Originally published as JCO Early Release 10.1200/JCO.2009.22.9799 on October 13 2009

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Google Scholar Articles by Thompson, G. N. Articles by Macmillan, K. A. PubMed PubMed Citation Articles by Thompson, G. N. Articles by Macmillan, K. A. Social Bookmarking                            What's this?

Prognostic Acceptance and the Well-Being of Patients Receiving Palliative Care for Cancer

From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB; Dr. H. Bliss Murphy Cancer Centre, St. John's, NL; Department of Family and Community Medicine, University of British Columbia, Vancouver, BC, Canada; and Faculty of Pharmacy, Université Laval, Centre de recherche de l'Hôtel-Dieu de Québec, Maison Michel-Sarrazin, and Centre de recherche Université Laval Robert-Giffard, Paris, France.

Corresponding author: Harvey Chochinov, MD, PhD, Department of Psychiatry, University of Manitoba and Manitoba Palliative Care Research Unit, 3017-675 McDermot Ave, Winnipeg, MB, R3E 0V9 Canada; e-mail: Harvey.chochinov{at}cancercare.mb.ca.

Purpose To identify the impact of prognostic acceptance/nonacceptance on the physical, psychological, and existential well-being of patients with advanced cancer.

Patients and Methods A Canadian multicenter prospective national survey was conducted of patients diagnosed with advanced cancer with an estimated survival duration of 6 months or less (n = 381) receiving palliative care services.

Results Of the total number of participants, 74% reported accepting their situation and 8.6% reported accepting with "moderate" to "extreme" difficulty. More participants with acceptance difficulties than without acceptance difficulties met diagnostic criteria for a depressive or anxiety disorder (² = 8.67; P < .01). Nonacceptors were younger (t = 4.13; P < .000), had more than high school education (² = 4.69; P < .05), and had smaller social networks (t = 2.53; P < .05) than Acceptors. Of the Nonacceptors, 42% described their experience as one of "moderate" to "extreme" suffering compared with 24.1% of Acceptors (² = 5.28; P < .05). More than one third (37.5%) of Nonacceptors reported feeling hopeless compared with 8.6% who had no difficulty accepting (² = 24.76; P < .000). Qualitatively, participants described active and passive coping strategies that helped them accept what was happening to them, as well as barriers that made it difficult to come to terms with their current situation.

Conclusion The challenge of coming to terms with a terminal prognosis is a complex interplay between one's basic personality, the availability of social support, and one's spiritual and existential views on life. Nonacceptance appears to be highly associated with feelings of hopelessness, a sense of suffering, depression, and anxiety, along with difficulties in terms of social–relational concerns.

Supported by a grant from the Canadian Institutes of Health Research (CIHR) and by a New Emerging Team grant from the Institute of Aging. H.M.C. is supported by a Tier I Canada Research Chair in Palliative Care from the CIHR.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?