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Purpose Caregivers face severe difficulties in communicating openly with their terminally ill relatives about illness and death. Some studies suggest that females are more likely than males to hold such conversations. We compared level of open communication between male and female spouse-caregivers, and the contribution of personal and situational characteristics to the explanation of open communication level within each gender group. Methods The study design was correlational. We interviewed 77 spousal-primary caregivers of terminal cancer patients. Participants were recruited over a 10-month period from the home hospice unit of the central region of Israel's largest Health Maintenance Organization. The questionnaire included measures of open communication, along with caregiver's personal and situational characteristics. Results Female spouses reported higher levels of open communication about illness and death with their loved ones, compared to male spouses. Among males, duration of care and self-efficacy emerged as significant contributors to open communication level. Among females, self-efficacy and ethnic origin were found to be significant explanatory variables. Conclusions This study demonstrates the important role gender plays in level of open communication between spousal caregivers and terminal cancer patients, concerning their illness and approaching death. Self-efficacy, ethnic origin and duration of care are also significant factors explaining open communication of both male and female caregivers. These factors should be considered by nurses and other healthcare professionals when developing intervention programs to increase the level of open communication between family caregivers and their terminally ill relatives.

To examine differences in health and functional status and in utilization of health services between holocaust survivors and their counterparts; and (b) to investigate if holocaust survivor status is a significant predictor of health status, functional status, and utilization of health services. The study included 1255 respondents of whom 272 were holocaust survivors. Interviews were conducted face-to-face at the respondents' homes. Participants were asked about their health (self-rated health and comorbidity) and functional (ADL and IADL) status, utilization of inpatient and outpatient health care services, age, gender, education, marital status, length of residence in Israel, and if they were holocaust survivors. Holocaust survivors, who were frailer and more chronically ill compared to their counterparts, visited their family physician and the nurse at the health care clinic more often than their counterparts did, and received more homecare services. Yet, there were no differences between them in the utilization of other health care services such as visits to specialists, emergency department, and hospitalizations. Holocaust survivors are more homebound due to more morbidity and functional limitations and therefore receive more health home care services that offset the utilization of other health services.

In a previous study, the will-to-live (WTL) was presented as a parsimonious and easy to use indicator of well-being, perceived differently by men and women. This study evaluates the role of WTL in long-term survival of elderly men and women. In 1994, socio-demographic, psychosocial, and health characteristics were collected from a sample of 1,138 Israeli elderly persons (70+) by structured interviews. Data regarding survival were gathered 7.5 years later. Results indicated that WTL was significantly related to survival in univariate analyses. However, in multivariate Cox analyses, conducted separately on men and women, the will-to-live predicted survival only among women after adjusting for age, self-rated health (SRH) and psychosocial variables, so that the stronger the WTL, the higher the chances of survival for women. Age, WTL and SRH were the only statistically significant predictors of survival in women. Survival of men was predicted by age, daily functioning, SRH, working outside home or volunteering, and self-esteem. Our findings show that the WTL predicts long-term survival among elderly women, and therefore has a prognostic value. This strengthens its previously presented importance as a generalized indicator of well-being. These findings have practical implications for formal and informal caregivers.

The objectives of this study were to evaluate caregivers' experiences concerning the care of a terminally ill loved one at home, and to compare the death experiences of caregivers with and without access to homecare programs. The primary caregivers of all the patients who died of cancer 6-18 months before the study period (1999-2001) in the Negev area were contacted. This group included 240 caregivers of patients who died in the home palliative care program and 404 caregivers of patients who died with no access to a home palliative care program. A total of 159 caregivers were interviewed, 76 from the home palliative program and 83 who had no access to a palliative care program. Death at home occurred for 80.3% of patients with access to homecare and 20.5% of those without access. Despite the fact that caring for a loved one at home was a greater financial and emotional burden, there was a greater overall satisfaction with the caring experience of those whose loved ones died at home and had access to the homecare program. Given appropriate professional support systems, home-based care at the end of life is preferable to most caregivers.

In view of the current social dilemmas regarding the use of life-sustaining treatments (LST) at the end of life, the purpose of the study was to reveal sources of interpersonal and intrapersonal conflict among the most involved parties, in a society where open doctor-patient communication about end-of-life treatment is rare. Two comparative analyses were conducted: (a) between physicians' practice and elderly persons' preferences regarding the use of different life-sustaining treatments in different illness conditions, and (b) between physicians' hypothetical practice for an elderly person in a metastatic cancer condition, elderly persons' preferences and physicians' preferences for themselves, should they be in the same illness condition. Data were collected in Israel from 339 physicians working in two medical centers, and from a random sample of 987 elderly persons. Attitudes and practice regarding artificial tube feeding, mechanical ventilation and cardiopulmonary resuscitation (CPR) in three different illness conditions were evaluated by close-ended questions. The findings indicate disagreements between the elderly and the physicians on a number of issues: in general, physicians report that they would use more LST than what the elderly report that they would want. Physicians differentiate among different illness conditions and different LST more than elderly persons do. Physicians are more likely to use artificial feeding than CPR, while elderly persons prefer the use of CPR more than artificial feeding. The comparison of physicians' hypothetical practice, the wishes of the elderly, and physicians' wishes for themselves regarding the use of LST in a metastatic cancer condition, shows that physicians would use LST differently from what the elderly want, and that they want less LST for themselves than they would order for elderly patients. The discrepancies found between the physicians' practice and the elderly persons preferences reflect differences in perceptions of artificial feeding and a lack of public knowledge regarding the effectiveness of CPR. They also reflect differences in attitudes regarding the prolongation of life in various illness conditions. The discrepancy between physicians' practice and their preferences for themselves underscores the personal and professional dilemmas related to these issues, which are faced daily by many physicians, and impede their compassionate behavior toward patients. Increasing the awareness of physicians of such discrepancies, and providing them with appropriate behavioral tools, including communication skills, is a timely need which should be addressed by the medical profession, medical services and medical schools.

Exercise testing is an important diagnostic and prognostic procedure in the assessment of patients with hypertension. An exaggerated blood pressure response to exercise among normotensive subjects was found to be one of the best predictors of future hypertension. The demographic characteristics of patients with an exaggerated blood pressure response during exercise have not been adequately described.The demographic and stress performance characteristics of 2 groups of normotensive patients referred for exercise testing, one composed of patients with an exaggerated blood pressure response (group I, n=146) and a group of patients with a normal blood pressure response (group II, n=439) were prospectively compared. Patients in group I were older than those in group II (54+/-12 vs 51+/-13 years, P.05). More men than women were found in both groups, yet significantly more in group I than in group II (83% vs 69% P.001). Significantly more among the patients in group I had a higher level of education and were of Western origin than those in group II (P.01). The resting systolic and diastolic blood pressures were higher in group I than in group II (131+/-18 vs 119+/-14 mm Hg, P.001, and 81+/-8 vs 76+/-7 mm Hg, P.001, respectively). The patients in group I achieved a higher percentage of the maximal predicted heart rate (88+/-7 vs 85+/-9 beats/min, P.01). No significant differences were found between the groups in the duration of stress test and effort ischemia.Patients with a hypertensive blood pressure response during stress testing have specific demographic and exercise characteristics.

This study investigated students' wishes regarding the use of life-sustaining treatments (LST) in different health conditions compared with their evaluations of the wishes of elderly people, and with reports of a group of elderly people about themselves. Data were collected from two consecutive classes of first year medical students (n = 101), and a random sample of Israeli elderly aged 70+ (n = 987) who responded to fixed-choice questions regarding their will to live and wishes for three kinds of LST in a number of hypothetical illness conditions. The students were also asked to assess elderly's wishes. Students ranked the will to live of elderly persons significantly lower than their own. The elderly ranked their will to live significantly lower than did the students, but higher than the students assumed about them, indicating that although the will to live is weaker among older people, it is stronger than young persons believe. With regard to the use of LST, students believe that old people want less LST than themselves, but the elderly want even less LST than assumed by the students. The best predictors of students' wishes for themselves were fear of dying and religiosity. Fear of dying, the students' self-esteem and religiosity were the best predictors of their evaluations of the elderly's wishes. The results indicate that both the elderly and the students have a relatively strong will to live, but this desire is dependent on quality of life. The implications of this study for medical education are discussed.

This study investigates the wishes of Israeli elderly concerning the use of life-sustaining treatments (LST) at the end of life, and suggests an explanatory causal model for these wishes. The data include 1138 Israeli elderly (70 +) respondents. The results indicate that most of the elderly want to prolong their life in mild health conditions, including having cancer with a relatively good prognosis, while only a small percentage want LST in severe illness. Structural equation analysis (LISREL) of wishes for LST in severe illness conditions revealed that personal experience with other people's illnesses is the single most powerful explanatory factor affecting choice regarding LST directly and indirectly, channeled through fear of death and fear of dying. The results of such experiences whether positive or negative affect wishes for LST in the same direction; however, since they are mostly negative, past experience mostly weakens the will to prolong life by LST. Beliefs and feelings regarding life and death, such as fear of death, fear of dying, the will to live and religiosity, are also good predictors of wishes for LST. Those who fear death, have a strong will to live, and those who are more religious are more likely than others to want to prolong their life by LST, while those who fear dying want it less. Religiosity affects these wishes directly and indirectly through fear of death, fear of dying, and the will to live. Health status and social support have only a minor effect on wishes for LST: the higher the present quality of life, the more likely are the elderly to want LST. Most of the socio-demographic characteristics have no significant effect on elderly persons' wishes for LST. Only gender has a minor direct and indirect effect, channeled through the fear of dying and the will to live. Women in comparison to men want less LST because they fear dying more and have a weaker will to live. The results of this study shed some light on the explanatory factors of wishes for LST in severe illness conditions. More research is needed in order to promote social understanding of the concerns and wishes of the most relevant parties regarding the use of LST. This is a necessary condition for the formulation of new societal guidelines for general policy and daily behavior.

The use of life-sustaining treatments (LST) for prolonging lives of terminally ill patients without being able to improve the quality of life is a source of ethical, medical, economic and legal dilemmas for physicians. Although physicians in all Western countries face these dilemmas, they are unique in each society due to the special combination of its dominant religion, and its priorities regarding social values and legislation. This paper presents opinions, attitudes, expectations and behavior regarding the use of LST among 25 physicians attached to one teaching hospital in Israel. The data, which was collected by in-depth, semi-structured interviews, indicate that all of the physicians agree that life does not always have to be artificially prolonged. The general message that the physicians conveyed was that they deal quite effectively with these issues. They are not at all bothered by economic considerations and found ways to deal with the legal, ethical and medical dilemmas. It is suggested that in Israel the core issue is not the current law, but lack of communication among physicians and between physicians and patients/families. The relevance of the dominant model of the doctor-patient relationship and applications for medical education and practice are discussed. A list of hypotheses derived from this exploratory study for future intra-societal and inter-societal research is presented.

The effects of recently experienced life events (RLE) and of a personal coping resource—the sense of coherence (SOC)—on the health of men and women were investigated among members of two small and cohesive communities—two kibbutzim in Israel ( n = 230). Results of analyses lend support to previous findings about the negative effects of life events on health, and to Antonovsky's theory about the positive influence of SOC on health. Separate analyses for men and women, however, show that while RLEs negatively affect women's health, SOC has no significant counterbalancing effect on their health. Among men, an opposite pattern is found; their health is not affected by RLE, but is significantly affected by their SOC. Our findings lead to the conclusion that men and women are differentially affected by stressors and make different use of their coping resources. These findings should be taken into consideration in further research on stress, coping and health.

An exploratory study of emergency department (ED) utilization, comparing Israeli adult Jews and Bedouin Arabs was conducted. The data interpretation derived from the premise that health services utilization reflects not only morbidity patterns but characteristics of both subcultures and the structure of health services. The Bedouins in the study are a Moslem traditional society going through a rapid process of urbanization and modernization, with a relative deficiency in primary health services. Data were collected from the general ED admissions registry. Patients (17+) who arrived at the ED during the first week of every even month of one calendar year were selected for this study (6815 Jews and 583 Bedouins). The findings indicate that, in general Bedouins use the ED significantly less than Jews. They adjust to the structure of the ED services and use them, more than Jews, as a primary service. Yet, the hospitalization rates of the two populations are similar. In both subcultures the pattern of gender differences changes after the age of 45. The change, however, is in the opposite direction. Differences in ED usage among Bedouin age-sex groups are discussed in terms of changes in social status during a period of socio-cultural transition.

Of 111 patients with normal coronary angiograms, 68 patients had elevated left-ventricular end diastolic pressure and ‘low-normal' ejection fraction (Group I) while the other 43 patients had normal left ventricular end diastolic pressure and ‘high normal' ejection fractions (Group II). Although the number of patients was too small for meaningful statistical analysis, systematically a higher percentage of patients with diabetes mellitus, hypertension, hypercholesterolemia and smoking history was found in Group I. In contrast to the patients in Group II, patients in Group I tended to have more angina and ischemic events.

This paper tests the hypothesis that structural changes in nurses' work settings, which allow nurses to autonomously exercise their knowledge and skills will lead not only to an enhanced feeling of professional autonomy, but also to an improvement in their professional self-image and to an increase in job satisfaction. An opportunity to test this hypothesis arose when physicians in Israel went on a strike which lasted 116 days. Primary care (PC) clinics were completely abandoned by physicians, leaving nurses to operate them on their own, while in hospitals, nurses continued to work as usual under physicians' supervision. The study compares the effect of the strike on head nurses in the two sectors. Data were collected by means of self administered questionnaires. The findings indicate that during the strike, PC head nurses expanded their activities and responsibilities and consequently felt more professional autonomy and job satisfaction, as well as an improvement in professional self-image. Hospital head nurses experienced significantly less changes in their work situation and, as expected, less change in all work related attitudes. It is suggested that, when given the opportunity to define for themselves roles where they can use their experience, knowledge and skills, senior nurses stand up to the challenge and consequently are more satisfied and their professional self-image improves.