Psycho-social factors of terminal illness were explored with 36 terminally ill hospice patients. These findings were compared with staff accounts to assess whether staff held different perceptions of terminal illness from patients. The dynamic nature terminal illness was explored by re-interviewing thirteen of the original patient-staff dyads 4-6 weeks later. Psychological responses to cancer have been shown to be affected by a variety of psycho-social factors, including age, length of illness and social support. The experience of terminal illness may be different from previous stages of cancer, possibly due to the patient's realisation of the nearness of death (Yalom, 1980). Models of dying highlight the patient's perspective and social environment in the determination of the dying process. Possible communication difficulties between patient and staff and the use of 'proxy data' in clinical and research settings highlights the need to explore patient and staff perspectives more fully. A measure which described positive and negative experiences of terminal illness was developed (POTIS) and administered with the Hospital Anxiety and Depression Scale to terminally ill patients within a hospice. Staff were identified with a patient and their ratings of the patient's experience gathered. Thirteen patients/staff pairs were re-interviewed using the above procedure. Results indicated that staff rated patients as being more anxious than patient's own ratings. There was no difference between staff and patient ratings of depression. Cluster analysis was used to describe natural groups occurring within patient responses to the POTIS and patient demographic data used to describe these groups. Small sample numbers limited conclusions regarding change of perceptions over time. Issues regarding staff and patient perceptions were discussed in terms of the clinical and research use of proxy data. Possible problems with the internal reliability of measures and sample bias which occur with this population were discussed.

There is evidence of a relationship between sleep-wake disturbances and pain variables in cancer patients. It is hypothesized that pain affects all aspects of sleep patterns. Pain has been known to affect sleep disturbances; however there are different facets of sleep-disturbances and pain that can be evaluated. These variables include pain distress, pain intensity, pain at its worst, relief from pain, sleep distress, how well the patient sleeps, how tired one feels, and drowsiness distress. Several studies identify relationships between sleep-disturbances and pain. This study using secondary analysis was designed to correlate variables related to sleep-wake disturbance and pain in cancer patients admitted to hospice home care. The study sample included 209 cancer patients from a previously completed clinical trial with various cancer diagnoses. Results of sleep and pain variables were re-analyzed using Pearson correlations. The results showed significant positive relationships between pain distress and sleep distress (p = .000), difficulty sleeping and pain intensity (p = .008), and sleep distress and pain at its worst (p = .008). There were no significant relationships found between sleep distress and relief from pain, pain distress and how well the patient sleeps, pain distress and how tired one feels, and pain distress and drowsiness distress. Sleep-wake disturbances and pain have been studied in cancer patients, but there is little known concerning pain and its correlation to sleep disturbances of cancer patients admitted to hospice home care. This study provided important information on the relationship between sleep-wake disturbance and pain variables in this group of cancer patients. This study provides data to support the necessity to provide complete and accurate assessments of sleep and pain symptoms on admission to hospice home care and throughout the patient's care to aid in improved quality of life.

This qualitative and quantitative study focused on exploring hospice patient’s perceptions of family support. Family support was conceptualized as which family member they expect to receive support from, types of support provided, frequency of support, family communication about medical illness, and type of support that is perceived to be most helpful. Fifteen partcipants between the ages of 70 to 98 were interviewed using purposive sampling. Findings showed that although participants found both physical and emotional support helpful, more than half reported perceiving emotional support as the most helpful. Recommendations for social work practice and research were discussed.

There is evidence of a relationship between pain and associated symptoms, specifically constipation and dyspnea, and quality of life. Literature supports that endstage lung cancer patients suffer more symptoms than those with other types of cancers, and the course of treatment is primarily palliative, as many of these diagnosed patients cannot be cured. The purpose of this secondary analysis of data was to evaluate the relationships between pain and other common symptoms in end stage lung cancer patients in hospice care, and the relationships among pain, dyspnea, constipation and quality of life. The study sample included fifty lung cancer patients admitted to a hospice program, reporting pain. A series of Pearson’s correlations were used to analyze relationships between the variables pain intensity, pain distress, dyspnea intensity, dyspnea distress, constipation intensity and the relationships of these variables with quality of life. The results showed positive significant correlations between pain intensity and pain distress (r = .44, p = .002), dyspnea intensity and dyspnea distress (r = .47, p = .001), and constipation intensity and quality of life (r = -.57, p = .013). Pain and the relief of pain have been studied extensively in cancer patients, yet little research has been done in the way of side effects of opioid use, specifically constipation. This study reinforces to vi nursing the importance of a thorough assessment upon admission to hospice, and at each subsequent nursing visit, which includes a bowel habit history, current medications in use, potential risk for developing constipation and management of constipation once it is present. Hospice patients with lung cancer are reporting a decrease in quality of life secondary to constipation. Prevention or rapid alleviation of this symptom will provide comfort and allow the patient to focus on important end of life tasks.