“When you have the most to lose” : Anxiety in patients with cancer in the palliative phase: a systematic approach

Abstract

Management of anxiety in patients with cancer in the palliative phase is a real challenge due the context of a short life expectancy. How often anxiety is experienced (presence), the severity and causes of anxiety in patients’ last months of life are not intensively studied yet. Which care is provided is a blackbox. This thesis focuses on providing more insight into the evidence and current practice of anxiety management and the needs for support in patients with incurable cancer. The perspectives of patients themselves, their loved ones and involved nurses are studied to support early recognition and management of anxiety. Anxiety management seems to be depended on the competencies of the individual professional; we found a lack of evidence-based nurse-led interventions regarding anxiety management to improve practice. We analyzed mood and dyspnea as important predictors for anxiety in this population. Information and sense of control, safety, adequate symptom management, talking about anxiety (or not) and respect for coping strategies are important needs of hospice-care patients with cancer. Loved ones should be involved more in anxiety management of the patient because of their unique “loved one” perspective. We learned that hospice-care nurses struggle in caring for patients with anxiety, especially during the evening and at night. This thesis highlights important angles how management of anxiety may be improved and how health care professionals can make a difference for anxious patients in the last phase of life to optimize quality of life and quality of dying.