Although suffering is frequently encountered in the hospice setting, few studies examine this condition. The purpose of this study was to examine the relationship between terminally ill hospice patients' pain and their physical, spiritual, and personal or family suffering. Using a tool developed to measure suffering in those categories, a convenience sample of 92 patients were asked to rate their worst pain within the last 24 hours, and to rate their suffering at the time of the interview. All items were rated on a 0-10 Numeric Intensity Scale. Pain scores and suffering scores were divided into four categories; no pain or no suffering (0), mild pain or mild suffering (1-3), moderate pain or moderate suffering (4-6), and severe pain or severe suffering (7-10). Mean scores were compared for pain and suffering. More patients experienced suffering than pain. The highest mean suffering scores occurred in the severe pain category. Correlation coefficients for each suffering and pain category were also calculated. Results indicated a statistically significant correlation only between severe pain and suffering in the categories of loss of enjoyment of life, unfinished business, and concern for loved ones. Data indicated that patients view pain and suffering as separate entities. Further research is needed to better define the relationship between pain and suffering in order to improve assessment and intervention in a hospice setting.
English Two prominent features of mental health policy in the UK in recent years have been the run-down of hospital provision and the changing of the balance between public and other provider sectors. This article examines the cost, quality of care and outcome implications. Public, voluntary and private providers of mental health care are compared, based on a long-term study of people moving out of psychiatric hospitals in London. Costs are found to be lowest in the private (for-profit) sector, and highest in the NHS and consortium (NHS and voluntary sector partnership) sectors. However, quality of care indicators suggest that the lowest cost sector is performing least well, and the highest cost sectors offer the best quality. These are associated with some differences in user outcome.
Introduction: Suffering at the end of life may be caused by many factors, including pain and other symptoms, concern about family and friends, and loss of control of one's life. Several authors have suggested that loss of meaning is pivotal in suffering. An ethical will (EW) is a statement, usually written, capturing one's values, wisdom, hopes, and advice. EWs have been suggested as a vehicle for finding meaning as the end of life approaches. This pilot study of EWs examined methods for exploring the role of EWs in reducing suffering at the end of life.Methods: Oncology clinic patients 65ϩ years of age in active therapy for cancer were randomly assigned to one of two arms: EW or control. Subjects in both arms had writing assignments, three home visits, and exit interviews. Suffering was measured at baseline and at the time of the exit interview, using a series of Likert-like scales.Results: Twenty-four subjects (10 EW and 14 control) completed the study. Among EW subjects, trends toward reduced suffering were noted in "concern for loved ones," "unfinished business," and "fear of the future." Several methodological issues were identified by this pilot study, including selection of population for studying suffering, placebo effect, and randomization.Conclusions: EW may be valuable in alleviating suffering; a larger study will be needed to examine efficacy. The study of interventions designed to reduce suffering at the end of life requires careful attention to the definition and measurement of suffering, study design, and subject selection.
Ethical wills require understanding the unique individuality of the person. This approach focuses on the intangibles as well as the tangibles of one’s inheritance. It provides for the passing on of one’s values, beliefs, heuristic learning, and feelings of love, forgiveness, and hope for the future. This approach allows the individual to live on in the hearts and memories of those who knew him or her. A caring tradition that stems from Genesis 49 is being revived and brought to life today.
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