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.
Method: 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.
Significance of results: 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.