Academic journal article Research and Theory for Nursing Practice

Psychological Responses to Terminal Illness and Eventual Death in Koreans with Cancer

Academic journal article Research and Theory for Nursing Practice

Psychological Responses to Terminal Illness and Eventual Death in Koreans with Cancer

Article excerpt

This qualitative study describes the psychological responses of Korean participants with terminal cancer (stages III-IV) from time of diagnosis to death. Eighteen participants, ages 48 to 73, were interviewed at various phases of dying. Using analytic induction, three categories (nonacceptance, resignation, submission), characteristic patterns of responses over the course of illness and typical responses within categories were generated. Nonaccepters denied the possibility of death while struggling to live; their typical response was resistance. Resigners displayed sorrow, thoughts about their destiny, and growing acceptance of their fate. Their typical response was nonresistance. Submitters were shocked initially, searched for God's will, and prepared for death with hope. Their typical response was hopeful that God would care for them and their families. Participants' ages, physical pain, burden to family, and beliefs played important roles in the patterns of responses.

Keywords: death; cancer; nonacceptance; resignation; submission

Many factors, including thoughts and attitudes about terminal illness, affect patients' psychological responses to diagnosis, treatment, and impending death (Meeker & Jezewski, 2004). A number of research studies have been conducted to examine psychological responses to terminal illness, but research is limited on the different types of reactions, how one's special responses vary depending on the general character of reaction and stage of illness, and what affects responses over the duration of illness. Therefore, the purposes of this study were to: (a) categorize overall reactions to terminal illness; (b) describe variations in successive psychological responses to the diagnosis of terminal cancer, treatment, and eventual death; and (c) determine tentative explanations for the variations in responses.

PSYCHOLOGICAL RESPONSES TO TERMINAL ILLNESS AND DEATH

The most common psychological problems seen in patients with terminal cancer are depression, fear, and anxiety (Sivesind & Rohaly-Davis, 1998). A depressed mood can be characterized as feelings of worthlessness or excessive guilt, diminished interest or pleasure in usual activities, suicidal thoughts, and a preoccupation with death. Depression can be related to anticipatory grief of impending loss of life and personal meaning, increased physical impairment, unmanaged severe pain, and hopelessness about living long enough to see loved ones again (Breitbart, Levenson, & Passik, 1993; Kang, 1996; Shakin & Holland, 1988).

Fear and anxiety often encompass the unknown aspects of cancer and its treatment. This can include fear of death, disability, pain and suffering, and loss or disruption of relationships with family, loved ones, friends, and favorite things (Gorman, 1998). Additional psychological reactions of terminal cancer patients are distress, guilt, despair, helplessness, misery, and withdrawal (Brallier, 1992; Yedidia & MacGregor, 2001).

Choi's (1991) phenomenological study of five terminal cancer patients in Korea revealed emotional reactions of loneliness, depression, anger, fear of loss of selfcontrol, and a strong negative attitude toward death. Negative attitudes increased with severe pain and physical deterioration. Believing in life after death and a Higher Being helped with acceptance of death.

Several studies have been done on responses from diagnosis of terminal cancer to death. In 1969, Kubler-Ross reported after interviewing 200 terminally ill patients that the patients went through the stages of denial, anger, compromise, depression, and acceptance. Later, Kubler-Ross clarified that this was not a linear process in which all dying patients go through the stages in order but rather that they may go back and forth among the stages.

Kim (1988) studied 65 terminally ill cancer patients who were hospitalized in three hospitals in Seoul. He reported that 13. …

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