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


METHODS
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.


CONCLUSIONS
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.
Grumann
Mareile M
MM
The Psychosocial Treatment Laboratory, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA. mgrumann@web.de
Spiegel
David
D
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D001293:Attitude to Death; D002140:California; D005195:Family Relations; D005239:Fear; D005260:Female; D006699:Home Care Services; D017051:Hospice Care; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D012067:Religion; D018709:Statistics, Nonparametric