It is naïve to think that successful research, like any lifelong academic pursuit, can be reduced to a pithy, simplistic formula. Yet, after years of attempting to get it right and with still much to learn, it strikes me that successful research is comprised of certain indispensable elements. Based on considerable personal experience and reflection, I humbly offer the “Five Research C's”; their intent is to provide a framework for novice and expert investigators alike, to contemplate some of the basic constituents of empirical research.

Objective: Depression in palliative care patients is often underrecognized. Screening can increase case recognition. The aims of this study were to assess the prevalence of depression in palliative cancer patients attending a pain and symptom control clinic and to investigate the validity and utility of a depression visual analogue scale in detecting depression in the advanced cancer outpatient population.

Method: One hundred and thirty-two oncology outpatients who came for consultation at a multidisciplinary pain and symptom control clinic were asked and agreed to complete the Brief Zung Self-Rating Depression Scale (BZSDS; Dugan et al., 1998) and depression visual analogue scale (DVAS).

Results: The majority of participants (72%) indicated clinically significant depressive symptoms according to the BZSDS (21% in the “mild” depressive symptoms range, 32% in the “moderate” range, and 19% in the “severe” range). Participants indicated low endorsement rates of items related to overt manifestation of depression (e.g., sadness, tearfulness, irritability, and suicide ideation). The DVAS showed high correlation with the BZSDS (r = .82) and is a potentially useful screening instrument for detecting depressive disorder in palliative care cancer patients.

Significance of results: The results of the study underline the importance of routine screening to detect depressive disorder in palliative care patients to improve their quality of care. The depression visual analogue scale was found to be an effective simple screening tool, easy to administer and use.

Objective: Completely compliant drug-taking behavior is associated with opioid therapy that is usually highly beneficial to the pain patient, whereas frequent and severe aberrant behavior is generally associated with therapy that is potentially harmful to the patient and borders on addiction. There is a large group of patients in the middle between these two extremes: those who display aberrant behaviors periodically, who may additionally have a mixed response to opioid therapy, the overall results of which are less than satisfying (often in the domain of functionality) to the clinician. We have used the term chemical coping to describe this vast middle ground and seek to begin a line of research starting with the development of a clinically useful tool to identify this subset of patients.

Methods: A background review is provided to highlight the need for better understanding of chemical coping. In addition, the first steps in creating a chemical coping tool are discussed, including the results of focus group interviews to determine the clarity, understandability of the items, and to assure that they are not objectionable or offensive. A total of 15 patients and 15 professionals completed this phase of the project.

Results: Both the professionals and patients reported that the items were generally clear and understandable. In addition, although the items cover potentially sensitive topics and some were designed with a provocative edge, the respondents had few requested changes. The researchers are moving forward with the next phase of research.

Significance of results: The middle ground between compliant medication use and addiction, which we call chemical coping, is poorly understood and woefully underresearched. Despite this gap in our knowledge base, it is an often observed phenomenon. Creating a tool to identify these characteristics can lead to better treatment outcomes and earlier interventions to help improve compliance with medication regimens.

Objectives: Communication between health care providers and patients with cancer and other chronic diseases typically references probabilities that certain future events will or will not occur. Beyond the context of diagnostic encounters and the transmission of “bad news,” such “prognostic” communications take place in various forms throughout the illness trajectory. It is well known that such information transmitted badly can have devastating psychosocial consequences for patients and their families and, conversely, that difficult information exchanged with sensitivity can lend tremendous support. This study aimed to extend our understanding of how such communications are received and interpreted by patients, so that we might optimally apply what we know about general principles of effective communication within the particularly challenging context of predicting futures.

Methods: We conducted a combined secondary analysis of two prior qualitative studies into patient perceptions of helpful and unhelpful health care communication with 200 cancer patients and 30 persons with chronic illness. These data sets offered a rich resource for comparing perceptions across a range of contextual variables, and secondary analysis focused on future-oriented interactions, including both prognostication and prediction.

Results: The accounts of patients with cancer and chronic illness reveal various ways in which health care communications involving future projections interact with their human experience of hope, powerfully shaping their capacity to make sense of and live with serious illness. They include a synthesis of what patients recommend health care professionals know and understand about this challenging dynamic.

Significance of results: The findings of this study offer a distinct angle of vision onto the various communications that involve future predictions, illuminating a patient perspective with the potential to inform health care communication approaches that are both informative and therapeutic. As such, the study supports a dynamic understanding of the tenuous balance between hope and honesty in the clinical encounter.

Objective: To investigate the meanings that people with advanced cancer ascribe to engaging in creative activity in palliative occupational therapy.

Methods: Sixteen interviews were conducted with eight participants over a period of 8–12 months. Participants were asked to narrate about their engagement in creative activities at a palliative intervention program. Transcribed interviews were analyzed with a phenomenological method.

Results: Engagement in creative activities was found to ease life in proximity to death for persons with advanced cancer and limited survival time. For the participants, creativity meant that some of the consequences of incurable cancer could be confronted and alternative potentials could be explored and acknowledged. This occurred in an ongoing process of creating alternative ways to deal with life.

Significance of results: Creative activity is a means for participants to develop ways to adapt and cope with declining physical abilities and existential concerns through working with their hands and bodies. This complements the often negative focus in palliative phases of cancer with an understanding of how enriching aspects of life can be maintained. The results highlight how people in palliative care experience their engagement in creative activity in the form of crafts, and how such engagements may be a significant tool for finding alternative ways to handle challenges in ongoing life.

Objective: Palliative care of the terminally ill requires not only treatment of physical pain, but also care for a patient's spiritual and social needs. In Japan, where many customs correlate closely with the seasons of fall, winter, spring, and summer, seasonal events carry significance for patients who have reached a terminal stage of disease. This study determined how Japanese hospice patients evaluate a program that celebrates seasonal events and considers the modality and significance of season events at hospices.

Methods: A questionnaire survey was conducted for 1 year between August 2000 and July 2001 at a hospice located in the suburbs of Tokyo, Japan. Of the original 48 instruments, a total of 43 instruments were returned (response rate: 89.6%).

Results: Results showed that 72.1% of respondents participated in seasonal events, and the majority of participants positively evaluated their experiences of seasonal events. Positive aspects included being able to get a feeling for the seasons (74.2%) and being able to interact with staff and volunteers (51.6%). Negative aspects included that the events were too long (9.7%) and tiring (6.5%), and that the events made one feel sad (6.5%). Reasons for participating in seasonal events included seeming fun (71.0%), recreative (58.1%), and being entertaining (48.4%).

Significance of results: Overall findings suggest that there is significance in celebrating the seasons with a monthly event at hospices. Further research is needed on the modality and experiences of celebrating the seasons at hospices in other nations.

Objective: This qualitative research study listens to the narratives of people experiencing the dying process who attended the Otago Community Hospice, Dunedin, New Zealand.

Methods: Ten people, aged between 51 and 65 years old, were approached; two declined and one died sooner than expected. All were women (although this was not part of the original design), and all had carcinoma. Data for the study were sought through qualitative research interviews, considering the development of each participant's illness in relation to her perception of her embodiment in the palliative care setting, and concluding with questions about what she wants the people who care for and about her to learn from her experience. Consistent with this phenomenological approach, the method of analysis was thematic and interpretive.

Results: The main theme was the uncertainty that all participants felt throughout the diagnostic process and during treatment. Uncertainty, too, was a factor in how they managed their day, whether they would be able to sustain an outing or an activity or not, and whether they would be pain free. None were afraid of dying but hoped that when they did die, they would do so comfortably. The relationship with their general practitioners varied. Where fatigue or the effects of medication were not an issue, they could think clearly, but their bodies were experienced as letting them down and limiting their activities. The ideal of “living until you die” was not able to be fulfilled. The increasing approach of social death as they withdrew from their employment and social responsibilities affected them.

Significance of results: Whether one has a “good death” or not is determined not only by the progression and management of the disease process by health professionals, but also by the way in which one is perceived, by self and others. There are no guidelines for the dying role; everybody dies differently and individually.

Objective: This study aims to clarify characteristics of the contents of life review in reminiscence therapies in cancer patients by age, gender, and stage of disease.

Methods: Sixteen patients who were terminally ill and were receiving anticancer treatments participated in life review therapy. Patients reviewed there lives according to their developmental stage, and they mainly reviewed impressive achievements. A clinical psychologist interviewed each patient four times and the total number of sessions was 64. The contents of each life review were transcribed, and a correspondence analysis and a significance test were conducted on these data to choose characteristic words or phrases.

Results: The main concern of 40-year-olds was “about children.” For 50-year-olds, it was “how to confront death” and for 60-year-olds, “death-related anxiety” and “new discoveries”. For 70-year-olds, “resignation about death” and “evaluative reminiscence of their lives” were most important, and for 80-year-olds the main concern was “relationships with others.” When analyzing the data according to disease stage and gender, “transcendence to children”, “reflection on their past behavior”, and “gratitude for my family” were characteristic words for males receiving treatment, “work,” “worries about children,” “side effects,” “homecare,” and “reflection on their past behavior” were characteristic words for females receiving treatment. “Physical condition”, “desire for death” and “how to confront death” were common phrase for males in the terminal stages of the disease process, while “resignation to life” was characteristic reaction for females.

Significance of results: There appear to be considerable differences in the focus of life review interviews by age, disease age, disease stage, and gender. Clinicians should consider these differences when using life-review therapy in order to tailor it to the individual.

“Chemobrain” is the phenomenon of cognitive decline some patients may experience after chemotherapy. Current research indicates the cognitive domains that may be most impacted by chemotherapeutic agents are visual and verbal memory, attention, and psychomotor functioning. These cognitive deficits can have an effect on a patient's ability to make informed treatment decisions, pursue occupational or academic pursuits, and his or her overall quality of life. The potential mechanisms that cause this disruption remain largely unknown, although contributing factors could be vascular injury and oxidative damage, inflammation, direct injury to neurons, autoimmune responses, chemotherapy-induced anemia, and the presence of the apolipoprotein E ε4 (APOE ε 4) gene. Interventions to help alleviate the symptoms of chemobrain could include nonpharmacologic treatment such as antioxidants and cognitive-behavioral therapy. In addition, patients may benefit from pharmacologic treatment such as recombinant human erythropoietin and psychostimulant drugs such as methylphenidate. It is important to note that the proposed therapeutics treat the symptoms of chemobrain based on the hypothesized mechanisms. Therefore, a detailed understanding of the mechanisms that cause chemobrain, as well as a comprehension of what specific cognitive domains are impacted, is crucial in developing more specific treatments to improve patients' cognitive functioning and overall quality of life.

Objective: Breathlessness is one of the core symptoms in many advanced conditions. The subjective nature of the symptom has been acknowledged in many definitions, emphasizing that it can only be fully perceived and interpreted by the patients themselves.

Aim: To review and assess the evidence on the psychosocial nature or experience of breathlessness.

Methods: Relevant literature was identified through electronic and hand searches. Studies with qualitative enquiry or mixed method designs were included. The methodological quality of studies was assessed with a standard grading scale.

Results: Twenty-two studies were identified, 12 from the United Kingdom, 4 from the United States, 3 from Canada, 1 from Sweden, 1 from Iceland, and 1 from Finland. The nature of the studies determined the themes in which the studies were subsumed. Studies on COPD (19) outnumbered “all other conditions” (3), one of which had COPD and cancer patients and so these were analyzed separately. Within the COPD category most studies (17) considered the experience of breathlessness from the perspective of the patient, 1 study from the informal carer, and 1 from the professional carer. Most of the papers sought to understand the meaning of the symptom in the patient's daily life. The other papers demarcated separate areas of the experience of acute exacerbations and the patient's view on care. The studies explored the subjective component of breathlessness, as part of human experience and social life. The papers showed the influence of the meaning the symptom has for those affected on their ability to cope and on their management.

Significance of results: Although the work in this area is still dominated by research on COPD, the totality of the evidence now shows breathlessness as an intractable symptom in other advanced conditions. Practice recommendations focused on the holistic approach as part of palliative and nursing care.

Objective: The purpose of this article is to provide a brief review of the empirical literature regarding the impact of advanced cancer on the marital relationship. The link between attachment, caregiving, and care-receiving behaviors are defined. Both are activated and challenged in this population because the continuity of the marital bond is threatened, as well as the balance of reciprocal caregiving, often resulting in heightened marital distress.

Methods: Emotionally focused therapy (EFT), based in a synthesis of systemic, experiential, and attachment theory, is introduced as a marital protocol to both conceptualize and potentially mitigate the level of increased marital distress, and to achieve reciprocal caregiving.

Results: Two case studies are presented and support the benefit of EFT for those couples facing end of life.

Significance of results: The findings from these case reviews advance the literature and offer an empirically validated marital therapy for this population. Such a protocol that emphasizes attachment theory and the inherent link to caregiving and care receiving may serve as a powerful tool to both explain and alleviate marital distress for couples facing end of life. Working models of attachment can contribute significantly to our understanding of why individuals' distress and their experience of emotional support from spouse caregivers vary in the context of end-stage cancer.

The need to facilitate healthy bereavement, resulting from both deaths from life-threatening illnesses as well as violent, sudden deaths, is great. For the past 9 summers, Bereavement Services at Calvary Hospital, Bronx, New York, has sponsored a week-long day camp for bereaved children and adolescents. Each year the program expands by adding new activities to meet the needs of grieving children in therapeutic ways congruent with current research and timely clinical interventions. This article reflects on our experience, which has evolved and become stronger over the past 9 years. It is believed that this program is replicable and can be initiated and developed by other hospitals and organizations interested in developing similar programs.