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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH063892-02
Application #
6644135
Study Section
Special Emphasis Panel (ZRG1-RPHB-3 (01))
Program Officer
Muehrer, Peter R
Project Start
2002-08-07
Project End
2006-05-31
Budget Start
2003-06-01
Budget End
2004-05-31
Support Year
2
Fiscal Year
2003
Total Cost
$515,681
Indirect Cost
Name
Yale University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Su, Amanda; Lief, Lindsay; Berlin, David et al. (2018) Beyond Pain: Nurses' Assessment of Patient Suffering, Dignity, and Dying in the Intensive Care Unit. J Pain Symptom Manage 55:1591-1598.e1
Kurita, Keiko; Siegler, Eugenia L; Reid, M Cary et al. (2018) It Is Not What You Think: Associations Between Perceived Cognitive and Physical Status and Prognostic Understanding in Patients With Advanced Cancer. J Pain Symptom Manage 56:259-263
Trevino, Kelly M; Litz, Brett; Papa, Anthony et al. (2018) Bereavement Challenges and Their Relationship to Physical and Psychological Adjustment to Loss. J Palliat Med 21:479-488
Trevino, Kelly M; Prigerson, Holly G; Maciejewski, Paul K (2018) Advanced cancer caregiving as a risk for major depressive episodes and generalized anxiety disorder. Psychooncology 27:243-249
Li, David; Prigerson, Holly G; Kang, Josephine et al. (2017) Impact of Radiation Therapy on Aggressive Care and Quality of Life Near Death. J Pain Symptom Manage 53:25-32
Nissen, Kathrine G; Trevino, Kelly; Lange, Theis et al. (2016) Family Relationships and Psychosocial Dysfunction Among Family Caregivers of Patients With Advanced Cancer. J Pain Symptom Manage 52:841-849.e1
Trevino, Kelly M; Zhang, Baohui; Shen, Megan J et al. (2016) Accuracy of advanced cancer patients' life expectancy estimates: The role of race and source of life expectancy information. Cancer 122:1905-12
Shen, Megan Johnson; Prigerson, Holly G; Paulk, Elizabeth et al. (2016) Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion. Cancer 122:1749-56
Garrido, Melissa M; Prigerson, Holly G; Bao, Yuhua et al. (2016) Chemotherapy Use in the Months Before Death and Estimated Costs of Care in the Last Week of Life. J Pain Symptom Manage 51:875-881.e2
Prigerson, Holly G; Bao, Yuhua; Shah, Manish A et al. (2015) Chemotherapy Use, Performance Status, and Quality of Life at the End of Life. JAMA Oncol 1:778-84

Showing the most recent 10 out of 89 publications