A Study to Assess the Death Anxiety among Terminally Ill Patients in a Selected Hospice, Bangalore

 

Prof. Senthil Kavitha R.

Vice Principal, Garden City College of Nursing, 16KM,Old madras Road, Vidya Nagar, Bangalore-36

*Corresponding Author Email:

 

ABSTRACT:

A study was aimed to assess the death anxiety among terminally ill cancer patients in a selected hospice.

Research Approach: A descriptive survey approach was selected for the study. Death anxiety can spike temporarily to a higher level for people who have been exposed to trauma and especially for terminally ill patients. Hospice care represents one of the advances made in the direction to improve the quality of life of such patients and to add life to their dying days.

Sample and Sampling technique: A convenient sample of 30 terminally ill patients was selected for the study.

Tool: Modified death anxiety scale of Templer, Weiner and Khalok death anxiety rating scale was used to assess the death anxiety. Reliability of the tool was tested and validity was ensured in consultation with guides and experts in the field of nursing and medicine.

Results: The results revealed that the analysis showed that 25(83%) of terminally ill patients had moderate death anxiety level and 5(17%) had severe death anxiety level. The chi square value revealed that there was a statistically significant association of death anxiety level with age, gender, education, family support and stages of cancer at 0.05 level where as it was not significant with marital status and pain management at 0.05 level.

Conclusion: Death anxiety due to disease condition is common among terminally ill cancer patients. Recommendation: Based on this finding the researchers can conduct further studies on therapeutic aspects in reducing the death anxiety of terminally ill patients on larger samples.

 

KEY WORDS: Death anxiety, Descriptive survey approach, Terminally ill patients, Hospice, Death anxiety scale.

 


 

 

Birth and death, the inseparable poles of all life on earth, should not be a secret to man.

 

Deep down we all know that our lifespan is limited: that some day we are going to die. But there is something strange about this human awareness of death. If we were to be continuously reminded of the blunt factual limits of our lifespan, this acute awareness of our inevitable death might hamper us in our daily activities.

 

Therefore in daily life, most people tend to not think too often about it. We tend to forget. Even when looking at our life in a somewhat wider time perspective, we concentrate mostly on our recent years and the years we expect to come next. So in ordinary daily life, the perception of the concrete limits of our lifespan remains somewhat fuzzy. This fuzziness is a mechanism that helps to shield us from fear, indifference or desperation1.

 

Death anxiety, also called thanatophobia, is defined as "A morbid or abnormal and persistent fear of death or dying." People afflicted with death anxiety may spend a large amount of time obsessing over death or trying to avoid talking about death. Many people experience fear or stress regarding death at some point in their lives. Death anxiety becomes a problem when it stands in the way of experiencing life2.

People fear death and almost everyone has a different idea of what death actually is. Nevertheless, the fact that death will enter our lives as part of the life experience is something we all must accept. Death is not always easy to accept. Grieving is an emotional and slow process3. 

 

Death anxiety is often seen as a kind of disorder, or as symptom of a disorder. It certainly can prevent people from functioning adequately, bringing about obsessive thoughts about death, nightmares, panic attacks etc. But if you think of it in a matter-of-fact way, such death anxiety is an understandable consequence of being acutely aware of your own expectable death. We might say that death anxiety is actually a natural reaction to having a less fuzzy, more realistic perception of your lifes limits1.

 

Anxiety has physical, psychological, social, spiritual, and practical aspects. It can present as agitation, insomnia, restlessness, sweating, tachycardia, hyperventilation, panic disorder, worry, or tension. As with depression, separating some physical symptoms of extreme anxiety from symptoms of the underlying disease is difficult at times4. 

 

Terminal illnesses, when diagnosed ahead of time, allows a person to set his or her affairs in order, make relationships right, and say goodbye to loved ones. In these cases, every person involved has a chance to gradually adjust and make peace with death, as much as possible. However, not everyone has this chance. Many deaths occur suddenly. Death can, and often does, strike without warning5

 

Hospice care is for people who are nearing the end of life. Hospice care services are provided by a team of health care professionals who maximize comfort for a terminally ill person by reducing pain and addressing physical, psychological, social and spiritual needs. To help families, hospice care also provides counseling, respite care and practical support6.

 

Nurses working in this specialty require skills related to the psychology of dealing with dying clients and their families. Preparation for death is the sole responsibility of the nursing profession and especially for patients dying in hospice, it is important to make provision for the adequate access of relatives, friends and other professionals such as the clergy when patients request their support. Hence understanding their death anxiety level helps to learn how best to provide psychological support during terminal illness can be the most rewarding experiences in nursing.

 

OBJECTIVES:

  To assess the existing level of death anxiety among terminally ill cancer patients

  To associate the level of death anxiety with demographic variables among terminally ill cancer patients

HYPOTHESIS:

There is a significant association of level of death anxiety with selected demographic variables among terminally ill cancer patients.

 

MATRIALS AND METHODOLOGY:

Research design: Descriptive survey approach

Research setting: Terminally ill cancer patients of selected hospice, Bangalore

Study variable: Death anxiety level of terminally ill patients

Sample: All the terminally ill cancer patients available in that hospice during the study period

Sample size: 80

Sampling technique: Non probability convenient sampling technique

Tool: Modified death anxiety scale of Templer, Weiner and Khalok death anxiety rating scale rating from strongly agree to strongly disagree.

         Part 1: Deals with demographic data.

         Part2: Modified death anxiety scale.

  Section A: Question regarding physical factors

  Section B: Question regarding Psychological factors

  Section C : Question regarding social factors

 

Scoring key:

Severe anxiety 15-26, Moderate anxiety 27-38, Mild anxiety 39-50, Normal 51-62,No anxiety - 63-75

 

Data collection procedure:

Formal permission obtained from the concerned authority. Samples were recruited accordance to the sampling criteria. With their consent 30 terminally ill cancer patients who were admitted in the hospice were selected. Death anxiety was assessed by using the rating scale.

 

Data analysis plan:

Demographic variables were described descriptively in terms of frequency and percentage. Chi square was done to find out association between the level of death anxiety and selected demographic variables. The level of significance was 0.05

 

RESULTS AND DISCUSSION:

Table 1: Analysis of overall level of anxiety among terminally ill cancer patients

Level of anxiety

Score Range

Frequency (N)

Percentage %

No death anxiety

15-26

0

0.0

Normal death anxiety

27-38

0

0.0

Mild death anxiety

39-50

2

3

Moderate death anxiety

51-62

29

36

Severe death anxiety

63-75

49

61

 

 


In Table 1 and figure 1 findings of the present study revealed that among 49 samples 61% were severely anxious, 29 (36% ) were having moderate death anxiety and 2(3%) were on mild anxiety.


 


 

Fig 1: Percentage distribution of overall distribution of level of anxiety of terminally ill patients

 

Table 2: Aspect wise analysis of overall Mean and SD of Death anxiety level

Aspect wise

Mean

Standard deviation

Physical factor

23.6

1.754

Psychological factor

27.91

2.141

Social factor

8.025

0.77

Over all

59.375

3.681

 

 

 

 

Fig 2: Mean and SD of impending death anxiety score

 


 

 


The findings of Table 2 and Figure2 depicts that mostly participants suffered with psychological problems and physiological problems than sociological problems.


 


Table 3: Association of the level of Death anxiety among terminally ill patients with selected demographic variables

Demographical variables

Range

 

Mild anxiety

Moderate anxiety

Severe

anxiety

Chi square

DF

P value

 

Age

25- 35yrs

1

10

5

12.65*

6

0.173

36-45yrs

-

9

9

46-55yrs

-

12

8

55andabove

1

18

7

Gender

Male

1

21

19

6.04*

2

0.013

Female

1

29

10

Religion

 

Hindu

1

12

8

3.41 NS

6

0.756

Christian

1

23

14

Muslim

-

13

5

Others

-

3

0

Marital status

Single

1

13

11

13.06*

6

0.059

Married

-

30

14

Widowed

1

5

4

Divorced

-

1

-

Education

Primary

1

7

3

12.9*

6

0. 18

Secondary

-

11

5

Higher Sec

1

27

10

Degreeand above

-

4

7

Family support

Yes

2

30

20

6.480*

2

0.27

No

 

21

9

Stage of Disease

Stage 1

-

3

2

14.4*

6

0.025

Stage 2

1

4

8

Stage 3

1

10

11

Stage 4

-

32

8

Pain management

Analgesics

1

11

9

2. 84NS

4

0.585

 

 


In Table 3 the analysis showed that 29(36%) of terminally ill patients had moderate death anxiety level, 49(61%) had severe death anxiety level and 2(3%)had mild anxiety. The chi square value revealed that there was a statistically significant association of death anxiety level with age, gender, education, family support and stages of cancer at 0.05 level so hypothesis was accepted for these variables,

where as it was not significant with marital status and pain management at 0.05 level.

 

CONCLUSION:

Findings from the current study showed that the level of death anxiety was found in all the study participants. Most of them (61%) had severe anxiety and 36% had moderate level of death anxiety. Chi square revealed that statistically significant association with age, gender, education, family support and stages of cancer.

 

REFERENCES:

1 Death Awareness: Anxiety; A review. Available from: URL:http://stayontop.org/2010/12/27/death-awareness/

2 Yvette Davis, What Is Death Anxiety? A review. Available from : http://www.ehow.com/about_6390401_death-anxiety_.html #ixzz2WIEIQyLu

3. Read more: How to Cope With Death | eHow http://www. ehow.com/how_2251810_cope-death.html#ixzz2WIFR8BGz

4. Robert L. Fine, Depression, anxiety, and delirium in the terminally ill patient :Proc (Bayl Univ Med Cent). 2001 April; 14(2): 130133. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291326/

5 The Mystery of Death -Truth About Death: A review . Available from: http://www.truthaboutdeath.com/blog/id/1590/the-mystery-of-death.aspx

6 End of life -Hospice care: Comforting the terminally ill: A review. Available from: http://www.mayoclinic.com/health/hospice-care/HQ00860

 

 

 

 

Received on 13.02.2013 Modified on 18.04.2013

Accepted on 25.04.2013 A&V Publication all right reserved

Asian J. Nur. Edu. and Research 3(3): July-Sept., 2013; Page 150-153