The geriatric cancer experience at the end of life: testing an adapted model.

PURPOSE/OBJECTIVES To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide evidence for the validity and reliability of the model for use in practice and research. DESIGN Nonexperimental and cross-sectional using baseline data collected within 24-72 hours of admission to hospice. SETTING Two hospices in the southeastern United States. SAMPLE 403 hospice homecare patients; 56% were men and 97% were Caucasian with a mean age of 77.7 years. METHODS Confirmatory factor analyses using structural equation modeling with AMOS statistical software. MAIN RESEARCH VARIABLES Clinical status; physiologic, psychological, and spiritual variables; and quality of life (QOL). FINDINGS A three-factor model with QOL as an outcome variable showed that 67% of the variability in QOL is explained by the patient's symptom and spiritual experiences. CONCLUSIONS As symptoms and associated severity and distress increase, the patient's QOL decreases. As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion), QOL also increases. IMPLICATIONS FOR NURSING The model supports caring for the physical and metaphysical dimensions of the patient's life. It also highlights a need for holistic care inclusive of physical, emotional, and spiritual domains.