A study of patterns of communications in families with a terminal cancer patient being treated at three urban institutions revealed that may first-order relatives (spouses, children, siblings) of patients did not have a communication link to the physician, especially if direct communication was not established at the time of diagnosis. Family members were frequently critical of the way information was communicated, yet relied upon the physician's interpretation of the patient's status to form their own opinion of the patient's future. Intra-familial communications regarding illness and dying were frequently discordance and guarded, leading to preceptions that the patient was withdrawing, and fostering a reliance upon the hospital for terminal care. More than half of the family members were uncomfortable visiting the patient in the hospital, experiencing feelings of helplessness, or sensing helplessness in the patients. Bearing the patient's pain was seen as particularly difficult.
Terminally ill cancer patients die at different rates and some of this variance is due to psychosocial differences. In order to discover this variance we developed the Survival Quotient, an index of relative longevity which is applicable across different tumor sites with widely differing life expectancies. The Quotient is based on the difference between Observed Survival, i.e., how long a patient lived from diagnosis to death, and Expected Survival, or how long he was expected to live when compared to a large series of deceased patients with the same tumor site. To obtain an estimate of Expected Survival for six cancer sites (lung, breast, stomach, colon, cervix, lymphoma), six detailed multiple regressions were done. To illustrate the procedure, only one site (lung) is used along with case samples. The Survival Quotient can be useful in research where it is necessary to assess the velocity of dying while controlling for biological differences and similarities.
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