CONSENSUS REPORT 889 ''My life is meaningless.'' ''I feel useless.'' Abandonment by God or others Lack of love, loneliness Not being remembered No sense of Relatedness ''God has abandoned me.'' ''No one comes by anymore.'' Anger at God or others Displaces anger toward religious representatives Inability to forgive ''Why would God take my child. .. it's not fair.'' Concerns about relationship with deity Desires closeness to God, deepening relationship ''I want to have a deeper relationship with God.'' Conflicted or challenged belief systems Verbalizes inner conflicts or questions about beliefs or faith Conflicts between religious beliefs and recommended treatments Questions moral or ethical implications of therapeutic regimen Expresses concern with life=death or belief system ''I am not sure if God is with me anymore.'' Despair=Hopelessness Hopelessness about future health, life Despair as absolute hopelessness No hope for value in life ''Life is being cut short.'' ''There is nothing left for me to live for.'' Grief=loss The feeling and process associated with the loss of a person, health, relationship ''I miss my loved one so much.'' ''I wish I could run again.'' Guilt=shame Feeling that one has done something wrong or evil Feeling that one is bad or evil ''I do not deserve to die pain-free.'' Reconciliation Need for forgiveness or reconciliation from self or others ''I need to be forgiven for what I did.'' ''I would like my wife to forgive me.'' Isolation Separated from religious community or other ''Since moving to the assisted living I am not able to go to my church anymore.'' Religious-specific Ritual needs Unable to perform usual religious practices ''I just can't pray anymore.'' Religious=spiritual struggle Loss of faith or meaning Religious or spiritual beliefs or community not helping with coping ''What if all that I believe is not true.'' 894 PUCHALSKI ET AL.

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Nursing interventions to manage chemotherapy-related symptom distress can improve patient quality of life and increase chances for survival by reducing treatment-related symptom distress and enhancing patients' ability to adhere to treatment regimens and cope with their disease.

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Purpose/Objectives To explore the new and complex phenomenon of distance caregiving in the advanced cancer population. Research Approach Qualitative. Setting A large comprehensive cancer center in the midwestern region of the United States. Participants 14 distance caregivers of parents with advanced cancer. Methodologic Approach Patients with advanced lung, gastrointestinal, and gynecologic malignancies consented to have their distance caregiving adult children contacted to participate in the study. Responses to three open-ended questions guided the tape-recorded telephone interviews with the distance caregivers. Following transcription, content analysis with inductive coding was performed. Findings Two major themes, communication and control, and five subthemes, benefits and burdens of distance caregiving, dealing with uncertainty, direct action through information seeking, protecting, and staying connected, emerged from the data. Conclusions Distance caregivers experience some of the same stressors that local caregivers of patients with cancer experience. In addition, they have unique psychosocial needs related to the burden of geographic distance. Interpretation Distance caregivers could benefit from nursing interventions targeted at their unique needs. Innovative interventions using Web-based computer technology for improved communication, as well as supportive care interventions, may be helpful.