title: The geriatric cancer experience at the end of life: testing an adapted model
abstract: To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide evidence for the validity and reliability of the model for use in practice and research.
  
  
  
  Nonexperimental and cross-sectional using baseline data collected within 24-72 hours of admission to hospice.
  
  
  
  Two hospices in the southeastern United States.
  
  
  
  403 hospice homecare patients; 56% were men and 97% were Caucasian with a mean age of 77.7 years.
  
  
  
  Confirmatory factor analyses using structural equation modeling with AMOS statistical software.
  
  
  
  Clinical status; physiologic, psychological, and spiritual variables; and quality of life (QOL).
  
  
  
  A three-factor model with QOL as an outcome variable showed that 67% of the variability in QOL is explained by the patient's symptom and spiritual experiences.
  
  
  
  As symptoms and associated severity and distress increase, the patient's QOL decreases. As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion), QOL also increases.
  
  
  
  The model supports caring for the physical and metaphysical dimensions of the patient's life. It also highlights a need for holistic care inclusive of physical, emotional, and spiritual domains.
authors.affiliation: Hartford Center of Geriatric Nursing Excellence in New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, USA. buckh@nursing.upenn.edu
authors.forename: Harleah G
authors.initials: HG
authors.lastname: Buck
authors.forename: Janine
authors.identifier: 0000-0002-0717-5263
authors.initials: J
authors.lastname: Overcash
authors.forename: Susan C
authors.initials: SC
authors.lastname: McMillan
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D001293:Attitude to Death; D005260:Female; D005851:Geriatric Nursing / Q000379:methods*; D006738:Hospices / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology*; D009859:Oncology Nursing / Q000379:methods; D010166:Palliative Care / Q000523:psychology; D011788:Quality of Life; D015203:Reproducibility of Results; D029181:Spirituality; D011795:Surveys and Questionnaires / Q000592:standards; D013727:Terminal Care / Q000523:psychology