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Evaluative research on the holistic approach to care and treatment of the terminally ill

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Title:
Evaluative research on the holistic approach to care and treatment of the terminally ill
Creator:
Hendon, Marvin Keith, 1960-
Publication Date:
Language:
English
Physical Description:
vi, 93 leaves : ; 28 cm.

Subjects

Subjects / Keywords:
Analysis of variance ( jstor )
Death ( jstor )
Disease remission ( jstor )
Diseases ( jstor )
Hospice care ( jstor )
Hospitals ( jstor )
Psychological assessment ( jstor )
Psychology ( jstor )
Questionnaires ( jstor )
Symptomatology ( jstor )
Dissertations, Academic -- Psychology -- UF
Holistic medicine ( lcsh )
Hospice (Terminal care) ( lcsh )
Psychology thesis Ph. D
Terminal care ( lcsh )
Terminally ill ( lcsh )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1985.
Bibliography:
Bibliography: leaves 88-92.
General Note:
Typescript.
General Note:
Vita.
Statement of Responsibility:
by Marvin Keith Hendon.

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Resource Identifier:
000878764 ( ALEPH )
14911772 ( OCLC )
AEH6523 ( NOTIS )

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EVALUATIVE RESEARCH ON
TO CARE AND TREATMENT


THE HOLISTIC APPROACH
OF THE TERMINALLY ILL


MARVIN


KEITH


HENDON


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE
DOCTOR OF PHILOSOPHY















ACKNOWLEDGMENTS


author


wishes


express


gratitude


several


individuals


who


encouragement


served


throughout


constant


this


entire


source


project.


support


Without


prayers,


emotional


and


financial


support


that


this


writer


received


from


family


friends,


doubtful


that


this


project


could


have


ever


been


completed.


author


particularly


she's


thank


mom


dad.


author


is especially


grateful


to The


Reverend


Henry


Porter


Development,


members


they


Westcoast


imparted


this


Center

writer


Human


first


ability


to dream


second


self-confidence


necessary


make


those


dreams


come


true.


Lastly,


patients


author


Methodist


wishes


Hospice


thank


who


both


willingly


staff


contributed


their


time


themselves.


Each


patient


who


was


inter-


viewed


this


study


served


a new


dimension


meaning


life.

















TABLE OF CONTENTS


PAGE


ACKNOWLEDGMENTS.......................................

ABSTRACT.................................. ...... .. ..

CHAPTER I INTRODUCTION................................


Rationale Underlying the Hospice.....
Purpose of Study....................
Definition of Terms..................
Summary and Hypotheses...............


CHAPTER II REVIEW OF RELATED LITERATURE...............


Needs of the Terminally Ill................
Hospice Care...............................
Developmental Status of Hospice..........
Evaluative Research Data on Hospice Care.
Conclusion.................................
Questionnaire Literature Review............
Beck Depression Inventory................
Threat Index.............................
Hopelessness Scale.......................
Summary and Expected Results...............


......6.6
....00...


CHAPTER III METHODS...... ..... ......................


Subjects..............
Life-Ending Group......
Life-Threatening Group.
Life-Limiting Group....
Instruments..............
Threat Index..........
Hopelessness Scale.....


* ..


Beck Depression Inventory....
Procedure......................


CHAPTER IV RESULTS....................................











TABLE OF CONTENTS (CONTINUED)


PAGE


CHAPTER V DISCUSSION AND SUMMARY......................

Discussion..........................................
Implications for Counseling and Future Research.....
Summary.............................................

APPENDICES

A HOSPICE INCLUSIONARY CRITERIA...................

B PSYCHO-SOCIAL AND HOSPICE INTAKE ASSESSMENT
FORM. ... ....... ........ .

C HOSPICE TREATMENT PLAN..........................

D CANCER IN REMISSION INCLUSIONARY CRITERIA.......

E THREAT INDEX. ...................................


HOPELESSNESS


SCALE ....... ............


G BECK DEPRESSION INVENTORY.......................

H INFORMED CONSENT FORMS..........................

I PERSONAL DATA SHEET.............................

J BAR GRAPHS OF MEANS FOR EACH GROUP..............

REFERENCES............................................

BIOGRAPHICAL SKETCH...................................















Abstract


of Di
Univer


ssertation


sity


Presented


Florida


Graduate


in Partial


School


Fulfillment


Requirements
Doctor of


ree


Philosophy


EVALUATIVE


TO CARE


RESEARCH


AND


ON THE


TREATMENT


HOLISTIC


OF THE


APPROACH


TERMINALLY


Marvin


Keith


Hendon


December


Chairperson:


Franz


Epting,


Ph.D


Major


Department:


Psychology


purpose


this


study


was


to examine


effective-


ness


hospice


care


assisting


terminally


patients


cope

show


with

that


their


impending


patients


who


death.

were


This


receiving


research


attempted


appropriate


care


through


hospice


would


less


threatened


more


pressed


pessimistic


about


life


than


patients


who


were


coping


with


temporary


life-


limited


illness


those


who


one


point


time


face


potentially


life-


threatened


illness.


Three


groups


subjects


were


used:


Terminally


patients


who


were


receiving


hospice


care


life-ending


group);


hospital


patients


who


were


coping


with


short-term










currently


within


remission


hospi


(life


program


-threatened


have


group).


Patients


prognosis


ess


than


months


had


to have


been


receiving


hospice


care


least


one


month.


Patients


within


cancer


re-


mission


group


have


favorable


prognosis


longer


receive


active


treatment


their


illness.


Patients


within


life-


limited


group


have


temporary


ness


which


was


severe


enough


require


a hospital


stay.


results


showed


that


there


was


significant


dif-


erence


between


patients


coping


with


terminal


illness


those


coping


with


temporary


illness


However,


both


groups


were


significantly


higher


than


cancer


in remission


group


on measures


hopele


ssness


These


results


were


also


found


on measures


depression.


final


variable


that


was


ex-


amined


was


fear


death.


results


showed


that


patients


who


their


were


own


within


death


hospice


than


group


patients


were


life-


ess


threatened


limited


group


life


-threatened


group.


Hopele


ssness


was


measured


Hopelessness


Scale


developed


Beck


Weissman.


Depre


ssion


was


measured


Beck Depression


Inventory


death


threat


was


measured


Threat


Index


developed


Krieger


, Epting


Leitner.















CHAPTER


INTRODUCTION


More


take


than


place


two-thirds


within


deaths


hospital


United


institutional


States


setting


(Strauss


Glass


1970).


Patients,


often


against


their


will,


are


forced


spend


last


fleeting


moments


life


some


type


extended


care


facility.


Family


members,


friends


and


well-wishers


alike


often


assume


that


best


leave


their


loved


ones


hands


those


who


are


trained


art


of prolongation


life.


Armed


with


latest


tools


medical


technologi-


advancement,


role


doctors


lifesaver.


and

With


nurses


cure


have


begun


remission


take


illness


their


aim,


medical


staff


sets


out


conquer


their


adversary.


While


these


goals


are


most


admirable,


there


comes


point


terminally


patient


when


these


goals


are


longer


appropriate.


this


point


that


many


begin


to question


adequacy


functional


value


continued


treatment.


Though


impending


death


inevit-


able,


doctors


are


often


unprepared


unwilling


accept













Freeman,


Brim


Williams


1970)


report


that,


with


exception


native


personality


endowments,


physicians


nurses


are


equipped


cope


with


needs


dying


patient.


Very


receive


training


that


would


qualify


them


deal


objectives


with


are


approaching


reflective


death.


death


Their


attitudes


avoidance


attitudes


that


are


apparent


within


society.


Freeman


further


note


sion


their


that


health


death


efforts


professionals,


with


patient


forestall


"commonly


his/her


dying


avoid


process


discus-


relatives;


fail


when


when


effort


useless,


they


customarily


lose


interest


withdraw


from


scene.


These


findings


have


been


cor-


roborated

Saunders


work


(1978);


Caldwell


sser


Mishara


and

(197


Strauss


(1965);

Cassell


(197


patient


family


friends.


left


death


alone,


usually


estranged


very


from


sorrowful,


painful


humiliating


ordeal.


pain


suffering


that


experienced


stems


from


more


than


just


physical


discomfort.


roots


are


almost


inextricably


intertwined


with


those


spiritual,


psycho-


logical


social


discomfort.


However,


dying


patient,


these


concerns,


though


crucial,


are


often


forced


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provide


more


holistic


form


treatment


those


with


terminal


illness.


focuses


incorporating


treatment


to meet


as many


varying


needs


dying


patient


as pos


sible.


purpose


this


study


to evalu-


effectiveness


this


form


treatment.


Rationale


Underlying


Hospice


Customarily,


hospi


ces


are


dedicated


total


care


dying


patient.


Their


aim


to keep


patients


pain


free,


comfortable


fully


alert


during


final


phases


their


illness


their


life.


Treatment


longer


geared


toward


cure


prolongation


life;


rather,


geared


toward


eradication


pain.


hospice


focu


ses


only


physical


aspects


pain,


but


psycho-


logical,


spiritual


social


factors


that


contribute


patient


discomfort.


task


hospice


staff


observe

present


(Woodson


appropriate


and

and


determine


active,


1976).


which

what c


Once


care


giver


four


combination ,


role


can


each


begin


components


to what


asses


are


degree


sed,


intervene.


care


giving


staff


generally


consists


doctors,


nurses,


psycho-


logi


, social


workers


, family


friends.


C. S


II I -


.













though unnecessary,

discomfort centers


commonly

around ke


accompany


!eping


death.


communication


One

open


such

and


honest.


staff


addresses


patient


s personal


fears


method


direct


provides


but


caring


patient


sensitive


with


answers


manner.


his/her


Thi


ques-


tions,


acts


a model


communication


which


relatives


friends


can


adopt,


thus


drawing


closer


together


patient


s/her


hospice


including


giving


family


team


patient


process.


also


signifi


cant


recognizes


s family


this


loved


highly


others.


need


value


ones


specialized


care


medical


technology,


with


hospice,


medication


the

the


patient


patient


family


that


may


family


care


are

and


members


needed


generally


welfare.


allowed

assist


very


little


Within


administer


maintenance


patient


s care.


hospice


commitment


care,


unlike


hospitals,


extends


beyond


needs


patient


inclusive


anyone


who


plays


a primary


role


patient'


s life.


Once


patient


counseling


died,


facilitate


hospice


family


staff


members


generally


through


offers


healthy


process


mourning.


They


alert


mourner


reality













that


grief


cess


that


takes


both


time


work.


They


also


mourner


in adapting


loss


loved


one.


hospice


movement


seeks


provide


compassionate


care


terminally


their


families.


Their


desire

live m


allow


eaningfully


those


until


who


they


are


die.


dying


Table


opportunity


, page


, provides


list


principles


hospice


(Dobihal,


Lack,


Rezendes,


Wald,


1975).


Purpose


of Study


been


demonstrated,


needs


terminally


patient


hospital


extend


beyond


practices.


competencies


effort


expand


standard


concept


medical


treatment


include


concerns


relevant


dying


patient,


concept


hospice


was


created.


hos-


pice


provides


patients


with


positive


atmosphere


that


designed


facilitate


foster


a positive


attitude


toward


death.


Given


dying


such


patient


environment,


would


less


can


depressed,


expected


more


that


optimistic


less


threatened


own


death


than


patients


who


receive


this


type


care.


purpose


s study


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TABLE


PRINCIPLES


OF HOSPICE


The
poss


patient
ible so


needs
that


to be
energy


as symptom


can


be used


free


to live.


Help is
whether


Continuity


same
local


Care
and


available


patient


care


care


must


health


givers
where t


to all


, relative


shall


team


those


involved,


friend.


sustained


regardless


always


patient


of the


available


needs


when


them


The
vide


structure
multiple


patient/family


health


team


care


options
under


in different


stem


must


available


care


pro-


same


settings


Twenty-four


hour


care


patient/family


blem


must


be available


wherever


pro-


Education


patient/family
communication.


couns


eling


is required


share


knowledge,


decisions.


staff


facilitate


reach


Care


requires


ciplines


care


collaboration


person


working


or many als
as a health


team.


Teams m
persons
munity


spice


lust
and


custom


made


and


institutions


in addition
staff.


call


com-


upon


to patient/family


care


staff
with


shall


integrate


medical


human


nurs


stic


care


religious,


istic
4- ; -1


components


philo


sophic


care


human-


are


as essen-


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TABLE


(CONTINUED)


patient/family


facing


death


needs


someone


who


emotional


cares


and


investment


this


requires


the.part


staff.


Caring
giving.


involves


The hospice
an optimal
health.


receiving


team will
environment


see


that


as well


to provide
fosters


Replenishment


within


emotional


family will


investments


be provided


through mutual


support


Hopelessness


Scale


developed


Beck,


Weissman,


Lester


Trexler


974)


dep


ression.


was


measured


Beck


Depression


Inventory


(1961).


Definition


Terms


facil


tate


reading,


terms


are


defined


below


which


are


either


unique


system


language


used


death


research


or are


operate


ionalized


this


study.


Threat


Index--


"A measure


death


threat


derived


from Kelly


sesses


s personal


extent


construct


to which a


theory.


person'


as-


construct


system i


structured


to anticipate death"














Hopelessnes


s--A


system


negative


expectancies


that


one


holds


concerning


himself


future.


Future--The


amount


time


existing


between


present


moment


time


one


s death.


Summary


hospice


focuses


on providing


palliative


care


terminally


ill.


While


such


care


does


foster


pro-


longation


life,


does


foster


notions


humanism


death


with


dignity


Given


environment


where


death


can


seen


more


transition


than


end-state,


can


hypothesized


that


degree


positive


feelings


associated


with


death


would


increase


fear


threat


death


would


decrease.


Testing


this


hypothesis


from


idealistic


standpoint


would


call


interviewing


terminally


patients


within


hospice


comparing


results


those


within


hospital


However,


open


discussion


death


with


terminal


non


-hospice


patients


proves


to be


impossible


task.


Most


doctors


1970) ,


consistent

Lynch (197


with


7),


research


Davidson


(1975),


Bowlby


Smith


Parkes

1971),


view


such


a discussion


as unethical


, bizarre


inapproprl-


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true.


Patients


have


not


been


prepared


deal


with


their


impending


death.


This


itself


lends


empirical


support


need


needs


establish


dying


impact


hospice


some


patient.


care


type


program


Thu


order


catering


need,


cater


evaluate


terminally


patients


will


compared


cancer


patients


who


are


remission


are


actively


involved


with


living


life.


Both


these


groups


will


then


compared


patients


who


are


coping with


temporary


life-limited


illness.
















CHAPTER


REVIEW


OF RELATED


LITERATURE


literature


reviewed


this


chapter


been


divided


into


major


sections.


first


section


focuses


examining


needs


terminally


ill,


develop-


mental


status


hospice


research


performed


hospice


care.


final


sec


tion


focuses


examining


research


ments


performed


Beck


each


Depression


three


Inventory


measuring


Threat


instru-


Index


Hopelessness


Scale.


Needs


Terminally


effort


justify


maintaining


stance


from


terminally


patient,


most


doctors


and


hospital


staff


assume


that


patient


does


want


talk


about


illness.


attempting


verify


this


myth,


Simmons


Given


1972)


performed


study


determine


dying


patient


willingness


express


feelings


about


own


death.


from

the


These


terminal


desire


researchers


illness.


communicate


studied


these

their


patients


who


patients,


feelings.


suffered


expre


However,


ssed

they


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reported


Buckingham,


Lack,


Mount,


MacLean,


Collins


(1976) .


These


researchers


note


that


dying


patient


communication


essential.


Communication


gives


patient


sense


control


involvement


with


decision


making.


This


helps


him


maintain


both


identity


self-respect.


terminal


patient,


emotional


death


often


pre-


cedes


biological


survival,


but


death.

hope.


patient


Found


1972)


not

notes


only r

that


obbed


patient


s health


fails,


they


begin


experience


gradual


decline


freedom.


They


longer


have


right


move


about

liar


freely,


home


interact


surroundings


and

and


explore.

control


They

over


are


their


denied


body


fami-


en-


vironment.


inability


patient


have


access


these


basic


freedoms


aids


destroying


their


will


live.


Once


this


destroyed,


patient


s remaining


months


are


very


dismal


filled


with


desire


a speedy


demise.


process


emotional


death


been


equated


with


Erickson


s stages


of psychosocial


development.


Grady


1975


notes


that


dying


patient


forced


into


conflict


ego

cess


integrity


fully


versus


integrate


despair.


their


When


impending


individuals


death,


cannot


despair


suc-


results.


notes


that


individuals


begin


experience


sense


despair


when


life


loses


a -. l s


Ouroose.


meaning.


order













this


conflict,


Grady


outlines


three


guidelines


that


health


care


staff


should


follow.


They


are


help


patients


review


their


life


(i.e.,


what


things


they


have


acc


ompli


shed


those


things


that


they


desire


to accomplish


patient


readily


share


feelings


depression,


anxiety,


comfort,


connect


patient


and


family


adequate


helping


resources.


While


these


needs


are


essential


dying


patient,


they


within


domain


of standard


hospital


care.


Klagsburn


(1971)


reports


similar


findings


study


needs


terminally


patient.


Klagsburn


notes


that


dying


patient


three


basic


needs.


They


are


need


to maintain


control


over


their


destiny,


procedures


need


(this


under


facilitates


stand


lowering


technical


anxiety


language


levels


thus


makes


easier


face


unfamiliar


treatments),


need


to share


feeling


of being


unjustly


denied


life.


McCorkle


(1974)


studied


effects


touch


seri-


ously


this


patients.


most


This


researcher


fundamental


need


notes


greatly


that


denial


enhances


feel-


ings

makes


patients


isolation


communication


with


and

and


terminal


withdrawal.


rapport


illness,


absence


harder


need


establish.


touch


touch

For


plays


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this


in his


research


on care


terminally


at home.


notes


that


important


patient


maintain


close,


loving


bonds


longer


patient


aware


emotional


ties,


healthier


their


emotional


life


will


This


point


stressed


writings


of Mount


(1976).


notes


that


terminally


patients


must


always s


helped


toward


maintaining


positive


outlook


based


reality,


confidence


trust.


ability


maintain


self-respect


sense


dignity


crucial


survival.


However,


dying


patient,


these


qualities


are


among


first


things


that


they

ify


se.


which


Nash


factors


(1977


affect


performed

ct the dj


a study


Lgnity


order t

person


o ident-


with


terminal


dignity


illness.


supporting


found


responses


that


were


most


indicative


frequent


pain,


non-


loss,


loneliness


intrusiveness.


Patients


often


feel


that


staff


when


does


they


understand


have


that


to continually


they


pain


are


important


medication.


This


turn


increases


their


feelings


loneliness


loss.


Concordantly,


their


self-respect


eaten


away


when


nurses


other


staff


members


intrude


and


patient


life


transitions.


This


happens


when


persons


mini


steering


n a^ lrrnral


nri1 n +-


* S,


Chnn E


C~nt


Lk~L


"F-nf


hn













terminal


patient


s world


begins


decrease,


their


need


treated


valuable


living


human


being


increases.


Wentzel


(1976)


reports


that


terminal


patients


often


need


more


affection


attention


final


phase


their


people


that


illness.


traditionally


when


However,


begin


tending


this


point


to withdraw.


needs


Hinton


dying


at which


(1972)


patient,


most


notes


"empha-


must


always


upon


tending


person,


battling


with


disease,


treating


one


who


feels


symptoms,


just


treating


symptoms"


Stoddard


1978)


states


that


most


important


need


terminally


that


they


need


to know


that


they


matter


as a human


being,


dying


patient


unique


network


needs


that


accompany


physical


ailment.


order


adequately


cater


must


their


expanded.


needs,


concepts


Concerns


such


treatment


alienation,


care


abandonment,


isolation


trust,


been


demonstrated,


are


crucial


dying


patient.


However,


these


often


remain


unat-


tended


Alternate


daily


forms


admini


treatment


stations


must


hospital


developed


care.


ensure


that


needs


terminally


are


met.


Hospice


Care













Christopher


care


s was


born


terminally


need


ill.


was


offer


first


palliative


free-standing


facility


that


was


dedicated


total


care


dying


patient.


founding


s hospice


under


director-


ship


Cicely


Saunders


marked


beginning


new


trend


treatment


terminally


patient.


growth


hospice


care


United


States


relatively


new


phenomenon.


pired


work


Saunders,


Sylvia


Lack,


1974,


established


first


hospice


United


States.


inability


establish


adequate


funding,


this


hospice


program


was


unable


secure


started


free-standing,


providing


autonomous


hospice


facility.


functions


Hence,


through


coordinated


home


service


model.


1981,


Joint


Commission


on Accreditation


Hospitals


(JCAH)


identi-


fied


United


existence


States


of well


(Vandenbos,


over


DeLeon


hospice


programs


Pallak,


Within


past


five


years,


this


figure


doubled


well


over


thousand.


Programs


hospice


care


now


currently


exist


four


different


models


These


include


hospital-based


palliative


care


units


home


care


services,


free-standing


institutions,


-I C 1.. .- .- t~--- r 4I-A--


,tIn -4-r


.,- ,ta ,,u 1 ,,


~ A A CL Y~ : ~ rr


~ UA CY


LA L*













are


independent


home


health


agencies,


percent


are


commun-


based,


percent


are


totally


volunteer


based.


Hos-


pice

twenty


programs

years.


have

They


shown

have r


remarkable


nade


growth


significant


over


strides


within


past

the


field


health


care.


Their


growth


can


evidenced


rapid


expansion


throughout


United


States


Great


Britain.


Evaluative


Research


Data


on Hos


pice


Care


While


great


deal


literature


been


written


hospice,


there


been


very


little


done


terms


research.


This


section


literature


review


will


focus


on studies


that


have


examined


usefulness


of hospice


care


terminally


ill.


Wald


(1971)


studied


effects


environment


dying


patient.


Based


re-


search,


she concluded


that


quality


a large


which the
self acts
the most


of the


extent


process
not only
effective


dying
the phy
occurs.


proc


ess


sical
The


as a catalyst
treatment for


affected


surroundings
surrounding


initiate
patient


an individual,


the complex
inextricably


also


psychosocial


entwined


assists


relationship


with


in managing


that


medi-


patient'


treatment


255) .













treatment.


less


threatening


patient


s environment,


easier


will


them


cope


with


their


dying.


addition


environment,


providing


hospice


patient


settings


with


attempt


nonthreatening


integrate


patient


s family


into


everyday


treatment


care


patient.

patients


Buckingham


(1982) ,


non-hospice


patients,


study

found


comparing


that


hospice


feelings


pers


onal


inadequacy


inferiority


were


significantly


lower


within


hospice


largely


hospice


group.


use


attributes


family


this


members


difference


primary


care


givers.


further


notes


that


such


practices


only


benefit


patient,


their


family


as well.


serves


relinqui


some


feelings


guilt


helplessness


that


family


often


experience


Buckingham


Foley


(1978


compared


hospice


hos-


pital


patients


on anxiety,


depression


social


adjustment.


control


effects


that


could


have


been


experi-


menter


bias,


these


researchers


used


self-report


question-


naires


Anxiety


was


measured


Zuckerman


Adj


ective


Checklist,


depression


was


measured


Symptom


Checklist


social


adjustment


was


measured


Social


Adjust-


ment


Self-Report


Patients


exhihi te


Scale.

r 1 nwsr


Their

1 pt* 1


results


SI l


showed


rflv1 O*?


S


that


A anra


spice
c? c i nn













these


same


researchers


results


Ingles


(1974)


also


staff


reports


tested


that


staff.


they


that


They


found


quality


care


found


patients.


that


dying


death.


patient


This


receives


researcher


affects


notes


perceptions


that


about


quality


own


care


significantly


increased


when


nurses


are


trained


meeting


needs


dying


patient.


notes


that


within


hospice


environment,


nurses


are


trained


accept


their


own


feelings


about


death,


listen


compassionately


construc-


tively


fears


others


promote


physical


psychological


support


patient.


This


type


train-


makes


transition


from


life


death


peaceful


poss


ible.


McNulty


(1971)


examined


usefulness


hospice


commitment


home


care.


notes


that


allowing


patient


spend


much


time


possible


home,


can


significantly


reduce


feelings


of isolation


estrange-


ment


that


patients


feel


from


their


family.


They


are


able


an active


participant


life


, which


serves


to maintain


feeling


of identity


sense


self


worth.


Melzac


, Ofiesh,


Mount


(1976


examined


effec-


tiveness


hos-


pice


s commitment


eradication


. S


1


R m l --


I -


__














inhibit


pain


signals


before


they


reach


nervous


system.


This


mixture,


administered


with


phenothalizine


(Valium,


Librium),


sensory


serves


awareness


decrease


anxiety,


pain.


despair


attempt


maintain


continuous


control


over


pain


usually


administered


every


four


hours.


This


assures


patient


that


they


will


remain


pain


free,


thereby


diminishing


their


fears


expec-


stations


pain.


researcher


administered


Brompton'


mixture


within


illness


oriented


mixture


However,


greater


patients


hospital

within


hospital


significantly


degree


patients


within


private


palliative


those


care


suffering


rooms


wards.


unit


with


different


found


reduced


pain


within


that


pain


reduction


palliative


(hospice

terminal

recovery


Brompton'


three


was


groups.


significantly


care


unit.


difference


is attributed


positive


psychological


input


unit.


cerned


notes


staff


that


help


presence


volunteers


highly


provide


con-


comfort


good


cheer


which


play


crucial


role


reduction


pain.


There


were


significant


differences


between


patients


private


rooms


on hospital


wards.


hospice


s commitment


post-death


follow-up


care


. f ,r


F-.... 1 .


i-vt


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- ....- n-. .


~r r I; n rr L


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I


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I













likely


experience


bereavement.


Families


unusual


within


amount


hospice


difficulty


follow-up


after


care


program


were


matched


with


families


who


were


receiving


type


twenty


group


months


follow-up

after be


experienced


support.


!reavement,


less


depre


families


SSion,


results

Within


fewer


showed


that


hospice


psychosomatic


symptoms


lower


anxiety


than


control


group.


hos-


pice


group


also


reported


ess


inclination


increase


their


consumption


of alcohol,


tobacco


tranquilizers.


Conclusion


There


are


evaluate


very


value


empirically


of hospice


care.


based

However,


studies


that


most


studies


that


have


been


performed


tend


provide


overwhelm-


support


alternative


to dying.


hospice


s commitment


Liss-Levinson


a more


1982)


positive


article


hospice


search


care,


emphasizes


performed


need


hospices.


qualitative


notes


that


re-


need


exists


within


hospice


well


trained


psychologists.


s need


further


highlighted


survey


performed


Buckingham


Lupu


1982) ,


which


they


found


that


only


percent


of existing


hospi


ces


employ


psychologists.


In order


h rnnnrrr; nS


1- -' InA t* -, sf


In*r~A~~~


/*/*.- 4- U


rnn


Irsr


Crru













Questionnaire


Literature


Rev iew


This


section


literature


review


examines


prior


research


performed


on each


three


questionnaires.


Beck


Depre


ssion


Inventory


Beck


Depression


Inventory


was


first


introduced


into


field


attempting


scientific


to provide


research


a measure


1961.


depression


authors


that


were


would


functional


itself


within


designed


depression.


complex

tive,

order i


emotional


notivationa


gain


theoretical


detect


authors

disorder

1 and b


accurate


conceive


framework.


measure


instrument


severity


depression


consisting


'ehavioral


affective,


components.


assessment


one


being


cogni-


Hence,


emotional


state,


it is


necessary


measure


each


these


symptoms


intensity.


inventory


does


this


asking


individu-


select


from


a group


statements


one


which


best


describes


their


mood.


more


dysphoric


statement,


greater


value.


Since


development,


Beck


Depression


Inventory


been


Witting,


used


wide


Hanlon


variety


Kurland


research.


(1963


used


Nussbaum,


Depression


Tnvunt-n ru


p > T 0 a ur r I I o f 4 -


^ u(-n ^-


Tnoa ela-To


C u n ~ Lm A YI L


T1--T0 .


nr


AYI


1 (













Depression


Inventory


both


prior


immediately


fol-


lowing


completion


month


treatment


program.


These


clinicians


found


that


individuals


who


were


clinically


treated


depression


scored


an average


Beck


Depression


Inventory


prior


treatment.


Their


scores


conclu


sion


program


dropped


significantly


average


progressed

moderate


These


from


patients


state


depression.


There


were


severe

were


considered


depression


significant


have


one


changes


noted


a comparable


control


group.


additional


study


performed


Nussbaum


Michaux


(1963) ,


Depression


Inventory


was


used


study


depressed


study,


patient


researchers


reaction


found


a negative


humor.


Within


correlation


this


between


depre


ssion


humor.


Their


results


showed


that


higher


individual


s score


was


Depression


Inventory,


less


likely


they


would


respond


to humor.


Subjects


this


study


were


selected


from


inpatient


psychiatric


unit


Veterans

responses


Administration


Inventory,


hospital.


They


categorized


were

into


based


separate


their

groups


ranging


from


depressed


severely


depressed.


Patients


who


were


severely


depressed


were


able


respond


J-. p -C L.crurr i~. %t*S~A


Lrr~~













Loeb,


Feshbach,


Beck


Wol f


(1964


used


Depression


Inventory


assess


effects


depression


altering


one


s perception


about


one


future


capability


es.


These


researchers


found


that


more


intense


individu-


state


of depression,


to underestimate


his/her


more


abilities


likely


to achieve


individual


success


similar


study


Loeb,


Beck,


Diggers


Tuthill


(1966),


these

increa


researchers


ses


found


does


that


intensity


tendency


devaluate


depression

actual


accomplishments.


Depression


Inventory


been


used


number


other


studi


criterion


measure


depression.


Beck


Ward


1961)


showed


that


depression


increased


"likelihood


dreams


characterized


masochi


stic


themes


(their


content


was


reflective


deprivation,


suffer-


other


unpleasant


experiences


288).


Beck


1961)


depre


used


ssed


Depres


person


sion


s the


Inventory


more


show


likely


that


s to


more


identify


himself/


self


as a loser.


In addition


to b


being


consid


ered


as a criterion


measure-


ment


ress


ion,


Depres


sion


Inventory


also


shown


signi


ficant


correlations


with


other


measures


depression.


.Lr It. a q 2.-. t.-- .-ii n4 -T,-a .U


M: r a. 4. -


,, ,1


at A 1II tl~l.lU


tt 1 -


Ln3


rrl


L~













study


also


showed


that


Depression


Inventory


correlated


with


independent


results


clinicians


actual


' assessments


correlations


will


depression


presented


greater


detail


Chapter


III).


Threat


Index


Threat


Index


developed


Krieger,


Epting


Letiner


(1974)


was


developed


means


operationally


defining


individual's


measuring


reluctance


death


threat.


to construe


scale


self


death


assesses


along


same


construct.


assumes


that


persons


who


describe


them-


selves


death


similar


terms


have


integrated


their


worlds


such


way


incorporate


death


a personal


reality.

opposite


Individuals


dimensions


who


would


place


have


themselves


to reorganize


and

their


death

system


order


to incorporate


death


with


their


existence.


Since


introduction


Threat


Index


mid-


1970


, Neimeyer,


Epting


Krieger


(198


note


that


a great


deal


research


Index


focused


that


on establi


been


shing


performed


psychometric


Threat


soundness


instrument.


been


compared


variety


other


death


instruments


threat.


that


survey


measure


showed


concepts


that


closely


there


related


a significant













study


performed


Epting,


Rainey


Wei


(1979)


found


Feifel


that


Threat


s Measures


Index


Fear


correlated


Death.


Feifel


significantly


index


with


measures


fear


death


three


level


conscious


level,


fantasy


level


nonconscious


level.


Threat


Index


correlates


significantly


with


Feifel


S conscious


level


fanta


level


fear


death.


Tobacyk


and


Eckstein


1979)


found


significant


correlations


between


Threat


Index


Dickstein


s Death


Concern


Scale.


Death


Concern


Scale


measures


extent


which


individual


sturbed


thoughts


support


consciously


interpreting


confronting


Threat


death.


Index


These


valid


studies


means


means


urging


one's


orientation


toward


death.


More


recent


research


performed


with


Threat


Index


involved


study


performed


Neimeyer,


Behnke,


(1984).


This


study


examined


sicians


responses


death.


These


complete


researcher


Threat


s asked


Index


pediatric


then


respond


residents


vignettes


depicting


personal


death.


clinicians


found


that


doctors


with


high


death


threat


orientations


were


more


likely


cope


with


death


through


using


denial


or avoidance


strategic


es.


an effort


to minimize


patient


s death,


doctors


were


more


1 i kc1 v


-rm 1 nr -rtl VT


+-homrnoo IT


E


**"h ^- -


t>Tn- V 1^


/^tt- It^ ^^ /


I I


I


b-


O


I n


L


C~rr













seem


share


image


ideal


physician


being


less


likely


talk


with


their


spouse,


experience


nightmares


guilt


recurrent


thoughts


dead


patient


Admitting


human


responsiveness


would


equivalent


admitting


inferiority"


155).


Rainey


Epting


(1977)


found


that


members


memorial


society


who


had


planned


their


funeral


who


provided


disposal


their


body


were


ess


threatened


death


than


individuals


comparable


control


group.


They


note


that


these


res


ults


were


expected


because


preplanners


have


recognized


have


anticipated


their


death


per-


sonal


reality.


Hopelessness


Scale


essness


Scale


was


first


introduced


into


rese


arch


community


Beck,


Weissman,


Lester


Trexler


(1974).


was


developed


measure


one


s negative


expectations


about


future.


Scal


allows


clinicians


researchers


assess


degree


which


individual


pessimi


Scal


stic


has been


about


use


their


in a


future


very


Since


limited


amount


inception,

of studies.


However,


eac


study


that


een


use


validated


soundness


viable


research


tool.


Kovacs,


Beck













who


been


attempt.


to be


These


hospitalized


researchers


better


significantly


subsequent


consistently


than


serious


found


Depression


suicide


hopelessness


Inventory


indicating


suicidal


risks.


s finding


corroborated


work


done


Minkoff,


Bergman,


Beck


Beck


(1973).


These


researchers


also


found


that


seriousness


suicidal


tent


more


highly


correlated


with


hopelessness


than


with


depression.


Hence


, by


using


Hopelessness


Scale


Beck


Depression


Inventory,


these


researchers


were


able


assert

intent


that

and


any

depre


states


ssion


cal

due


association


between


presence


suicidal


third


variable,


namely,


hopelessness.


Vatz,


Wing


Beck


(1969)


used


Hopel


essness


Scale


measure


optimism


about


future


depressed


patients.


These


researchers


found


that


depressed


patients


have


unre-


stically


negative


attitudes


toward


future.


s team


research


hers


was


able


note


that


patients


began


recover


from


their


depression,


their


negative


expectancy


began


reduce.


Beck


(1974)


found


that


following


success-


experiences

depression


performance


on card


show


sorting


an increase


on similar


tasks


, patients


in optimism


This


turn


hospitalized


regarding


general


future


zes


* S
al ak~...1 TI a a a -


C a 1 -_ *


^-1 -1


:~~UIrA~~UL


fl~IAU













research


performed


with


Hopelessness


Scale


shows


that


optimism


plays


major


role


one


view


expectations


been


them


used


selves.


a wide


Whil


variety


Hopel


studies,


essness


it has


Scale


been


proven


to be a valid


measure


assessing


pessimism.


Summary


Expected


Results


Hospice


programs


were


developed


to provide


patients


who


were


coping


with


terminal


illness


a more


positive


alterna-


tive


standard


hospital


treatment.


been


demon-


strated


literature,


terminally


patient


brings


with


him/her


more


complex


and


highly


specialized


needs


most


individual


suffering


with


temporary


life


-restricting


ailment,


these


needs


can


easily


con-


sidered


secondary.


However,


patients


who


will


recovering,


becomes


necessity


insure


that


they


receive


adequate


emotional


as well


phys


ical


care.


While


hospice


programs


have


been


attempting


to provide


appropriate


care


their


patients,


very


little


been


done


research


support


their


effectiveness.


present


study


will


attempt


expand


current


existing


body


research


performed


spice


care


lend


a. -.. -


_ __ a


r.- ...a


11


- tr -- A .. J


CL-~UI


L1 ii













literature


presence


depreciate


each


these


absence


quality


them


life.


three

can


Given


variables

greatly


hospice


indicates


enhance


commitment


total


care


dying


patient,


their


open,


honest


exploration


feelings,


their


attentiveness


their


patient


emotional


needs,


following


results


are


expected:


Analysis


expected


that


there


will


significant


differences


on the Hopelessne

patients receive


between


This -

care


Scale.


appropriate


either


is expected


giving


three


because


intervention


groups


hospice

ns that


foster


acceptance


concept


living


until


they


die.


is assumed


patients


that


who


these


have


patients


some


will


point


just


their


as optimi


lives


stic


had


face


this


life-threatened


illness


recovered.


Both


groups


patients


are


who


turn

are


expected

currently


to be ec

coping


iually


with


optimi

life-


stic


-limited


illness.


Analysis


expected


that


there


will


significant


differences


between


either


three


groups


Depression


Inventory.


This


expected


because


spice


patients


are


afforded


opportunity


openly


ni c r f ~nnr


Fa ~rc


err Ci c/d


4-n l^ar


etQha V


ar^/^n+-


tha; r


I11n


< n1r


I













assumed


that


there


will


significant


difference


between


terminally


cancer


patients


those


who


are


remis


sion.


This


expected


because


patients


remission


have


able


time


prognosis.


cope


Hence


with


, they


their


should


illness,


show


have


no signs


favor-


of depres-


sion


that


can


directly


attributed


their


illness.


(Note:


patients


within


this


group


will


asked


fill


both


Depres


sion


Inventor


Hopelessness


Scale,


light


of how


their


illness


would


affect


their


answers.


This


will


done


order


control


situational


factors


that


unjustly


expected


score


bias


their


within


responses).


same


range


Both


groups


patients


who


are


are


having


cope


with


temporary


life-limited


illness.


Analysis


III.


expected


that


hospice


patients


will


have


be less


faced


threatened


cancer


their


patients


own


who


death


are


than


coping


patients


with


who


life-


limited


illness.


This


hypothesized


because


hospice


patients


have


face


cope


with


their


impending


death.


They


have


been


offered


opportunity


explore


their


geared


patients


feelings


toward


who


about


seeing


are


dying


within


death


remission


environment


positive


have


light.


that


Cancer


actively


deal


T71i 4-h


t-hn r




-h,4i r


cnra Q


Ilil I II-


Tnrnv


'Ph roa-f


Th i ic













illness,


their


scores


are


expected


to be


lower


than


patients


are


coping


with


a life-limited


illness.















CHAPTER I
METHODS


Subjects


Three


groups


subjects


were


used


this


experiment.


first


group


(life-ending


consisted


group).


terminally


second


group


cancer


consisted


patients


cancer


patients


were


in remission


(life-threatened


group)


final


group


was


made


up of patients


coping


with


temporary


life-limited


illness


(lif


e-limited


group).


Life-Ending


Group


hospice


group


was


made


total


of 30


subjects


males


females).


All


patients


within


this


group


were


selected


nursing


staff


hospice


team.


Selec-


tion


teria


patients


(see


was


Appendix


performed


Prior


based


initial


predetermined


researcher


cri-


contact


with

the


patient,


patient


about


the

the


nurse


or primary


purpose


care

study


giver

and


informed

obtained


verbal


permit


ssion


research


follow-up.


Of those


were


asked


to participate,


agreed.


participants


within


group


were


taken


from


Methodist


Hosnita 1


vI r ria _


.Tnr'olnrn74 1 l nr


Sn1^,r













health


care


terminally


ill.


Each


patient


is assigned


interdisciplinary


health


care


team


which


s directed


trained


s pain


hospice


prevention


physician.


symptom


s phy


control.


sician


Upon


specialty


acceptance


into


hospice


program,


regis


tered


nurse


assigned


patient.


first


duty


per form


detailed


psychosocial


assessment


patient


emotional


phys


ical


nee


see


Appendix


Each


case


then


reviewed


weekly


team


member


conference


patient


s care


meetings.


team


provides


an opportunity


each


to provide


information


how


they,


unit


can


best


coordinate


health


care


to suit


needs


client


see


Appendix


copy


treatment


plan


that


drawn


each


patient)


Each


hospice


patient


receives


a minimum


of 3


to 4


sits


from


someone


care


team


each


week


Both


needs


patient


needs


family


are


considered


main


priority


staff.


Life


-Threatened


Group


life


-threatened


group


was


made


cancer


patients

subjects


who

(20


were


femal


remission.


This


group


Patients


consi

were


.sted


solicited


through


- American


Cancer


Society


Jack


sonville,













The

must


advertisement


met


informed


order


patients


considered


criteria


appropriate


that

the


study.


Persons


who


were


interested


participating


con-


tacted


researcher


time


complete


questionnaire.


Life-Limited


Group


life-limited


group


consisted


patients


who


were


coping


with


transient


illness


which


was


severe


enough


require


hospital


confinement.


This


group


was


made


subjects


males,


females).


Special


care


was


given


insure


that


this


group


would


as homogeneous


on extraneous


variables


, such


emotional


development,


previous


groups.


Patients


within


this


group


were


selected


from


local


nursing


home


service


list.


Patients


within


this


group


to meet


following


requirements


order


present


considered


study:


eligible


hospital


participation


confinement


this


minimum


one


week,


temporary


illness


which


total


re-


cover


average


would


age,


expected.


Table


as well


range


provides


of each


list


group.













TABLE


AVERAGE


AGE


OF GROUP


NUMBER OF AVERAGE
GROUP PARTICIPANTS AGE RANGE


Life-Ending 30 63.5 22-92

Life-Threatened 22 65.5 17-93

Life-Limited 30 53.9 20-88


Instruments


This


validity


section


test


reviews


information


reliability


each


related


measuring


instruments.


Threat


Index


Threat


Index


presented


in Appendix


paper


pencil


measure


that


designed


assess


degree


which


with


individual


life.


incorporated


based


notion


theoretical


death


framework


George


Kelly


s Personal


Construct


Psychotherapy.


Threat


Index


exists


several


different


versions.


one


selec-


this


present


study


TIp40.


This


consists


list


forty


bipolar


cons


tructs.


individual


asked


to select


from


each


pair


construct


which


best


describes













was


determined


comparing


questionnaires


that


measured

behavioral

yielded s:


concepts

measure

significant


closely


death


correlation


related


threat.

s when


death


threat


Threat


correlated


Index


with


Lester


Fear


Death


Scale;


Templer


Death


Anxiety


Scale,


Collett


-Lester


Fear


Death


Scale.


This


suggests


that


Threat


Index


providing


a valid


measure


death


orientation.


Test


-retest


reliability


been


determined


Threat


Index.


being


evaluated


temporal


consis-


tency,


rank


Index


Threat


correlation


measures


Index


been


.87.


death


This


orientation


reported


suggests


are


to have


that


relatively


a Spearman


Threat


enduring.


Internal


consistency


Threat


Index


was


determined.


s was


done


splitting


constructs


into


odd


even


numbered


constructs


split


-half


coeffi


cient


TIp40


was


.96.


further


information


Threat


Index,


reader


refer


Threat


Index:


a research


report


Rigdon,


Epting,


Neimeyer


Krieger


(1979)].


Hopelessness


Scale


elessness


Scale


(presented


Appendix


designed t


measure


ssimism.


This


scal


consists














scores


each


individual


item.


higher


score,


greater


degree


of pessimism.


Concurrent


comparing


validity


Hopelessness


Hopelessness,


with


this


scores


other


scal
er~. 1


with


tests


was


clinical


signed


determined


ratings


measure


negative

between


attitudes


about


Hopelessness


the

Scale


future.


clinical


correlation


ratings


elessness


further


s .74


correlated


C .001).


Stuart


Hopelessness


Future


Scale


Test.


was


tests


yielded


lend


correlation


support


.001).


ability


These


Hopelessness


findings


Scale


assess


essimism.


Reliability


this


instrument


was


determined


testing


approximately


patients


who


were


hospitalized


recent


suicide


attempt.


internal


consistency


Scale


was


analy


zed by


means


alpha


20),


which


yields


reliability


coeffici


.93.


This


suggests


that


items


Scale


indeed


consistently


measure


Hopele


ssness


Beck


1961


further


performed


factor


analyst


on the


Hopele


ssness


Scale


Items


which


a factor


loading


greater


than


were


used


identify


meaning


*- < -* A-


*! -' _- __


r


1 1- -


n-













emotional


involvement


concerns


themes


hope


en-


thusiasm.


second


factor


centers


around


one


desire


give


longer


again.


final


factor


centers


around


what


life


would


like.


information


obtained


reliability


validity


Hopelessness


Scale


was


taken


from


article


written


Beck


, Weissman,


Lester


Trexler


(1974).


Beck


Depression


Inventory


Beck


Depres


sion


Inventory


is designed


measuring


depth


intensity


depression.


consists


symptom


categories


that


have


been


shown


related


depression.


Each


symptom


category


four


statements


that


reflect


varying


degrees


severity.


subjects


were


asked


choose


statement


from


each


category


which


best


described


how


they


were


feeling.


more


intense


individual


s statement


was,


higher


score


received


from


that


category.


Beck


determined


concurrent


validity


instrument


comparing


other


psychometric


tests


depres


sion


to clinical


Scale


evaluations


MMPI,


of depression.


Depression


When


compared


Inventory


showed


Pearson


Product


Moment


Correlation


.66.


When














coefficient


.75.


This


suggests


that


Beck


Depression


Inventory


a valid


measure


of depression.


Test-retest


reliability


Depression


Inventory


was


calculated


an indirect


manner.


Beck


administered


Depression


Inventory


patients


6-week


intervals.


found


that


changes


clinical


ratings


depth


pression


thus


paralleled


indicating


changes


consistent


scores


relationship


Inventory,


between


Inventory


patient'


clinical


state.


Beck


performed


factor


analysis


Scale


found


that


each


category


fell


under


four


major


factors


physical


aspects


depression,


self-debasement,


suicide


ideations,


indeci


sion-inhibition.


nature


re-


search


being


performed,


first


factor


listed,


physical


aspects


depression,


was


omitted


from


questionnaire


patients


were


given


fill


out.


This


was


done


that


results


would


unjustly


balanced


against


hospice


group.


physical

weight ]

these ci


Patients


within


limitations


Loss,


that


fatigability,


.rcumstances,


are


hospice


accompany


loss


group


their

appetite)


indicative


have


illness

) which,


certain


(e.g.,

under


depression.


further


information


reliability


validity










40


Procedure


Upon


agreeing


participate


this


study,


subjects


were


given


option


filling


questionnaires


private,


filling


them


with


researcher


present,


having


researcher


read


questionnaire


client


mark


groups


his/her


chose


choices.

latter.


Most su

Patients


objects

within


within

each


all

group


three

were


asked


first


sign


appropriate


consent


*form


(see


Appendix


Once


this


was


done,


patients


began


to provide


answers


appropriate


questionnaire,


as well


personal


data


sheet


(Appendix


average


patient


took


approximately


minutes


to complete


participation


study.


most,


questionnaires


provided


them


opportunity


reflect


over


their


lives,


as well


con-


sider


their


goals.


Administration


que


stionnaire


was


basically


same


across


groups.


ma3or


difference


involved


cancer


remi


ssion


group.


This


group


was


asked


fill


questionnaires


light


their


illness


affected


their


life-


style.


This


was


done


order


insure


that


patients


within


this


group


gave


consideration


how


coping


with


cancer


affected


their


outlook


life.


Subj


ects


within


both


spice













while


either


hospital


within


weeks


their


discharge.


Administration


questionnaires


proved


very


difficult


task.


Patients


within


three


groups


experienced


very


little


difficulty


with


Hopelessness


Scale


Depression


Inventory.


However,


most


patients


found


Threat


Index


very


difficult


to understand.


Hence,


extra


precaution


to be


taken


to insure


that


patients


were


responding


in accordance


with


directions.


Patients


difficulty


with


Threat


Index


centered


around


understand-


meanings


some


constructs.


This


was


taken


care


giving


participant


a rather


brief


concise


definition


construct


in question.


working


with


hospice


group,


proved


more


effective


administer


questionnaires


patient


alone


without


presence


family


care


giver.


While


patients


were


rather


comfortable


talking


about


their


death,


it proved


to be


difficult


some


well


meaning


family


members


who


had


not


yet


totally


accepted


tient


s approaching


death.


They


would


often


want


inter-


ject


tell


patients


should


be feeling.


most


part,


patients


within


three


groups


- *- _


C A ^.ni


- n 4


Cr,


L


er*lrl


1.IA 1P A A ~ AA Y















CHAPTER


RESULTS


results


analysis


effect


hospice


care


terminally


are


presented


s chapter


Analysis


variance


was


calculated


Hopelessness


Depre


ssion


Fear


of Death.


When


F-ratio


was


signifi


cant


level,


test


least


significant


differ-


ences


was


done


order


identify


differences


among


pairs


means.


Analysis


variance


was


also


performed


identify


significant


differences


among


sub-


scales


Beck


Depression


Inventory


and


Hopeles


sness


Scale.


Additional


significant


analysis


differences


was

that


also

could


performed


identify


attributed


of the


subjects


Because


each


three


questionnaires


measures


variables


that


are


closely


related,


statistical


procedures


were


performed


order


insure


that


they


were


measuring


different


constructs.


these


three


A multivariate


questionnaires.


comparison


This


was


analysis


carried


s yielded


an F of


.92,


which


significant


against


Wilks


Lambda


Criterion


with


degrees


freedom.


This


finding


"inss-i fiA


nnmhi nht mnn


rsma i n i n a













Analysis


was


expected


that


there


would


no significant


dif-


ferences


was


care


among


expected

giving i


three


because


groups


hospice


interventionss


that


Hopelessness


patients

t foster


Scale.


receive appropri

acceptance of th


concept


living


until


die.


was


assumed


that


these


patients


would


just


optimistic


patients


who


have


face


life


-threatened


illness


recovered.


Patients


both


these


groups


were


expected


to be equally


optimi


stic


patients


who


we re


currently


coping


with


life-


limited


illness


results


showed


that


there


was


significant


difference


between


groups


Hopelessness


F(2,79)


see


Table


test


least


sig-


nificant


difference


indicated


that


cancer


patients


remi


sion


were


significantly


more


optimi


stic


1.9)


than


patients


who


were


dying


- 4.03)


those


who


were


coping


with


life-limited


illness


4.1) .


There


were


sig-


nificant


differences


between


hospice


group


life-


limited


group


see


Table













TABLE


ANALYSIS


OF VARIANCE


FOR


DIFFERENCES


ON THE


HOPELESSNESS


SCALE


SOURCE DF SS MS F p


Treatment 2 76.24 38.12 3.20 0.0463

Error 79 942.25 11.92

Total 81 1018.50





TABLE 4. LSD FOR DIFFERENCES ON THE
HOPELESSNESS SCALE


LIFE-THREATENED LIFE-ENDING LIFE-LIMITED


1.9 4.03 4.13




*means connected by line are not significantly different


Analysis


was


expected


that


there


would


no significant


dif-


ferences


among


three


groups


Depression


Inventory.


This


was


expected


because


hospice


patients


are


afforded


opportunity


openly


discuss


their


feelings


about


their













cope


with


their


illness


and,


most


part,


carry


favorable


prognosis.


Both


crouos


were,


turn,


expected


score


within


same


range


those


facing


life-limited


illness.


anal


ysis


variance


showed


that


there


was


significant


difference


among


three


groups:


F(2,79)


.81,


(see


Table


The


test


least


significant


ference


indicated


that


patients


remission


were


less


depressed


than


patients


-limited


group


5.76)


life-ending


group


6.76) (see


Table


TABLE 5.


ANALYSIS


OF VARIANCE FOR DIFFERENCES


ON THE BECK


DEPRESSION


INVENTORY


SOURCE DF SS MS F p


Treatment 2 211.51 105.75 38.81 0.0262

Error 79 2190.59 27.72

Total 81 2402.10




TABLE 6. LSD FOR DIFFERENCES ON THE
BECK DEPRESSION INVENTORY


LIFE-THREATENED LIFE-LIMITED LIFE-ENDING
,*, .













Analy


s III


was


expected


that


patients


within


hospice


group


would


ess


threatened


their


own


death


than


patients


who


have


illness


either


life


face


-limited


potentially


illne


This


life


was


-threatened


expected


cause


hospice


patients


have


cope


with


face


their


impending


death


They


have


opportunity


explore


their


feelings


about


dying


within


positive


environment


geared


toward


acceptance


death.


These


patients


are


expected


score


significantly


different


from


patients


other


groups.


Cancer


patients


remission


were


expected


score


higher


than


patients


who


are


facing


life-


limited


illness


results


showed


that


there


significant


difference


Table


between


Patients


groups


within


2,79)


hospice


3.95,


group


<-.02


were


(see


ess


threatened


their


own


death


1.83)


than


patients


with-


life-


limited


group


6.96)


patients


within


life-ending


group


There


were


significant


diff


erences


between


patients


within


life-limited


group


life-threatened


group


see


Table














TABLE


ANALYSIS


OF VARIANCE


FOR


DIFFERENCES


ON THE


THREAT


INDEX


SOURCE DF SS MS F p


Treatment 2 436.47 218.23 3.95 0.0231

Error 79 4363.13 55.22

Total 81 4799.60




TABLE 8. LSD FOR DIFFERENCES ON THE
THREAT INDEX


LIFE-ENDING LIFE-THREATENED LIFE-LIMITED


1.46 6.00 6.96



*means connected by line are not significantly different


Additional


Analy


ses


Additional


analysis


was


performed


determine


whether


there


were


significant


differences


among


groups


sub-


sca


Beck


ress


Inventory


essness


Scal


Further


analysis


was


also


performed


determine


whether


was


significant













Multivariate


comparisons


were


also


calculated


three


subscales


Beck


Depression


Inventory


and


Hopelessness


Scale.


The


multivari


yielded


ana


which


Hopelessness


not


significant


Scale


against


Wilks


Lambda


Criterion


with


degrees


freedom.


Hence,


difference


found


between


three


groups


would be


no greater


than


that


expected by


chance


alone.


Post-hoc


analysis


variance


Hopelessness


sub-


scale


showed


that


there


were


signi


ficant


differences


first


factor,


lings


about


future:


(2,79)


1.11,


p<.3341


(see


Table


TABLE


ANALYSIS OF VARIANCE


ON HOPELESSNESS
ABOUT THE FUTURE


FOR DIFFERENCES


SUB-SCALE


FEELINGS


SOURCE DF SS MS F p


Treatment 2 2.13 1.06 1.11 0.3341

Error 79 75.92 0.96

Total 81 78.06
ii' i


anal vsis


variance


second


rhi- scal e


illC


L


, ZB 1


-U A L. A. ii


%.. A-













.0083


difference


see


Tabl


showed


10) .


that


test


patients


least


remission


significant


were


signifi


cantly


more


motivated


.02)


than


patients


hospi


group


1.26)


life-limited


group


.56)


However,


there


were


significant


differences


between


hospice


group


life


-limited


group


see


Table


11).


TABLE


ANALYSIS


OF VARIANCE


FOR


DIFFERENCES


ON THE


HOPELESSNESS


-SCALE


LOSS


OF MOTIVATION


SOURCE DF SS MS F p


Treatment 2 24.12 12.06 5.09 0.0083

Error 79 187.09 2.36

Total 81 211.21




TABLE 11. LSD FOR DIFFERENCES ON
LOSS OF MOTIVATION


LIFE-THREATENED LIFE-ENDING LIFE-LIMITED


0.02 1.26 1.56
*


*means connected by line are not significantly different













final


sca


hopel


essness


inventory


measured


future


expectations.


The


analysis


showed


that


there


were


significant


differences


among


groups


this


factor


2,79)


.35,


.1017


see


Tabl


TABLE


ANALYSIS


OF VARIANCE


FOR


HOPELESSNESS


-SCALE


FUTURE


EXPECTATIONS


SOURCE DF SS MS F p


Treatment 2 8.35 4.17 2.35 0.017

Error 79 140.19 1.77

Total 81 148.54


multivariate


analyst


sub-scal


Beck


Depression


Inventory


Aided


.11,


significant


degrees


again


Wilks


freedom.


This


Lambda


result


Criterion


lends


with


states


significance


following


findings.


Analysis


variance


first


- sca


Beck


that


Depre


there


sslon


were


Inventory,


label


significant


diff


-Debasement,


erences


showed


among


groups


F(2,


C-.2106


see


Table


13) .















TABLE


ANALYSIS
ON BECK


SCALE


OF VARIANCE


DEPRESSION


FOR


DIFFERENCES


INVENTORY


SELF-DEBASEMENT


SUB-


SOURCE DF SS MS F p


Treatment 2 6.33 3.16 1.59 0.2106

Error 79 157.42 1.99

Total 81 163.76




The second sub-scale on the Beck Depression Inventory

measures suicide ideations. The analysis of variance for

this scale showed that there were no significant differences

among the three groups: F(2,79) = 2.56, p
14).




TABLE 14. ANALYSIS OF VARIANCE FOR DIFFERENCES
ON THE DEPRESSION INVENTORY SUB-
SCALE SUICIDE IDEATION


SOURCE DF SS MS F p


Model 2 4.74 2.37 2.56 0.0841

Error 79 73.31 0.92

Total 81 78.06


mlt-. -


. a -r -- S


L


1*


II 1


~I


_ ^














,79)


13.03,


p <.0001


see


Table


15) .


follow-up


test


showed


that


cancer


in remission


group


was


ess


inhibited


than


hospi


group


hospital


life-limited


group


.10) (


see


Tabi


16).


TABLE


ANALYSIS


ON THE
SCALE


OF VARIANCE


DEPRESSION
WORK INDECI


FOR


INVENTORY


SION-


DIFFERENCES


INHIBITION


SOURCE DF SS MS F p


Model 2 61.99 30.99 13.03 0.0001

Error 79 187.95 2.37

Total 81 249.95





TABLE 16. LSD FOR DIFFERENCES ON THE WORK
INDECISION-INHIBITION SUB-SCALE


LIFE-THREATENED LIFE-LIMITED LIFE-ENDING


0.6 2.10 2.83
*


*means connected by line are not significantly different


Additional


analysis


was


formed


determine


whether


.- t -- I 6


** / I


SUB-


1 I


_I _


______


L














TABLE


ANALYSIS


OF VARIANCE


FOR


SIGNIFICANT


DIFFERENCES


ON AGE


SOURCE DF SS MS F p


Age 2 1877.004 938.50 2.89 0.0618

Error 79 25698.75 325.30

Total 81 27575.75


Graphs


mean


scores


on each


sca


each


group


are


contained


Appendix















CHAPTER


DISCUSSION


SUMMARY


Discussion


original


design


this


study


called


comparing


terminally


patients


currently


under


hospice


care


with


terminally


However,

hospice


review


patients


attempts


population


committees


proved


most


not

gain

to be


major


receiving


access

futile.


hospitals,


hospice


services.


terminal


Doctors,


non-


as well


would


sanc-


tion


usage


patients


this


type


research.


They


cited


research


design


bizarre


inappropriate.


Several


oncologists


stated


they


would


allow


their


patients


fill


questionnaires


fear


that


they


would


have


could


potentially


produce


adverse


reaction


their


patients.


general


concern


most


doctors


was


that


project


such


this


could


potentially


bring


barrage


emotions


that


would


potentially


very


damaging


concerned.


next


attempt


gain


access


this


population


involved


testing


patients


who


been


referred


hospice


program


who


not


begun


receiving


services.


While


this


initially


seemed


to be













viable


solution,


presented


a number


stumbling


blocks.


Attempts


obtain


information


from


patients


who


had


been


referred


hospice


served


validate


perception


that


these


patients


were


just


point


look


their


impending


that


death.


attempts


Most

gain


were


experiencing


information


from


such


them


severe


seemed


pain


almost


inhumane.


one


occasion,


a patient


mistook


researcher


hospice


intake


doctor


repeatedly


asked


"How


long


will


be before


experiences


such


can


something


these


lend


pain


themselves


While


to provid-


quantitative


evidence


support


need


hospice,


they


however,


very


realistic


manner


point


inappropriateness


standard


hospital


practices


validate


both


need


value


hospice


programs.


Since


realistic


constraints


logistical


difficulties


rendered


this


sign


virtually


untestable,


alternative


system


hypotheses


were


generated.


was


researcher


intent


show


that


hospice


patients


were


receiving


care


designed


facilitate


foster


acceptance


their


fate


part


life.


Patients


within


this


group


were


expected


equally


optimistic


patients


who


were


coping


with


life-limited


illness


who


had


one


t i me


fare


nnlt-0n+-il l\


1 t FTa


illnECc


I I I *














equally


optimistic


patients


who


were


remission.


Hospice


patients,


however,


were


significantly


different


from


patients


who


were


hospital


life-limited


illness


(e.g.,


herniaectomies


removal


kidney


stones).


Although


these


results


not


wholeheartedly


support


this


hypothesis,


they


imply


that


hospice


program


ineffective.


contrary,


rather


encouraging


when


terminally


patients


are


just


optimi


stic


patients


are


coping


While


Beck


with


does


transi


not


ent


report


life-limited


normative


illness.


data


Hopelessness


Scale,


interesting


note


that


patients


within


each


three


groups


report


relatively


scores


Hopelessness


Scale.


This


may


suggest


that


although


patients


within


hospice


group


are


experiencing


a degree


hopelessness,


may


considered


minor


clinically


insignificant


when


assessing


individual


levels


of optimism.


In light


fact


that


cancer


in remission


group


was


comprised


largely


females


one


could


argue


that


significant


differences


could


attributed


differences


in gender.


While


this


does


present


a bias


inherent


study,


attention


must


given


fact


that


Beck,


Weissman,


Lester


Trexler


(1974)


reported


that


there


were


- ** a a.


1*


I


*


__


*


1


'1 f~













294

have


individuals


been


who


were


reported


hospitalized


differences


depression.


There


gender


subsequent


research


utilizing


Hopelessness


Scale.


interesting


note


that


same


pattern


results


was


duplicated


Beck


Depression


Inventory.


Patients


within


cancer


remission


group


were


ess


depressed


than


e-limited


patients


group.


both


However,


hospice


there


were


group


significant


different


life


ces


-limited


advanced


between

illness


that


hospice


hospice

Here


patients


again


programs


patients


argument


are


making


with


could


significant


impact


lives


patients,


that


terminally


patients


were


more


depressed


than


patients


within


hospital.


analysis


three


factors


show


that


major


difference


found


work


indeci


sion-inhibition


scale.


This


fact,


rather


than


being


an indicator


of depres-


sion,


could


indicate


form


acceptance


patients


their


limitations.


example,


one


hospice


patient


was


construction


worker


prior


receiving


diagnosis


cancer.


While


under


care


hospice


staff,


patient


been


very


However,


active


amount


terms


care


doing


going


things


enable


home.


him


con-


*


* ~ *


*1


*













Because


a modified


version


Depression


Inventory


was


used,


normative


data


were


available


with


which


compare


normative


scores


data


the

the


three

full


groups.


looking


version


Depression


Inventory,


Beck


reports


that


individuals


who


report


scores


that


average


between


14.3


could


considered


experiencing


virtually


none


mild


forms


depression.


(For


further


information


norming


sample,


see


Metcalfe


Goldman


1965


making


somewhat


inferential


leap,


plausible


hypothesize


that


patients


within


hospice


group


are


experiencing


very


mild


moderate


forms


depression


6.7) .


been


demonstrated,


patients


who


are


receiving


treatment


transient


ailments


experience


moderate


levels


depression


Hence,


this


lends


support


claim


that


scores


obtained


hospice


patients


reflect


discomfort


their


illness


rather


than


their


impending


death.


Here


again


one


must


careful


attention


fact


that


cancer


remission


group


was


made


a majority


female


es.


significant


However,


difference


Depression


between


Inventory


scores


shown


males


females.












patients


within


other


groups.


These


patients


successfully


integrated


their


death


into


their


daily


exis-


tence,


whereas


patients


within


remaining


groups


not


done


fact


that


hospice


patients


are


less


threatened


their


own


death


lends


credence


argu-


ments


advanced


results


previous


hypothesis.


Hospice


patients


have


almost


completely


integrated


their


own


death.


Thus,


they


are


more


iike li to
S.^'


give


realistic


appraisal


their


capab


ilities.


Hence,


with


threat


death


removed,


these


patients


are


more


likely


spend


less


time


stages


denial


anger,


thereby


increasing


amount


time


that


they


have


quality


living.


The


average


score


patients within


hospice


group


Threat


Index


was


1.46.


This


reflects


very


high


degree


death


integration.


This


one


lowest


averages


reported


Threat


Index.


Rainey


Epting


(1977),


their


research


individuals


who


were


planning


their


death,


found


average


score


seems


that


patients


who


are


aware


their


diagnosis


have


almost


completely


accepted


their


death.


(Most


parti-


cipants within


hospice


group died


within


one month


after


completing


questionnaires.


Further


research


with term-














life-threatened


groups


also


report


relatively


scores


Threat


Index


6.96


6.00,


respectively).


Across


three


groups


several


factors


in addition


hypothesized


variables


may


responsible


scores


Threat


Index.


Research


performed


Robin


son


Wood


1984)


shows


that


correlates


significantly


with


scores


Threat


Index.


Older


individuals


tend


score


lower


Threat


Index


than


younger


ones.


This


seems


suggest


that


as patients


closer


toward


death,


they


begin


structure


their


lives


include


this


valid


claim,


can


used


support


need


that


terminally


patients


have


open,


honest


communication


(Simmons


Given,


1972).


Communication


such


this


would


facilitate


a healthy


integration


death


with


life.


Communication


this


type


been


demonstrated


standard


practice


within


hospice.


Implications


Counseling


Fu Re searc


This


study


served


statistical


significance


importance


addressing


emotional


needs


terminally


ill.


With


current


trend


in medical


treatment


I- S -


A .


I *


. -


Future


Research


I


-I


I













restore


more


holistic


form


care


terminally


patient,


doctors


significance


well


that


counselors


emotional


well


need


being


to be


plays


aware


care.


Future


research


needs


to be


done


order


to develop


a means


to identify


measure


variables


that


would


play


a sig-


nificant


role


enhancing


health


care.


From


optimal


standpoint,


subsequent


method


patients


gaining


information


involvement


with


both


hospice


prior


programs


needs

the e


to be developed.


effectiveness


This


of hospice


would

program


provide


an assessment


on producing


change


their


patients


' emotional


state.


Summary


This


study


attempted


to show


that


hospice


patients


were


living


coping


just


well


those


who


have


terminal


illness.


While


results


lend


support


this


concept,


they


show


that


there


were


significant


differences


with


between


life-limited


terminally

illness.


ill

This


patients


patients


fact


self


implies


that


hospice


patients


are


benefiting


from


holis-


approach


care.


testing


this


concept,


three


groups


subjects


were


.-. .. _1 I -


rl *
















ability


to meet


predetermined


criteria


inclusion


within


this


study.


hospice


group


was


taken


from


patients


within


Methodist


Hospice.


cancer


remi


ssion


group


was


selected


from


respondents


advertisement


published


newsletter


American


Cancer


Society


Jacksonville,


Florida.


final


group,


those


with


life-limited


illness,


was


selected


from


Jacksonville,


Florida,


nursing


home


service


list.


Patients


within


this


group


were


either


currently


hospital


been


released


within


weeks


preceding


onset


this


study.


Selecting


patients


from


a nursing


home


service


was


done


order


insure


that


this


group


would


be within


same


range


as patients


within


other


groups.







































APPENDIX A












APPENDIX


HOSPICE


INCLUS IONARY


CRITERIA


UNIVERSITY OF FLORIDA
GAINEI VILL.E, 32 1i


ODPANTMENT OF PSYCHOLOGY


ABSnIACT


"Evaluative Research on the Holistic
Approach to Care and Treacment
of the terminally ill"


This study is designed to examine


various


forms of


care


for the terminally


ill patient. As previous research has indicated the needs of ten
patients extend far beyond the capencencies of standard hospital
In an effort to provide a more pallitive form of care the concept


pice was created. Its goals are
rather than the quantity of life.


designed to increase


The purpose


pirical support to this widely accepted


the qual


of this study


icy
s Ci


mnally ill
practices.
of the hos-
of life
o lend ean


notion.


The variables that will be examined include depression,
fear of death. Patients within the hospice will be camared
suffering from a terminal illness within the hospital.


Below is a list of criteria chat each hospice patients mast
to be considered appropriate for this study:


Patient mast be aware of his/her


optimism, and


to those


meet


are


in order


diagnosis.


Patient n~st have been under hospice
one minth.


Patient must have soma form of


care


for a mininm. of


cancer.


Patient must no longer receive
toward the prolongation of life
radiation, etc.)


any type
(i.e. c


oat treatment
harmtherapy,


geared


Attached is a copy of the questionnaires that I will be


a


patient to fill out, along with the Informed Consent Form chat
Upon completion of my study, I will inform you of the results
effective your care has been on reducing the pain that each pe


asking
they


mIsC


and show how


rson


experiences.


This study has been approved by th-e fthan
hUniversity of Florida and has been determined


Subjects


to be


the participants. It is being conducted under t
Epting, Director of Training Counseling Psycholo,
Florida, Gainesville, Florida, and Dr. Hannalore
Education Departnenc, University of Florida, (Ed
Education.)


Ccmnittee


acne of minimal]


he supervision


gyDe?
Wass,
icor o


aProentso
Proresso


fr the


of the


risks


of Dr. Franz
University o.
r. Counselor


Journal


of Death


EQUAL EMPLLOYMNT OpPON TUi TV/flAltMA TlVE A CTIa CIL.OYCR







































APPENDIX B














APPENDIX


PSYCHO-SOCIAL


AND


Methodist Hospital HSPICE
980 W. EIGHTH STREET


HOSPICE


INTAKE


ASSESSMENT


PLAN


PHYSICIAN


FORM

OF CARE


'S CERTIFICATION


& RECERTIFICATION


JACKSONVILLE, FLORIDA


32209


PATIENT


MEDICAL RECORD .


DATE
rPATllUT


rIkCSAl'


Al iEln lIN


STATUS


HOnt CAM


SERVICES/TREATMENTS PNSumsv oC O vstrs

SKILLED NURSING Ao AAS rMRaecmf ARnME

a vA&uwAwn/MOrroou/cO ft
o AS MS TmN la AC TMIIvs
0 ?MH*MUTIC tTQ O 001 ASt PmOCUS
a UACO6M/OOWCI. tmImnG sGnS fa SThUTOs
0 TRADSflK/AtGNSCtT 0 AMU,4AT0tM
a MUEDCAInoNs OSTOMT CAMI





SOtrmAl





PHYSICAL THERAPY im-



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C DOTCl


SPEECH PATHOLOGY | ncy

: tVALUAIBOU
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IXPtESSNA S PECN Ao LAt.sGUAG.

OCCUPATIONAL THERAPY a Urs"

O EQUATION MUSCLE tE-IOUCATION AN PI YSICM RESTOMATCi
0 SELS CAI. C OTHER


MEDICAL SOCIAL SERVICES :,s

o Asusa eMOM STUAnr A ACTING MeCaCA CAMS
O AUS5 580CM AMOO IMOTOMAL FACTOR RILAIO 7TO tLUS
0 0a7as CAstWOm UneCIS

HOME HEALTH AID|


0 mN.e UlLEDO
MUASING 54NVCI5. -- -..


Hucritional Counseling

Dietician RN
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"-AN ___ R R ENPATR (n
OlAGNOSISIESI PRIMARY (Pi SECONDARY (SI


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MENrAL STalUi
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th sectound


YU dayv ariet ion


p.rtead


period,


the itrsl 90 dv Cl *ct In pert'd


Ith 11 dnay elect lusn


_ __








































APPENDIX C










APPENDIX


HOSPICE


TREATMENT


PLAN


FLORUIA'S FIRST COMPREHENSIVE


HOSPICE


MeCTHOIST HOS PIAL


Ian aTH STmEET JACKSONVILLE. FLORIDA 3a22



DR.


HULTIDLSCLPLINHAIY PL.AK iOF PATIENT CARE &


TEAM CONFERrNC.E SUMMAiiY




PATifET:


MEDICAL RECORD 3:
REFERAASL SOURCE:
CATes


DIACHOSIS:


-i-
a 0


I III I IIum m


DISCIPLINES/VISIT REQUtCYT -
________ _____ PT Or SPLKCH I


PSYCHOLOGIST


CLERGY


VOLUWIIER


a-* -
PHYSICAL: (MD RN HHA) -



ii -
--


-~~~ ----- L
S- a
M I M I M IIlil 1 111 1 1 1 11 111 111 m ig g M IM ~ il
Ill~ illll~ illllll m illiilliiIIIIIIiiII


..e *


II
- S

.a- -,


Oa M+ I


SlINATURE:


THERAPY. SUMMARY


(pr. r


SPft"lpn


- i


SGNACHTURE


(PSYCHOLOGIST,


HSW, CLKECY,


VOLUNTEERS)
-aliI


- -n e


--.....I.AAsTURB


COALS & OBJECTIVES:


I
)* n* -e -e -sm


- --a. -


P'SYCIOSOCIAL & SPIRITUAL SUMHARY:z


--i


__ __ __ __ __


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( --
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m m l IlM M II M Il ll M MH m M M i l il Mu


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1







































APPENDIX D











CANCER


APPENDIX D
IN REMISSION INCLUSIONARY


CRITERIA


!!Needed,
o help an
ome point
eing done
o terminal
riteria t
idered ap


thirty


people


d who hav
in their
to exami
lly ill p
hat you m
propriate


who


have


to cope w
. Resear
hods of i
s. Below
t in orde
his study


sincere
ith can
ch is c
mprovin
is a 1
r to be


desire
er at
rrently
care
st of
con-


Participants
cancer.


must


have


some


form


Participant
sis; i.e.,


must have
symptoms in


a favorable progno-
good remission.


Participants
any type of


must


be currently


treatment


receiving


cancer.


If you
contact
has be
Commit
minima
conduct
Epting
Psycho


are 1
Mary
n app
ee an
risk
ed un
Dire
oav D


Gainesville,


terested
n Hendon
oved by t
has been
to the pa
er the su
tor of Tr
apartment,
Florida.


in participating,


53-7061.
uman Subj
ermined t
pants.
vision of
ng, Couns


Univer


sity


please


This study
cts
be of
t is being
r. Franz
ling
Florida,








































APPENDIX E









APPENDIX


THREAT


INDEX


For each o( the dimensions


below please


more closely associate your own death;
occur at this time in your life.


think


circle
of you:


the side with which you


r each as


if it were to


predictable random productive unproductive

empty meaningful learning not learning

sad happy purposeful not purposeful

personal impersonal responsible not responsible

lack of control bad good
control

satisfied dissatisfied not caring caring

relating to not relating crazy healthy
others to others personality

pleasure pain contfoming not confor ina

feels bad feels good animate inani ace

objective subjective veak strong

alive dead useful useless

helping being selfish closed open
others

specific general peaceful violent

kind crue 1 freedom res criction

Fncompetent competunt non-existence existence

insecure secure understanding not understanding

static changing sick healthy

unnatural natural stagnation groavh

calma anxious abstract concrete

easy hard hope no hope
















For each dimension below circle the side with which you would prefer


to see yourself more closely associated.


For example,


would you prefer to


see yourself associated more with the term "predictable" or "random"?


predictable random productive unproductive

empty meaningful learning not learning

sad happy purposeful not purposeful

personal impersonal responsible not responsible

lack of control bad good
control

satisfied dissatisfied not caring caring

relating to not relating crazy healthy
others to others personality

pleasure pain conforming not conforming

feels bad feels good animate inanimate

objective subjective weak strong

alive dead useful useless

helping being selfish closed open
others

specific general peaceful violent

kind cruel freedom restriction

incompetent competent non-existence existence

insecure secure understanding not understanding

static changing sick healthy

unnatural natural stagnation grovth

calm anxious abstract concrete

easy hard hope no hope






































APPENDIX F








APPENDIX


HOPEL


ESSNESS


SCALE


Below


is a list


for the future.


about


your


future,


statements


Circle


T for


circle F


that
true


for False


are concerned with


if it best


if i


your


outlook


describes how you


doesn't


(Note


feel


Future


refers


to anytime


look


forward


between


the present


to each day with


your


hope


death).


and enthusi


asm.


I might
better


3. When
they


4. I


as well


give up


for myself.


things are
can't stay


because


going badly
that way to


can't imagine what


future.


can't make


, I am helped by
reuer.


life would be


like


things


knowing


in the


have enough


wan t


to do.


time


to accomplish


the things


most


6. In the future


me most.


expect


to succeed


in what


concerns


future seems


dark


to me.


I expect
than the


to get more of
average person


the good


things


in life


9. I


just


don't


to believe


get the breaks,


will


in the future.


and there's no


reason


10. My


past


experiences


future.


have prepared me well


All I


than


can see ahead
pleasantness.


me is unpleasantness


rather


don'


expect


to get what


really


want


When


as happy


look


ahead


or happier


to the future,


than


am now.


expect


will


* Things


just won't work


out the way


wan t


them


15. I


have great


faith


in the future.


never


anything.


get what


wan t


so i


s foolish


to want


sati


s very
sfactio


unlikely
n out of


that


will


get any


my day to day living.


real


. The


19. I


future


can look


bad times.


seems v

forward


ague


and uncertain


to more good


times


to me.

than


_ =







































APPENDIX G









BECK


APPENDIX
DEPRESSION


INVENTORY


BECK INVENTORY


Date


On this questionnaire are groups of


statements.


Please read each group


of statement carefully.


Then pick out the one scacement in each group which


best describes the way you have been feeling the P
Circle the number beside the statement you picked.


AST WEEK,
If seven


INCLUDING TODAY


ral


statemencs


in the


group seem to apply equally well, circle each one.


sure


to read all the


statements in each group before making your choice.

1. 0 I do not feel sad
1 feel ad
2 I am sad all the time and I can't snap out of it
3 I am so sad or unhappy that I can't stand ic


2. 0 I am not particularly discouraged about the future
1 I feel discouraged about the future
2 I feel I have nothing to look forward to
3 I feel that the future is hopeless and that things cannot improve


3. 0 I do not feel like a failure
1 I feel I have failed more than the average person


As I look back on my life, all I


can see is a lot of failures


I feel ZI a a complete failure as a person


I get as much satisfaction out of things as I used to
I don't enjoy things the way I used to
I don't get real satisfaction out of anything anymore
I am dissatisfied or bored with everything


I don't feel particularly guilty
I feel guilty a good part of the time
I feel quite guilty most of the time
I feel guilty all of the time


I don't feel ZI a being punished-
I feel I may be punished
I expect to be punished
I feel I am being punished


I don't feel disappointed in myself
















I don't feel I am any worse than anybody else
I am critical of myself for my weaknesses or mistakes
I blame myself all the time for my faults
I blame myself for everything bad that happens


I don't have any thoughts of killing myself


I have thoughts of killing myself,


but I would not carry them out


I would like to kill myself
I would kill myself if I had the chance


I don't cry anymore than usual
I cry more now than I used to
I cry all the time now
I used to be able to cry, but now I can't cry even though I want to


I am no more irritated now than I ever am
I get annoyed or irritated .ore easily than I used to
I feel irritated all the time now
I don't get irritated at all by the things that used to irritate me


I have not lost interest in other people
I am less interested in other people than I used to be
I have lost most of my interest in other people
I have lost all of my interest in other people


I make decisions about as well as I


ever


could


I put off making decisions more than I used to
I have greater difficulty in making decisions than before
I can't make decisions at all anymore


I don't feel I look any worse than I used to
I am worried that I am looking old or unattractive
I feel that there are permanent changes in my appearance that make mea
look unattractive
I believe that I look ugly


I can work about as well as before
It takes an extra effort en et started at domin something








































APPENDIX H










APPENDIX H
INFORMED CONSENT


FORM


Informed


Consent


Form


care
three
are d
are c


This study ;
on hospital
relatively
designed to a
confined to t


concerned with evaluating the effects of
patients. You will be asked to complete
ort questionnaires. These questionnaires
ess your attitudes and feelings while you
hospital.


your


strictly cc
Your name
placed by a
be helpful
terminally
recording
answers in
you desire


attitudes


)nfidential and
will not be us
number. Becai
in evaluating
ill, we encourage
your responses
this study nor
to explore ar


stionnaires,


therapist


reactions


I within legal limits


led
ise
var
ige

are
ny


will


be available


rill
of


kept
law.


De re-
de may
or the
e when
wrong
Should
by the


you.


Please feel free
about the study at this
project. You also may
time without prejudice.


to ask
time or
withdraw


any questions you may
at any time throughout
w your participation at


have
the
any


Date


Marvin Hendon
Principal Investigator
Department of Psychology
University of Florida


I understand
participate.


nature


this


study


agree


Signature


Participant


Date


in this study but will ]
the information you provi
ious approaches to care f
you to be open and since
There are no right or
There any known risks.
of the concerns raised I


W










APPENDIX


INFORMED


CONSENT


CONSENT


AND


FORM


RELEASE


I un
University


derstand


Florida


Department
conducting


Psychology
study of the


effects


palliative


gained


care


from
for


care


this study
persons who


the
will
are


terminally


used


terminally


ill.


to evaluate


knowledge
approaches


ill.


wish


to participate


withdraw


from


this


study.


study


understand


time.


have


that
been


assured


strictest


known


that


information


confidence


form c
risks,


participating


Dr manner.


that


have


psychologically
in this study.


give
name


been
or


will


will
told


held


not
that


otherwise,


public


there
to


arn


shed
e no


persons


hereby


chology, Univers
this information


public
name.


shin'


give


ity
I


g of the


give


consent
Florida,
them in


results


Department


to interview
their study.


this


study,


Psy-


agree


without


using


use
the
my


authorize


of Psychology,


Methodist


University


Hospital
E Florida,


allow


to interview


Department
me and to


interview
Methodist


those


persons


Hospital


rendering


from


care
all


me.


liability


release


from


partic


ipation


s study.


Signature
Department
University


of Investigator
to Psychology
of Florida


Patient


s Signature


Date:


Date:


above


hereby
study.


consent


patient


participation


Physician


s Signature








































APPENDIX I












APPENDIX


PERSONAL


DATA


SHEET


NAME


AGE


ILLNESS


Educational


Level:


(Check


highest


level


completed)


(highest


complete
grade c


high


ompl


school


eted


completed


high


school


rece


ived


voc


national


or technical


training


(trade


school)


completed
a degree


college


courses


but


did


receive


received

received


complex


. college

. college


degree

degree


graduate/postgraduate


study


Name


of Hospice


/Hospital






































APPENDIX J














APPENDIX J
BAR GRAPH OF HOPELESSNESS MEANS







SCATTER DIAGRAM

BAR CHART OF MEANS


HOPELESS MEAN


3.6+


3. 3+
I


3.30+
I



!

2.7 +
1
I
I
2.4+
I
I

2.1 +
I
SI
I


1.9+
I








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HTQ HCQ CRC















APPENDIX J


BAR GRAPH


OF BDI MEANS


SCATTER DIAGRAM

BAR CHART OF MEANS


BDI MEAN


j***
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HTG HCG CRC

GROUP














APPENDIX J
BAR GRAPHS OF THREAT MEANS














SCATTER DIAGRAM

BAR CHART OF MEANS


THREAT MEAN


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care


dying


patient


New


York


McGraw-Hill,


Simmons


Given,


Nursing


care


terminal


pati


ent,


Omega,


-225.


Smith,


W.G.


1971)


strategies
Psychiatry,


Critical


in mental


, 103


life


health


events


, Archives


nd prevention
of General


-109.


Stodd


ard,


hospi


movement.


New


York


n ;a n y*


flfl 17


a h ar


I IY


J


ollkl -


31













Tobacyk


stein,


concerns


. (1979)
college


Death


student,


threat
Omega,


death


-155


Vandenbo s


native


., DeLeon, P.,
to traditional


Pallak,


medical


(198


care


An alter-
terminally


ill,


American


Psychologist


-1248.


, 37


Vatz,


Winig,


sense
tions


script,


future


depr


Univer


time


ession.


sity


k, A. (1969)
constriction


Philad
Pennsy


elphia
Ivania


simism


as cognitive d
: Unpublished


Medical


stor-
manu-


School


Wald,


. (1971)


(unpubli
Columbia


shed


mas


Univer


A hospice
ter's the


for
sis,


terminally
School of


pati


ents


hitecture,


sity)


Wentzel, K.
Journal


1976)


Nurs


dying


ing,


are


living,


American


956-957.


Woodson,


(1976)


care


in terminal


illness


Psychosocial
McGraw-Hill,


care


of the


dying


patient.


New


York















BIOGRAPHICAL


SKETCH


Marvin


Keith


Hendon


was


born


October


1960,


Miami,


Florida.


There


attended


both


elementary


secondary


school.


Upon


graduation


from


high


school


1977,


enrolled


University


Florida.


August


1980,


After

his e


graduated


finishing


education


with


Bachelor


bachelor


entering


Arts


degree


doctoral


in psychology.


chose


program


pursue


in counseling


psychology


University


Florida.


While


program,


was


awarded


Master


Science


degree


1982.


This


dissertation


marks


completion


doc-


toral


program.









I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
a dissertation for the degree of Doctor of Philosophy.


Franz in
Proves or o


frD., Chairman
ychology


I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality, as
a dissertation for the degree of Doctor of Philosophy.


Dorothy 1t&
Professor


ill, Ph/.D.
jf Psychology


I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality, as
a dissertation for the degree of Doctor of Philosophy.


Everett Hall, Ph.D.
Associate Professor of
Psychology


I certify that I have read thi


s study and that in my


opinion it conforms to acceptable standards of scholar
presentation and is fully adequate, in scope and quali
a dissertation for the degree of Doctor of Philosophy.


:ly
ty, as


Norman Markel,


Ph.D.


Professor of Speech


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sSJaQ^


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