Patterns of Social, Psychological, and Spiritual Decline Toward the End of Life in Lung Cancer and Heart Failure

• Published in: Journal of pain and symptom management 2007-10, Vol.34 (4), p.393-402
• Main Authors: Murray, Scott A., MBChB, MD, FRCGP, FRCP, Kendall, Marilyn, BA, PhD, Grant, Elizabeth, MA, PhD, Boyd, Kirsty, MBChB, FRCP, MMedSci, Barclay, Stephen, MA, MSc, FRCGP, MD, Sheikh, Aziz, BSc, MBBS, DRCOG, DCH, FRCP, MSc, MD, FRCGP
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Attitude to Health; Biological and medical sciences; cancer; Cardiac Output, Low - psychology; Cardiac Output, Low - therapy; Cardiology. Vascular system; disease trajectories; end of life; Female; Heart; heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Interviews as Topic; Lung Neoplasms - psychology; Lung Neoplasms - therapy; Male; Medical sciences; Middle Aged; Needs Assessment; Neoplasms - mortality; Pain Medicine; Palliative care; Pharmacology. Drug treatments; Pneumology; Psychology; spiritual distress; Spirituality; Terminally Ill - psychology; Tumors of the respiratory system and mediastinum; United Kingdom - epidemiology
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2006.12.009

Abstract Typical trajectories of physical decline have been described for people with end-stage disease. It is possible that social, psychological, and spiritual levels of distress may also follow characteristic patterns. We sought to identify and compare changes in the psychological, social, and spiritual needs of people with end-stage disease during their last year of life by synthesizing data from two longitudinal, qualitative, in-depth interview studies investigating the experiences and needs of people with advanced illnesses. The subjects were 48 patients with advanced lung cancer ( n = 24) and heart failure ( n = 24) who gave a total of 112 in-depth interviews. Data were analyzed within individual case studies and then cross-sectionally according to the stage of physical illness. Characteristic social, psychological, and spiritual end-of-life trajectories were discernible. In lung cancer, the social trajectory mirrored physical decline, while psychological and spiritual well-being decreased together at four key transitions: diagnosis, discharge after treatment, disease progression, and the terminal stage. In advanced heart failure, social and psychological decline both tended to track the physical decline, while spiritual distress exhibited background fluctuations. Holistic end-of-life care needs to encompass all these dimensions. An appreciation of common patterns of social, psychological, and spiritual well-being may assist clinicians as they discuss the likely course of events with patients and carers and try to minimize distress as the disease progresses.