Original Article
Patterns of Social, Psychological, and Spiritual Decline Toward the End of Life in Lung Cancer and Heart Failure

https://doi.org/10.1016/j.jpainsymman.2006.12.009Get rights and content
Under an Elsevier user license
open archive

Abstract

Typical trajectories of physical decline have been described for people with end-stage disease. It is possible that social, psychological, and spiritual levels of distress may also follow characteristic patterns. We sought to identify and compare changes in the psychological, social, and spiritual needs of people with end-stage disease during their last year of life by synthesizing data from two longitudinal, qualitative, in-depth interview studies investigating the experiences and needs of people with advanced illnesses. The subjects were 48 patients with advanced lung cancer (n = 24) and heart failure (n = 24) who gave a total of 112 in-depth interviews. Data were analyzed within individual case studies and then cross-sectionally according to the stage of physical illness. Characteristic social, psychological, and spiritual end-of-life trajectories were discernible. In lung cancer, the social trajectory mirrored physical decline, while psychological and spiritual well-being decreased together at four key transitions: diagnosis, discharge after treatment, disease progression, and the terminal stage. In advanced heart failure, social and psychological decline both tended to track the physical decline, while spiritual distress exhibited background fluctuations. Holistic end-of-life care needs to encompass all these dimensions. An appreciation of common patterns of social, psychological, and spiritual well-being may assist clinicians as they discuss the likely course of events with patients and carers and try to minimize distress as the disease progresses.

Key Words

Palliative care
disease trajectories
end of life
cancer
heart failure
spiritual distress

Cited by (0)

The Chief Scientist Office of the Scottish Executive funded the two original research studies. The funding body played no part in the design of the study, nor in the collection and interpretation of the data, nor in the preparation of the manuscript.

Note: SM, MK, EG, and KB designed the original studies, MK and EG completed the interviews. AS and SM conceived the idea for this analysis. MK and SM take responsibility for the integrity of the data and the accuracy of the analysis. All authors participated in data interpretation and writing the manuscript.