82, 165–177.CrossRefGoogle Scholar
Vachon, M.L.S. (2000). Burnout and symptoms of stress in staff working in palliative care. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 303–319. Oxford, New York: Oxford University Press.
Viederman, M. (2000). The supportive relationship, the psychodynamic life narrative, and the dying patient. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 215–222. Oxford, New York: Oxford University Press.
Walsh, R. & Vaughan, F. (1982). What is a person? New Realities, 4, 48–52.Google Scholar
Welwood, J. (1983). Awakening the Heart. Boulder, CO: Shambala Publications.
Yalom, I.D. (1980). Existential Psychotherapy. New York: Basic Books.
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.Google Scholar