Onyechi, K.C., Onuigbo, L.N., Eseadi, C., Ikechukwu-Ilomuanya, A.B., Nwaubani, O.O., Umoke, P.C., . . . Utoh-Ofong, A.N. (2016). Effects of rational-emotive hospice care therapy on problematic assumptions, death anxiety, and psychological distress in a sample of cancer patients and their family caregivers in Nigeria. International Journal of Environmental Research and Public Health, 13, E929. 

To evaluate the degree to which a rational emotive behavioral approach and techniques can benefit patients and family members in hospice care

A manual for the intervention approach was developed to guide the treatment process. It was based on a cognitive behavioral approach, including cognitive restructuring, confrontation, therapeutic alliance, acceptance, dialogue, reframing, use of metaphors worksheets, and motivational activities. The intervention was provided for 10 weeks in 45-minute sessions weekly, with four weeks of follow-up meetings in each household. Study assessments were conducted at baseline, after the 10-week intervention, and after the four weeks of follow-up, using self-report instruments and structured interviews. Participants randomized to the control intervention received usual care involving spiritual support, caregiving, counseling, etc., for the same amount and duration of time.

• N = 32 patients and 52 family caregivers   
• MEAN AGE = 48.33 years (SD = 6.17)
• MALES: 15.38%, FEMALES: 84.62%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Breast, cervical, and prostate cancers; all patients were at terminal stage of disease. 
• OTHER KEY SAMPLE CHARACTERISTICS: The majority lived in rural settings.

• SITE: Single site   
• SETTING TYPE: Home    
• LOCATION: Nigeria

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care 

Randomized, controlled trial

• Patients and Family Caregivers' Assumptions Questionnaire
• Death Anxiety Questionnaire
• Kessler Psychological Distress Scale

Overall baseline problematic assumptions and death anxiety were high, and distress scores showed severe distress. Respeated measures analysis of variance (ANOVA) showed that the intervention program had a significant effect on problematic assumptions (p = 0.00), death anxiety (p = 0.00), and distress (p = 0.00) in caregivers and patients compared to those in usual care. This difference was maintained at follow-up.

The findings show that cognitive behavioral techniques and the specific approach used here were effective in reducing problematic assumption, death anxiety, and psychological distress among patients with cancer and their family caregivers.

• Small sample (< 100)
• Risk of bias (no blinding)
• Findings not generalizable
• The study involved mainly patients and family members living in rural Nigeria; the results may not be applicable to other cultural groups.

The findings demonstrated that cognitive behavioral approach techniques are helpful in reducing stress and anxiety in patients in hospice and their informal caregivers. Nurses can incorporate these types of approaches into usual counseling and supportive interventions with caregivers and patients.