The relationship between patients' concerns and psychological distress in a hospice setting.

A total of 87 patients admitted to two hospices during a 9 month period were assessed by trained nurses to determine their current concerns. These assessment interviews were tape recorded. A trained researcher then administered a semi structured concerns interview using the Concerns Checklist, the Hospital Anxiety and Depression Scale and the Spielberger State Anxiety Inventory. Patients reported an average of 6.5 concerns. Concerns about loss of independence and the family were most common. Although a third of the patient sample died within a short time after the interview, concerns about cancer, the future and dying were infrequent. Using a threshold score on the Hospital Anxiety and Depression Scale of > 19 to allow for the effect of disease, 17% of the sample were judged to be probable cases of clinical anxiety and/or depression. There was a strong association between the number of concerns patients experienced and psychological distress (p < 0.001). Concerns about pain and treatment were particularly associated with anxiety whereas concerns about disability were linked with depressed mood. Concerns about cancer were linked with both anxious and depressive changes in mood (p < 0.001). The study highlights the diverse nature of hospice patients' concerns and shows a clear link between psychological distress and number of concerns expressed by patients.