The Effects of Counseling about Death and Dying on Perceptions, Preparedness, and Anxiety Regarding Death among Family Caregivers Caring for Hospice Patients: A Pilot Study원문보기
Jung, Yeojung
(Department of Nursing, Jeonbuk National University Hospital)
,
Yeom, Hyun-E
(Department of Nursing, Chungnam National University)
,
Lee, Na-Ri
(Department of Hema-oncology, Jeonbuk National University Hospital)
Purpose: This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. Methods: Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospic...
Purpose: This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. Methods: Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants' scores before and after counseling were compared using the paired t-test. Results: Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P<0.001) and preparedness for death and dying (t=-16.23, P<0.001) improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit. Conclusion: The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones. Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.
Purpose: This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. Methods: Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants' scores before and after counseling were compared using the paired t-test. Results: Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P<0.001) and preparedness for death and dying (t=-16.23, P<0.001) improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit. Conclusion: The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones. Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.
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문제 정의
The aim of this study was to provide preliminary evidence on the effect of death counseling for family caregivers of hospice patients on their perceptions, preparedness, and anxiety regarding death.
This study investigated the effect of death counseling provided to family caregivers of hospice patients on perceptions, preparedness, and anxiety regarding death with the major goal of building upon preliminary evidence for developing a comprehensive care program for hospice patients and their family members.
제안 방법
, family caregivers) and patients, perceptions of death, anxiety related to death, and level of preparedness for death was assessed using a self administered questionnaire. Considering the potential emotional responses or physical fatigue after death counseling, the post-counseling survey on perceptions of death, anxiety, and level of preparedness for death was conducted the day after counseling.
of hospice patients. Due to the ethical difficulty in creating a comparison group, considering the circumstances of hospice patients who are at the end of life, the study was designed with a single group.
For a better understanding of the characteristics in the preparedness for the patient’s death among the family members of hospice patients in detail, content analysis was conducted of the responses to the open-ended questions asking about what type of support family members needed in preparation for death. Before death counseling, the participants expressed a great demand for information about symptoms of death, whereas after death counseling, they expressed need for support in providing a comfortable death.
Preparedness for death was measured with a scale developed for this study. One professor in nursing and two advanced practice nurses in hospice and palliative care with more than 10 years of clinical experience created 11 preliminary items based on the following resources: the Hospice Service Guide provided by the National Cancer Center [10], the guidelines regarding the conceptual basis and practice of hospice and palliative care presented in the “Death Education and Family Support” chapter of a textbook entitled Hospice and Palliative Care [24], and empirical evidence from several countries on hospice nursing care regarding the mental and practical preparations of family members of hospice patients for the patients’ death.
for the patient. The characteristics of hospice patients were recorded using five items on the duration in hospice, whether they were terminal, main symptoms, and whether they had completed advance directives.
The content on the dying process included responding to common symptoms during the dying process such as difficulty breathing, delirium, and pain, and saying the last good-byes with family members. The information about the period after death contained body cleaning and religious ceremonies. Lastly, information about the psychological characteristics of grieving, the process of overcoming sadness, and grief support groups for family members were provided.
The content was categorized into before death, the dying process, after death, and the grieving period. The information about the period of before death included physical and emotional changes that signal imminent death, the care desired by family members, advance medical directives, and wills. The content on the dying process included responding to common symptoms during the dying process such as difficulty breathing, delirium, and pain, and saying the last good-byes with family members.
These studies focused on educational interventions for providing information and there is little information on death counseling. Therefore, it is worthwhile that this study evaluated the effect of death counseling that incorporated therapeutic communication skills, which are not limited to the provision of information about the characteristics of each stage (before death, dying process, after death, and grief), but also encompass the emotional and psychological characteristics of the family member’s relationship with the patient and personal life experiences.
[21] and translated into Korean by Jeong [11]. This scale consists of 17 items measured on a 4-point scale, categorized into three sub-scales of closeness (9 items), sense of control (3 items), and clinical symptoms (5 items). Each item is answered on a scale of “not important at all” (1 point), “not impor- tant” (2 points), “important” (3 points), and “very important” (4 points).
대상 데이터
80, a minimum of 34 participants was necessary. Considering a 10% drop-out rate, data were collected from 37 participants.
9. For the paired t-test with an effect size of 0.5, a significance level (α) of 0.05, and power of 0.80, a minimum of 34 participants was necessary. Considering a 10% drop-out rate, data were collected from 37 participants.
The study participants were family members who were the primary caregivers for patients who had been hospitalized for at least 3 days and scored less than 40% on the Palliative Performance Scale (PPS) in a hospice and palliative care unit in a teaching hospital in J city, North Jeolla Province and who voluntarily chose to participate in death counseling.
데이터처리
Differences in perceptions, preparedness, and anxiety regarding death before and after death counseling were analyzed using the paired t-test. Answers to the open-ended question were analyzed using content analysis, which is based on grounded theory as a method for inductively deriving a theory from data.
후속연구
Since this study only included family members of terminal cancer patients in a hospice and palliative care unit of one university hospital in J city, death counseling should be implemented for participants who are facing death in various environments other than a hospice and palliative care unit. Future studies should take into account sociodemographic characteristics and psychosocial characteristics, which can influence death counseling for the family members of hospice patients, and efforts should be made through further research to develop a practical protocol for hospice patients and their family members to prepare for death.
Therefore, it is expected that this tool can be used to promote quality improvement in hospice and palliative care services that implement comprehensive care. The content validity of the items used to measure preparedness for death was evaluated by an expert group, but further scientific evidence for expanding the use of this tool use to studies of the family members of hospice patients should be obtained by conducting systematic tests of the construct validity of the items in the future.
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