IMPACT OF WITNESSING DEATH ON HOSPICE PATIENTS

In the three decades since the concept of ''awareness'' was introduced to describe the nature of communication between dying people and thei r carers, there has been a radical change in hospital policies and med ical practice. It is now common for the majority of cancer patients to be given full information about their disease and prognosis. Hospices provide a model of care in which death and dying are dealt with in an open manner. While this approach has been welcomed by the majority of people, a minority might still prefer a more limited awareness. An in evitable part of hospice care is the exposure to, and awareness of, pe ople who are dying. There is little empirical data that considers the impact of death on fellow patients. This pilot investigation compared psychological morbidity, perceptions of comfort and/or distress, and d escriptions of a ''good death'' in hospice cancer patients who reporte d witnessing a fellow patient's death (n = 34) with patients who did n ot have this experience (n = 33). Patients were assessed using the Hos pital Anxiety and Depression scale, an Events Checklist and a semi-str uctured interview. The results indicate that patients witnessing a dea th were significantly less depressed than those who did not. Awareness of dying was found to be both comforting and distressing, although ov erall patients reported more comforting than distressing events. A ''g ood death'' was defined by patients in terms of symptom control, inclu ding dying in their sleep, being pain free, quietness and dignity. Nar ratives were used to describe the meaning of a ''good death''. Quantit ative and qualitative analyses have been undertaken to provide a compl ex interpretation of these issues. Copyright (C) 1996 Elsevier Science Ltd