Graduation Year


Document Type




Degree Granting Department


Major Professor

Janine Overcash, Ph.D.

Co-Major Professor

Susan C. McMillan, Ph.D.

Committee Member

Lois O. Gonzalez, PhD.

Committee Member

Kevin E. Kip, PhD.


Symptom severity, Symptom distress, Quality of life, Structural equation modeling, Spiritual needs


The National Institutes of Health recommends the development of conceptual models to increase rigor and improve evaluation in research. Validated models are essential to guide conceptualizations of phenomena, selection of variables and development of testable hypotheses. Structural equation modeling (SEM) is a methodology useful in model testing due to its ability to account for measurement error and test latent variables. The purpose of this study was to test a model of The Geriatric Cancer Experience in End of Life as adapted from Emanuel and Emanuel's framework for a good death using SEM. It was hypothesized that the model was a five-factor structure composed of clinical status, physical, psychological, spiritual and quality of life domains and that quality of life is dependent on the other factors. The sample was comprised of 403 hospice homecare patients. Fifty six percent were male, 97% were white with a mean age of 77.7. Testing of the model used AMOS statistical software. The initial five-factor model was rejected when fit indices showed mis-specification. A three-factor model with quality of life as an outcome variable showed that 67% of the variability in quality of life is explained by the person's symptom experience and spiritual experience. As the number of symptoms and the associated severity and distress increase, the person's quality of life significantly decreases (ß -0.8). As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion) the person's quality of life significantly increases (ß 0.2). This is significant to nursing because the model provides a useful guide for understanding the relationships between symptoms, spiritual needs, and quality of life in end of life geriatric cancer patients and suggests variables and hypotheses for research. This study provides evidence for a strong need for symptom assessment and spiritual assessment, development of plans of care inclusive of symptom control and spiritual care, and implementation and evaluation of those plans utilizing quality of life as an indicator for the outcome of care provided by nurses.