The long-term objective of this proposal is to analyze the trajectory and patterns of quality of life of terminally ill elders. An intensive longitudinal case-study approach will be used to chronicle and reveal the end-of-life experiences of elders. At least 10 elders with advanced cancer, and a prognosis of 4 to 6 months to live, will be followed. Weekly phone contact will determine the frequency of visits (increasing from every 3 weeks to weekly as each patient's functional status decreases and death nears). Open-ended questions will be used to ascertain their perceptions and conceptualizations of quality of life and their issues and concerns regarding end-of-life care and the death experience. Instruments measuring quality of life, symptom occurrence and distress, physical functioning, anxiety and depression, spirituality, social support, family functioning, and cognitive functioning will be used at numerous data collection points to explicate and chronicle the end-of-life experience of terminally ill elders with advanced cancer. SPSS and NUD*IST will be used to facilitate organization, analysis, and displays of quantitative and qualitative data, respectively. P-technique factor analysis will be used to show how groups of variables covary across time for each participant, indicating the underlying change processes. Similarity and dissimilarity of factor loading patterns between individuals will be compared using the coefficient of congruence. Graphs of results obtained by instruments will allow the trajectory of quality of life and its elements to be illustrated. Matrices and contingency tables will depict a synthesis of information gathered, allowing a comprehensive picture of quality of life to emerge.
