Because the diagnosis of 'cancer' i

Because the diagnosis of 'cancer' is associated with a poor prognosis, we also asked how much insight the patient was thought to have had into his diagnosis. The figures were similar to those obtained for the degree of insight into the prognosis, and there were no differences between home-centred and hospital-centred care.The stress upon the respondent in each pattern of care is shown in Table 5; it is clear that there are few differences between the groups. Spouses of patients at home were rather more inclined to worry about the relief of pain and about separation from their spouse if he or she should have to be moved elsewhere, but neither of these differences reached significance. Those at home were significantly less likely to worry about their own future and marginally less likely to worry about revealing fears to their spouse or about others hurting or harming the patient.Respondents whose spouses were at home were able to perform their normal work tasks as well as respondents whose spouses were in hospital, and were rather better able to care for children or other dependents.Inability to hide fears or express positive feelings was a problem for a minority in both settings. In general, spouses of patients cared for at home seemed to recall no more or less anxiety than spouses of patients cared for in hospital. The only general score which differentiates the two groups was the psychophysical stress symptom score. This was obtained by adding together six five-point scales concerning the commoner psycho-physical accompaniments of anxiety (anorexia, weight loss, insomnia, tremor, tiredness, and forgetfulness). The mean scores seem to indicate that spouses of hospital-centred patients suffered rather more of these symptoms than spouses of home-centred patients. However, differences are not large and, since respondents had often forgotten such details, little reliance can be placed on these figures.Respondents' memories were fresher for symptoms which had been present since bereavement. A postbereavement score was obtained by adding scores on 22 five-point scales about the physical and emotional accompaniments of bereavement. These ranged from measures of the intensity of pining for the lost partner to symptoms such as excessive sweating and palpi¬ tations. The mean post-bereavement score for the spouses of home-centred patients was 18*3 and for spouses of hospital-centred patients, 18-7. Clearly there is no evidence from these figures to indicate that the pattern of care provided was associated with differences in the adjustment to bereavement.