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From the Department of Psychiatry and Behavioral Sciences (L.D.B., C.K., M.J.C., S.DiM., D.S.), Stanford University School of Medicine, Stanford, California and Pacific Graduate School of Psychology (R.W.G.), Palo Alto, California.
Address requests for reprints to: Lisa D. Butler, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford CA, 94305-5718. Email: butler{at}psych stanford.edu
OBJECTIVE: This study was designed to examine the course of psychological distress and pain from study entry to death in 59 women with metastatic breast cancer participating in a randomized trial of the effects of group psychotherapy on psychosocial outcomes and survival. It was hypothesized that psychological distress would increase significantly before death independent of changes in pain.
METHOD: Data were collected as part of a larger study (N = 125). Analyses were based on data from a subset of women who had died and for whom we had data from at least three assessments. Mean levels of mood, trauma symptoms, depression symptoms, well-being, and pain over three time points were examined: at baseline (T1), the second-to-last assessment before death (T2), and the last assessment before death (T3).
RESULTS: Results indicate that while psychological distress remained relatively constant or declined from T1 to T2, means on all measures significantly changed in the hypothesized direction from T2 to T3. Neither self-reported pain, nor the passage of time, appeared to account for these changes. Additionally, participation in group psychotherapy did not have a significant impact on this change in distress proximal to death.
CONCLUSIONS: Results suggest that specialized end-stage clinical interventions are particularly needed for cancer patients as they approach death. Moreover, intervention studies for patients with deteriorating illnesses may need to take this "spike" in psychological distress and pain proximal to death into account to avoid Type II errors in evaluations of psychological outcomes.
Key Words: psychological distress • pain • breast cancer • death • course • methodology
Abbreviations: POMS = Profile of Mood States;; IES = Impact of Event Scale;; CES-D = Center for Epidemiologic Studies—Depression;; PSOM = Positive States of Mind.
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