"End-of-Life Care is more than Wound Care": Health-Care Providers' Perceptions of Psychological and Interpersonal needs of Patients with Terminal Cancer.

ABSTRACT

AIM: People diagnosed with cancer and in end-of-life care may have a range of needs. These needs may be inadequately expressed, recognized, or responded to by family members and health-care providers. The present study aimed at exploring health-care providers' perceptions of the interpersonal needs, psychological needs, and unfinished business among terminally ill cancer patients during the end-of-life care. METHODS: The sample consisted of 11 health-care providers, including physicians, counselors, social workers, and nurses from the end-of-life care settings in Bengaluru, India. A cross-sectional qualitative design was used and involved semi-structured interviews and focus group discussions. RESULTS: Thematic analysis identified themes related to health-care providers' perceptions of patients' prominent interpersonal needs, psychological needs, and expressions of "unfinished business" and their perspectives and experiences. There were three themes related to psychological needs and concerns (i) experience and expression of negative emotions, (ii) mental health concerns, and (iii) confronting mortality. Three themes emerged in the domain of interpersonal connections (i) support and closer connections with family, (ii) disconnection from family relationships, and (iii) building new connections at the hospice. Two themes were identified related to unfinished business (i) types of unfinished business and (ii) addressing unfinished business. The findings also highlighted health-care providers' perspectives and experiences (i) need for expanded end-of-life care training and (ii) experiences of emotional labor. CONCLUSIONS: The findings have implications for comprehensive training of health-care providers and for assessment, support, and care services in palliative care settings in India.