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

Grumann M.M. and Spiegel D.

Palliative & Supportive Care 2003; 1:23-32

Notwithstanding the high prevalence of death-related worries and concerns in terminal cancer patients, mental health professionals are not always part of the core staff of home hospice settings. The aim of this pilot study was to evaluate how terminal cancer patients, admitted in a home hospice programme, deal with their impending death and the need for greater involvement of mental health professional in caring for these patients.

Twelve women, median age 63 years, with advanced cancer, a prognosis less than 6 months, cared for in home hospice setting, physically and mentally able to be interviewed were included.

The Authors identified three death-related issues: 1. How and whether each patient approached her impending death; 2. Fear of dying and death and its correlates; 3. Spirituality/religious faith and its role in mitigating fear of death.

After having given their consent, the patients were interviewed in their own homes, sometimes with the nurse, friends or family present. The interviews were carefully planned and based on questions from standardized questionnaires such as the Brief Pain Inventory, the Brief Fatigue Inventory, the Death Anxiety Scale, the Hospital Anxiety and Depression Scale.

The interviews showed that the patients often thought about death or most of the time thought about it. Fifty percent of them felt troubled when thinking about death.  This group of patients presented higher fatigue, pain and intense anxiety and reported having unresolved issues. Most patients did not feel nervous when the subject of death was discussed with them or in their presence and, on the contrary even felt relieved.

Although these women were aware of their impending death, some of them were hoping for a Miracle, or the benefits of a therapy based on herbs, or available abroad. Fear of death was almost always present in 50% of the patients. Fear of death and fear of dying in pain were considered two separate concepts in a greater number of these patients. Six patients reported unresolved issues and five of them also reported fear of death and fear of further intense pain with respect to those without unresolved issues. For most women (9/12), what distressed them more than death itself was to leave the family, especially children, and to this issue, emotions such as sadness, worry, guilt, and a sense of loss were associated.  For nine patients, their spirituality and their religious faith was of great importance and gave them support and strength.

This study indicates that terminal cancer patients have problems dealing with their approaching death and thus a close collaboration of mental health professionals is necessary.

Why I chose this article

I chose this article because it indicates what our patients, aware of their impending death, think of and feel.   

Moreover I chose this article to present you a
new international palliative care journal, Palliative & Supportive Care (P&SC). P&SC is the first international journal of palliative medicine that focuses on the psychiatric, psychosocial, spiritual, existential, ethical, philosophic, and humanities aspects of palliative care. The Editor-in-Chief   is   William Breitbart, M.D., Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York.

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