Caring for the terminally ill: expectations of patient and family.

Preparation for an "easeful" death is the responsibility of the patient, the family, and the medical staff. Two basic elements are acknowledgment and communication, which can be helped or hindered by the physician's way of informing the patient and family about the immediate future. Inadequate communication can result in a disturbing death for the patient and create ill feelings and guilt in the family members and the medical staff.

Psychosocial impact of gynecologic cancer.

The stress that a cancer diagnosis places on a patient and family is frequently aggravated by management and treatment, unless considerable attention is paid to psychologic and social coping and adaptational issues. Cancer arouses feelings of helplessness, dependency, guilt, alienation, and vulnerability, and depending on the stage of illness and on the degree of therapeutic mutilation of genital organs, long-term suffering may ensue unless attention is paid to the support-systems available to the patient. Support includes information sharing, exploring fears and fantasies, helping patients feel some element of control, and, not infrequently, putting patients in touch with others who had adapted to the experience. Considerable attention is now being paid to sexual counseling in recognition of the need for intimate bonding that exists in people. The physician's responsibility in cancer management is to provide resource directly or by referral in order to maintain the morale system of the patient and family over a long time period.

Family members' perceptions of communications in late stage cancer.

A study of patterns of communications in families with a terminal cancer patient being treated at three urban institutions revealed that may first-order relatives (spouses, children, siblings) of patients did not have a communication link to the physician, especially if direct communication was not established at the time of diagnosis. Family members were frequently critical of the way information was communicated, yet relied upon the physician's interpretation of the patient's status to form their own opinion of the patient's future. Intra-familial communications regarding illness and dying were frequently discordance and guarded, leading to preceptions that the patient was withdrawing, and fostering a reliance upon the hospital for terminal care. More than half of the family members were uncomfortable visiting the patient in the hospital, experiencing feelings of helplessness, or sensing helplessness in the patients. Bearing the patient's pain was seen as particularly difficult.

Moral dilemmas in clinical cancer experimentation.

An examination of certain moral tensions that have developed in clinical cancer experimentation is offered. It is argued that the individual partner must be addressed in his singular unique position, rather than as a potential for the future good.

The impact of hospice care on families.

The impact of a hospital-based Hospice service for late-stage cancer patients, on the families of fifty-eight bereaved spouses was studied, retrospectively. Hospice care in general was rated significantly higher when compared to the prior care (p less than .001) received by patients and families. Hospice care contributed to improved family functioning and well-being, with the vast majority of spouses reporting feelings of increased support, improved coping by all family members and increased closeness, when compared to prior care. Consequently, over three-quarters of the families reported being emotionally prepared, and prepared in a practical sense, for the death of their loved one. Families appear to be coping reasonably well during bereavement especially those who reported feeling emotionally prepared for the death. Health problems were reported as a large problem in 15 percent of the respondents, which compares favorably to previously documented research on bereavement and illness. These findings indicate that a Hospice mode of care, with its support of families during terminal and bereavement stages, impacts significantly on families' abilities to cope with the terminal phase and adapt afterwards.