Ethical wills and suffering in patients with cancer: a pilot study.
BACKGROUND
Suffering at the end of life may be caused by many factors, including pain and other symptoms, concern about family and friends, and loss of control of one's life. Several authors have suggested that loss of meaning is pivotal in suffering. An ethical will (EW) is a statement, usually written, capturing one's values, wisdom, hopes, and advice. EWs have been suggested as a vehicle for finding meaning as the end of life approaches. This pilot study of EWs examined methods for exploring the role of EWs in reducing suffering at the end of life.


METHODS
Oncology clinic patients 65+ years of age in active therapy for cancer were randomly assigned to one of two arms: EW or control. Subjects in both arms had writing assignments, three home visits, and exit interviews. Suffering was measured at baseline and at the time of the exit interview, using a series of Likert-like scales.


RESULTS
Twenty-four subjects (10 EW and 14 control) completed the study. Among EW subjects, trends toward reduced suffering were noted in "concern for loved ones," "unfinished business," and "fear of the future." Several methodological issues were identified by this pilot study, including selection of population for studying suffering, placebo effect, and randomization.


CONCLUSIONS
EW may be valuable in alleviating suffering; a larger study will be needed to examine efficacy. The study of interventions designed to reduce suffering at the end of life requires careful attention to the definition and measurement of suffering, study design, and subject selection.
Gessert
Charles E
CE
St. Mary's/Duluth Clinic Health System, Duluth, Minnesota 55805-1983, USA.
Baines
Barry K
BK
Kuross
Steven A
SA
Clark
Cinda
C
Haller
Irina V
IV
D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D004989:Ethics; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010146:Pain / Q000523:psychology*; D010865:Pilot Projects; D018709:Statistics, Nonparametric; D013727:Terminal Care; D014918:Wills