How to come to terms with facing death: a qualitative study examining the experiences of patients with terminal Cancer

Ayumi Kyota,Kiyoko Kanda

doi:10.1186/s12904-019-0417-6

Abstract

BackgroundCancer patients who have reached the terminal stage despite attempts at treatment are likely to experience various problems, particularly as they encounter increasing difficulty in doing what they were able to do easily, and their physical symptoms increase as the disease advances. The purpose of this study is to explore how terminal cancer patients who have not clearly expressed a depressed mood or intense grief manage their feelings associated with anxiety and depression.MethodsEleven terminally ill patients with cancer who were receiving symptom-relieving treatment at home or in palliative care units were interviewed. Interviews were generally conducted weekly, two to five times for each participant. In total, 33 interviews were conducted, and the overall interview time was 2027 min. Data were analyzed via qualitative methods.ResultsThe following five themes were extracted regarding the experience of managing feelings associated with anxiety and depression when facing death: “I have to accept that I have developed cancer,” “I have to accept the undeniable approach of my own death,” “I have to accept my need for assistance,” “I have to accept this unsatisfactory circumstance” and “I have to accept this as my destiny and an outcome of my life.”ConclusionThe present study revealed key themes related to how patients come to terms with their impending death. Nurses are required to comprehend the patients’ complicated mental patterns that are expressed in their daily languages. Furthermore, the findings clarify the necessity for nurses to help patients understand the acceptance of a terminal disease state during a patient’s final days.

Highlights

Cancer patients who have reached the terminal stage despite attempts at treatment are likely to experience various problems, as they encounter increasing difficulty in doing what they were able to do and their physical symptoms increase as the disease advances
More than 80% of cancer deaths occur in general wards; home hospice and palliative care units (PCUs) accounted for less than 20% of cancer deaths [4]
The purpose of this study is to explore how terminal cancer patients who have not clearly expressed a depressed mood or intense grief manage their feelings associated with anxiety and depression

Summary

Introduction

Cancer patients who have reached the terminal stage despite attempts at treatment are likely to experience various problems, as they encounter increasing difficulty in doing what they were able to do and their physical symptoms increase as the disease advances. In 2011, 37.4% patients who died worldwide could have benefitted from specialist palliative care [1]. More than 34% of adults in need of palliative care eventually died due to cancer [1]. The need for palliative care for terminal cancer patients is high worldwide. There were 357 palliative care units (PCUs) and 7184 beds to serve Japan’s population of 127 million [3]. More than 80% of cancer deaths occur in general wards; home hospice and PCUs accounted for less than 20% of cancer deaths [4]. PCUs have beds for cancer and acquired immune-deficiency syndrome patients with the average length of stay of 33 days, and the average deceased patient discharge rate is 84% [3]. Only 991 hospitals (or 13.3%) have palliative care teams for

Objectives

Methods

Results

Discussion

Conclusion