title: Prognostic acceptance and the well-being of patients receiving palliative care for cancer.
abstract: OBJECTIVE
  To identify the impact of prognostic acceptance/nonacceptance on the physical, psychological, and existential well-being of patients with advanced cancer.
  
  
  METHODS
  A Canadian multicenter prospective national survey was conducted of patients diagnosed with advanced cancer with an estimated survival duration of 6 months or less (n = 381) receiving palliative care services.
  
  
  RESULTS
  Of the total number of participants, 74% reported accepting their situation and 8.6% reported accepting with "moderate" to "extreme" difficulty. More participants with acceptance difficulties than without acceptance difficulties met diagnostic criteria for a depressive or anxiety disorder (chi(2) = 8.67; P < .01). Nonacceptors were younger (t = 4.13; P < .000), had more than high school education (chi(2) = 4.69; P < .05), and had smaller social networks (t = 2.53; P < .05) than Acceptors. Of the Nonacceptors, 42% described their experience as one of "moderate" to "extreme" suffering compared with 24.1% of Acceptors (chi(2) = 5.28; P < .05). More than one third (37.5%) of Nonacceptors reported feeling hopeless compared with 8.6% who had no difficulty accepting (chi(2) = 24.76; P < .000). Qualitatively, participants described active and passive coping strategies that helped them accept what was happening to them, as well as barriers that made it difficult to come to terms with their current situation.
  
  
  CONCLUSIONS
  The challenge of coming to terms with a terminal prognosis is a complex interplay between one's basic personality, the availability of social support, and one's spiritual and existential views on life. Nonacceptance appears to be highly associated with feelings of hopelessness, a sense of suffering, depression, and anxiety, along with difficulties in terms of social-relational concerns.
authors.affiliation: Department of Psychiatry, University of Manitoba and Manitoba Palliative Care Research Unit, Winnipeg, MB, Canada.
authors.forename: Genevieve N
authors.initials: GN
authors.lastname: Thompson
authors.forename: Harvey M
authors.initials: HM
authors.lastname: Chochinov
authors.forename: Keith G
authors.initials: KG
authors.lastname: Wilson
authors.forename: Christine J
authors.initials: CJ
authors.lastname: McPherson
authors.forename: Srini
authors.initials: S
authors.lastname: Chary
authors.forename: Fiona M
authors.initials: FM
authors.lastname: O'Shea
authors.forename: David R
authors.initials: DR
authors.lastname: Kuhl
authors.forename: Robin L
authors.initials: RL
authors.lastname: Fainsinger
authors.forename: Pierre R
authors.initials: PR
authors.lastname: Gagnon
authors.forename: Karen A
authors.initials: KA
authors.lastname: Macmillan
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001293:Attitude to Death; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care / Q000523:psychology*; D011379:Prognosis