Little is known about the prevalence and treatment of psychiatric disorders among terminally ill cancer patients and their caregivers, nor about the ways in which mental health may affect the patient's comfort at death, and the impact this may have on the caregiver' s bereavement adjustment. A sample of cancer patients (N=300) with a life-expectancy of < 6 months, and their primary caregivers (eg, spouses, adult children; N=3 00), will be recruited from cancer clinics at Yale, the Veterans Affairs Connecticut Healthcare System, and Memorial Sloan-Kettering. A structured diagnostic interview will be used to evaluate psychiatric status of patients and caregivers. Newly refined and validated instruments will determine """"""""caseness"""""""" of Complicated Grief and provide a thorough evaluation of suicidality of patients and caregivers. Interviews will occur at 2 time points: (1) at baseline when patients are terminally ill and caregivers are attending to them; (2) at follow-up for caregivers 6 months after the patients' death. The study aims are to determine: (1) the prevalence of psychiatric disorders and their treatment among terminally ill cancer patients and their primary caregivers, and (2) the influence of the patients' mental health on their degree of comfort at the time of death (eg, lack of pain, physical, emotional, social, existential distress). The study also aims to determine the extent to which the bereaved caregiver's mental health at follow-up is influenced by: a.) the caregiver's baseline mental health and mental health service use, b.) realistic caregiver expectations of the patient's life expectancy, c.) patient comfort, and d.) caregiver satisfaction about the way the death occurred (eg, absence of regrets about the care provided, having an opportunity to say """"""""good-bye""""""""). By determining the prevalence of specific psychiatric disorders and their treatment in terminally ill cancer patients and their caregivers, clinicians will be alerted to likely mental disorders for which to screen, refer, and/or treat. If patient's with better mental health are more likely to die comfortably, then interventions to improve patient mental health would be expected to improve the patient's quality of life at the time of death. If caregiver's better mental health at follow-up is significantly influenced by their baseline mental health, their realistic expectations of the patient's life-expectancy, and their satisfaction with the way the death occurred, each of these factors could be targeted by future interventions designed to improve the mental health of bereaved survivors.
Showing the most recent 10 out of 89 publications
