DISCLOSURE OF CONCERNS BY HOSPICE PATIENTS AND THEIR IDENTIFICATION BY NURSES

As part of an evaluation of the training of hospice nurses in communic ation skills, the selectivity of patients in disclosing their concerns and the ability of nurses to register ail the concerns disclosed were studied. Forty-two nurses were recruited from two hospices in the nor th of England. They were asked to determine and write down patients' c urrent concerns before and after training, and nine months later. Thei r interviews were tape recorded to permit rating of the concerns discl osed. After each interview a research nurse used a semistructured inte rview and the Concerns Checklist to elicit patients' concerns. The Spi elberger State Anxiety Scale and Hospital Anxiety and Depression Scale were then administered to assess patients' mood. In total, 87 patient s were thus assessed. Patients were highly selective in what they disc losed and showed a strong bias towards disclosing physical symptoms. O verall, 60% of concerns remained hidden and concerns about the future, appearance and loss of independence were withheld more than 80% of th e time. Patients who were more anxious or depressed were less likely t o disclose concerns. The nurses registered only 40% of the concerns di sclosed to them at interview, and less than 20% of patients' concerns were identified approprately. The nurses were selective in the categor ies of concerns that they registered. Pain, family worries, appetite a nd weight loss, nausea and vomiting were noted most frequently, while concerns about cancer, bowel function, treatment and emotional worries were not registered. The patients' main concern was identified and re corded in only 45% of cases. Overall, it was found that hospice patien ts selectively disclosed physical symptoms while nurses did not elicit or register patients' concerns accurately. Nurses therefore need to i mprove their ability to elicit and register all of their patients' con cerns and to pay particular attention to those who are anxious and dep ressed.