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Delgado-Guay MO, De La Cruz MG, Epner DE. 'I don't want to burden my family': handling communication challenges in geriatric oncology. Ann Oncol 2014; 24 Suppl 7:vii30-35. [PMID: 24001760 DOI: 10.1093/annonc/mdt263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Oncologists need excellent communication skills to effectively handle challenging conversations regarding prognosis, transition to palliative care, code status, and other sensitive topics. Foundational skills include: 1) posing open-ended, exploratory questions, 2) allowing for appropriate silence in the conversation, 3) listening actively, 4) recognizing emotions, 5) responding to emotions with empathy rather than biomedical information, and 6) speaking with clarity by avoiding technical jargon and offering small chunks of information. Conversations about sensitive topics can be particularly challenging with geriatric patients, who experience functional and sensory limitations. The risk-benefit ratio of diagnostic and therapeutic interventions tips precariously in older patients as many develop geriatric syndromes. Older cancer patients have the unique perspective of looking back on a long life and looking forward to impending death. Higher order skills can be very powerful in helping geriatric cancer patients find meaning and dignity at the end of life. These skills include exploring spirituality and coping strategies and engaging the patient in conversation and reflection about their legacy.
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Affiliation(s)
- M O Delgado-Guay
- The University of Texas M D Anderson Cancer Center, 1400 Pressler, Houston, TX 77030, USA
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Vehling S, Mehnert A. Symptom burden, loss of dignity, and demoralization in patients with cancer: a mediation model. Psychooncology 2013; 23:283-90. [PMID: 24123321 DOI: 10.1002/pon.3417] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/20/2013] [Accepted: 09/04/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Sigrun Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Anja Mehnert
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology; University Medical Center Leipzig; Leipzig Germany
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Lowe SS, Watanabe SM, Baracos VE, Courneya KS. Home-based functional walking program for advanced cancer patients receiving palliative care: a case series. BMC Palliat Care 2013; 12:22. [PMID: 23663868 PMCID: PMC3655875 DOI: 10.1186/1472-684x-12-22] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/02/2013] [Indexed: 11/22/2022] Open
Abstract
Background Although meta-analyses have demonstrated that physical activity can positively impact quality of life outcomes in early stage cancer patients, it is not yet known whether these benefits can be extended to patients with advanced cancer. In a previous pilot survey of patients with advanced cancer with a median survival of 104 days, participants felt willing and able to participate in a physical activity intervention, and reported a strong preference for walking and home-based programming. Here, we report on the initial development and feasibility of a home-based functional walking program in patients with advanced cancer receiving palliative care. Methods Nine adult patients were recruited from outpatient palliative care clinics and palliative home care. A pilot intervention trial was conducted over a 6-week period. The McGill Quality of Life Questionnaire (MQOL), Late Life Function and Disability Instrument (LLFDI), Edmonton Symptom Assessment System (ESAS), Seniors Fitness Test, four-test balance scale, and grip strength, were performed pre- and post-intervention. Participants wore activPAL™ accelerometers to monitor ambulatory activity levels. Results Of the nine recruited participants, three participants dropped out prior to baseline testing due to hospital admission and feeling overwhelmed, and three participants dropped out during the intervention due to severe symptoms. Only three participants completed the intervention program, pre- and post-intervention assessments: two reported improvements in total MQOL scores, yet all three shared an overall trend towards worsening symptom and total fatigue scores post-intervention. Two participants passed away within 90 days of completing the intervention. Conclusions This case series demonstrates the challenges of a physical activity intervention in patients with advanced cancer receiving palliative care. Further feasibility research is required in this patient population. Trial registration This study is registered under ClinicalTrials.gov as NCT00438620.
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Affiliation(s)
- Sonya S Lowe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada
| | - Sharon M Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada ; Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Alberta, Canada
| | - Vickie E Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Alberta, Canada
| | - Kerry S Courneya
- Physical Activity and Cancer, Physical Education & Recreation, University of Alberta, E-488 Van Vliet Centre, Edmonton, Alberta, T6G 2H9, Canada
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Bausewein C, Calanzani N, Daveson BA, Simon ST, Ferreira PL, Higginson IJ, Bechinger-English D, Deliens L, Gysels M, Toscani F, Ceulemans L, Harding R, Gomes B. 'Burden to others' as a public concern in advanced cancer: a comparative survey in seven European countries. BMC Cancer 2013; 13:105. [PMID: 23496878 PMCID: PMC3637205 DOI: 10.1186/1471-2407-13-105] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 02/18/2013] [Indexed: 11/12/2022] Open
Abstract
Background Europe faces an enormous public health challenge with aging populations and rising cancer incidence. Little is known about what concerns the public across European countries regarding cancer care towards the end of life. We aimed to compare the level of public concern with different symptoms and problems in advanced cancer across Europe and examine factors influencing this. Methods Telephone survey with 9,344 individuals aged ≥16 in England, Flanders, Germany, Italy, Netherlands, Portugal and Spain. Participants were asked about nine symptoms and problems, imagining a situation of advanced cancer with less than one year to live. These were ranked and the three top concerns examined in detail. As ‘burden to others’ showed most variation within and between countries, we determined the relative influence of factors on this concern using GEE and logistic regression. Results Overall response rate was 21%. Pain was the top concern in all countries, from 34% participants (Italy) to 49% (Flanders). Burden was second in England, Germany, Italy, Portugal, and Spain. Breathlessness was second in Flanders and the Netherlands. Concern with burden was independently associated with age (70+ years, OR 1.50; 95%CI 1.24-1.82), living alone (OR 0.82, 95%CI 0.73-0.93) and preferring quality rather than quantity of life (OR 1.43, 95%CI 1.14-1.80). Conclusions When imagining a last year of life with cancer, the public is not only concerned about medical problems but also about being a burden. Public education about palliative care and symptom control is needed. Cancer care should include a routine assessment and management of social concerns, particularly for older patients with poor prognosis.
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Affiliation(s)
- Claudia Bausewein
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
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Montoya-Juarez R, Garcia-Caro MP, Campos-Calderon C, Schmidt-RioValle J, Gomez-Chica A, Marti-García C, Cruz-Quintana F. Psychological responses of terminally ill patients who are experiencing suffering: A qualitative study. Int J Nurs Stud 2013; 50:53-62. [DOI: 10.1016/j.ijnurstu.2012.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 08/22/2012] [Accepted: 08/25/2012] [Indexed: 10/27/2022]
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Warmenhoven F, van Weel C, Vissers K, Prins J. Screening Instruments for Depression in Advanced Cancer Patients: What Do We Actually Measure? Pain Pract 2012; 13:467-75. [DOI: 10.1111/papr.12012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Franca Warmenhoven
- Department of Primary and Community Care; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Judith Prins
- Department of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
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Beng TS, Guan NC, Seang LK, Pathmawathi S, Ming MF, Jane LE, Chin LE, Loong LC. The Experiences of Suffering of Palliative Care Patients in Malaysia. Am J Hosp Palliat Care 2012; 31:45-56. [DOI: 10.1177/1049909112458721] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A qualitative study was conducted with semi-structured interviews to explore the experiences of suffering in 20 adult palliative care inpatients of University Malaya Medical Centre. The results were thematically analyzed. Ten basic themes were generated (1) loss and change → differential suffering, (2) care dependence → dependent suffering, (3) family stress → empathic suffering, (4) disease and dying → terminal suffering, (5) health care staff encounters → interactional suffering, (6) hospital environment → environmental suffering, (7) physical symptoms → sensory suffering, (8) emotional reactions → emotional suffering, (9) cognitive reactions → cognitive suffering, and (10) spiritual reactions → spiritual suffering. An existential–experiential model of suffering was conceptualized from the analysis. This model may inform the development of interventions in the prevention and management of suffering.
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Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Lim Kheng Seang
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Subramaniam Pathmawathi
- Department of Nursing Science, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Moy Foong Ming
- Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Lim Ee Jane
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
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Östlund U, Brown H, Johnston B. Dignity conserving care at end-of-life: A narrative review. Eur J Oncol Nurs 2012; 16:353-67. [DOI: 10.1016/j.ejon.2011.07.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 06/07/2011] [Accepted: 07/31/2011] [Indexed: 11/26/2022]
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Dempsey LE, Karver MS, Labouliere C, Zesiewicz TA, De Nadai AS. Self-Perceived Burden as a Mediator of Depression Symptoms Amongst Individuals Living With a Movement Disorder. J Clin Psychol 2012; 68:1149-60. [DOI: 10.1002/jclp.21901] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Self-perceived burden in chronic pain: relevance, prevalence, and predictors. Pain 2012; 153:1735-1741. [PMID: 22703692 DOI: 10.1016/j.pain.2012.05.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 04/27/2012] [Accepted: 05/03/2012] [Indexed: 11/22/2022]
Abstract
Chronic pain is a debilitating condition that can have an impact on various facets of interpersonal functioning. Although some studies have examined the extent to which family members are affected by an individual's chronic pain, none have examined patients' perceptions of feeling that they have become a burden to others. Research on self-perceived burden in different medical populations, such as cancer, amyotrophic lateral sclerosis, and stroke, has shown that it is associated with physical symptoms and, more robustly, with psychological difficulties and concerns. The present study examined the prevalence and predictors of self-perceived burden in a tertiary chronic pain sample. Participants were consecutive patients (N = 238) admitted to an outpatient, interdisciplinary, chronic pain management program at a rehabilitation hospital. At admission, participants completed a battery of psychometric questionnaires assessing self-perceived burden, as well as a number of clinically relevant constructs. Their significant others (n = 80) also completed a measure of caregiver burden. Self-perceived burden was a commonly reported experience among chronic pain patients, with more than 70% of participants endorsing clinically elevated levels. It was significantly correlated with pain intensity ratings, functional limitations, depressive symptoms, attachment anxiety, pain self-efficacy, and caregiver burden. Self-perceived burden was also correlated with an item assessing suicidal ideation. In a hierarchical regression model, depressive symptoms, pain self-efficacy, and adult attachment significantly predicted self-perceived burden after controlling for demographic and pain-related variables. In conclusion, self-perceived burden is a clinically relevant and commonly reported interpersonal experience in patients with longstanding pain.
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Greer JA, Traeger L, Bemis H, Solis J, Hendriksen ES, Park ER, Pirl WF, Temel JS, Prigerson HG, Safren SA. A pilot randomized controlled trial of brief cognitive-behavioral therapy for anxiety in patients with terminal cancer. Oncologist 2012; 17:1337-45. [PMID: 22688670 DOI: 10.1634/theoncologist.2012-0041] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Patients with terminal cancer often experience marked anxiety that is associated with poor quality of life. Although cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety disorders, the approach needs to be adapted to address realistic concerns related to having cancer, such as worries about disease progression, disability, and death. In this pilot randomized controlled trial (clinicaltrials.gov identifier NCT00706290), we examined the feasibility and potential efficacy of brief CBT to reduce anxiety in patients with terminal cancer. METHODS We adapted CBT by developing treatment modules targeting skills for relaxation, coping with cancer worries, and activity pacing. Adults with incurable malignancies and elevated anxiety based on the Hamilton Anxiety Rating Scale (HAM-A) were randomly assigned to individual CBT or a waitlist control group. Primary outcomes included the number of completed CBT visits and the change in HAM-A scores from baseline to 8-week follow-up per a treatment-blind evaluator. The feasibility criterion was 75% adherence to the intervention. RESULTS We randomized 40 patients with terminal cancers to CBT (n = 20) or waitlist control (n = 20) groups; 70% completed posttreatment assessments. Most patients who received CBT (80%) participated in at least five of the required six therapy sessions. Analysis of covariance models, adjusted for baseline scores, showed that those assigned to CBT had greater improvements in HAM-A scores compared to the control group, with an adjusted mean difference of -5.41 (95% confidence interval: -10.78 to -0.04) and a large effect size for the intervention (Cohen's d = 0.80). CONCLUSION Providing brief CBT tailored to the concerns of patients with terminal cancer was not only feasible but also led to significant improvements in anxiety.
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Affiliation(s)
- Joseph A Greer
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Yawkey Building, Suite 10B, 55 Fruit Street, Boston, Massachusetts 02114, USA.
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Esbensen BA, Thomé B, Thomsen T. Dependency in elderly people newly diagnosed with cancer – A mixed-method study. Eur J Oncol Nurs 2012; 16:137-44. [DOI: 10.1016/j.ejon.2011.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 04/18/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
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Akechi T, Miyashita M, Morita T, Okuyama T, Sakamoto M, Sagawa R, Uchitomi Y. Good Death in Elderly Adults with Cancer in Japan Based on Perspectives of the General Population. J Am Geriatr Soc 2012; 60:271-6. [DOI: 10.1111/j.1532-5415.2012.03895.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Mitsunori Miyashita
- Department of Palliative Nursing; Health Sciences; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care; Palliative Care Team and Seirei Hospice; Seirei Mikatahara General Hospital; Hamamatsu; Japan
| | - Toru Okuyama
- Department of Palliative Medicine; Nagoya City University Hospital; Nagoya; Japan
| | - Masaki Sakamoto
- Department of Palliative Medicine; Nagoya City University Hospital; Nagoya; Japan
| | - Ryuichi Sagawa
- Department of Palliative Medicine; Nagoya City University Hospital; Nagoya; Japan
| | - Yosuke Uchitomi
- Department of Neuropsychiatry; Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama University; Okayama; Japan
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Low prevalence of depressive disorder in ambulatory advanced cancer patients using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1). J Affect Disord 2012; 136:1209-11. [PMID: 22154709 DOI: 10.1016/j.jad.2011.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/17/2011] [Accepted: 11/17/2011] [Indexed: 11/23/2022]
Abstract
Depressive disorder is assumed to be highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. The more robust the assessment instrument to diagnose depressive disorder is, the lower the reported prevalence of depressive disorder in advanced cancer patients. This study confirms a low prevalence of depressive disorder (3%) in 64 advanced cancer outpatients using a robust structured clinical assessment (SCAN 2.1). Furthermore, in this article we discuss possible implications of using predefined psychiatric labeling in the assessment of mood symptoms in advanced cancer patients.
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67
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Van Orden KA, Bamonti PM, King DA, Duberstein PR. Does perceived burdensomeness erode meaning in life among older adults? Aging Ment Health 2012; 16:855-60. [PMID: 22401290 PMCID: PMC3416966 DOI: 10.1080/13607863.2012.657156] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Identification of risk factors for the loss of meaning in life among older adults is needed. In this article, we test hypotheses derived from the Interpersonal Theory of Suicide concerning the role of perceptions that one is a burden on others as a risk factor for lower meaning in life. METHODS A prospective design was used to examine the temporal associations between perceptions of burdensomeness on others and perceived meaning in life among older adults (n=65) seeking mental health treatment (primarily for depression and/or anxiety) at an outpatient geriatric mental health clinic. Participants completed self-report questionnaires within a month following intake. Follow-up questionnaires were completed over the phone two months later. RESULTS Perceived burdensomeness predicted lack of meaning in life two months later, while accounting for depression severity. In contrast, baseline levels of meaning in life did not significantly predict the levels of burdensomeness at two months. CONCLUSION The findings suggest that burdensomeness may contribute to suicide morbidity and mortality in late-life by eroding meaning in life. Empirically supported treatments for late-life depression could be adapted to focus on perceptions of burdensomeness and its connections with meaning in life.
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Bleek J. Ist die Beihilfe zum Suizid auf der Grundlage des Wunsches, anderen nicht zur Last zu fallen, ethisch gerechtfertigt? Ethik Med 2011. [DOI: 10.1007/s00481-011-0148-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Warmenhoven F, van Rijswijk E, Engels Y, Kan C, Prins J, van Weel C, Vissers K. The Beck Depression Inventory (BDI-II) and a single screening question as screening tools for depressive disorder in Dutch advanced cancer patients. Support Care Cancer 2011; 20:319-24. [PMID: 21243377 PMCID: PMC3244603 DOI: 10.1007/s00520-010-1082-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 12/27/2010] [Indexed: 11/29/2022]
Abstract
Purpose Depression is highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. Screening instruments could facilitate diagnosing depressive disorder in patients with advanced cancer. The aim of this study was to determine the validity of the Beck Depression Inventory (BDI-II) and a single screening question as screening tools for depressive disorder in advanced cancer patients. Methods Patients with advanced metastatic disease, visiting the outpatient palliative care department, were asked to fill out a self-questionnaire containing the Beck Depression Inventory (BDI-II) and a single screening question “Are you feeling depressed?” The mood section of the PRIME-MD was used as a gold standard. Results Sixty-one patients with advanced metastatic disease were eligible to be included in the study. Complete data were obtained from 46 patients. The area under the curve of the receiver operating characteristics analysis of the BDI-II was 0.82. The optimal cut-off point of the BDI-II was 16 with a sensitivity of 90% and a specificity of 69%. The single screening question showed a sensitivity of 50% and a specificity of 94%. Conclusions The BDI-II seems an adequate screening tool for a depressive disorder in advanced cancer patients. The sensitivity of a single screening question is poor.
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Affiliation(s)
- Franca Warmenhoven
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Huispost 630, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Abstract
Palliative care is an interdisciplinary and holistic approach aimed at alleviating suffering from physical, psychosocial, and spiritual issues in progressive, advanced disease. Progressive fatigue and anorexia-cachexia syndrome can contribute to loss of physical function in the palliative cancer patient, to the detriment of overall quality of life. Physical activity is one potential intervention, which may address these needs in the palliative cancer patient. There is preliminary evidence that at least some palliative cancer patients are willing and able to tolerate physical activity interventions, with some patients demonstrating improvement in select supportive care outcomes postintervention. Methodologically rigorous studies and consensus on common definitions are required to advance this area of research.
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Affiliation(s)
- Sonya S Lowe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, 11560 University Drive NW, Edmonton, T6G 1Z2, Alberta, Canada.
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Moorman SM. Older adults' preferences for independent or delegated end-of-life medical decision making. J Aging Health 2010; 23:135-57. [PMID: 20947875 DOI: 10.1177/0898264310385114] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study assesses the proportions of participants who prefer independent or delegated medical decision making at the end of life and examines the relationships of personal beliefs, affiliative beliefs, and end-of-life planning behaviors to decision-making preference. METHOD Data are drawn from the Wisconsin Longitudinal Study, a sample of nearly 4,500 healthy White Midwestern high school graduates in their mid-60s. RESULTS Four fifths of participants wanted to make decisions independently. Valuing independence, being less avoidant of thoughts of death, and valuing quality of life over length of life had strong associations with a preference for independent decision making. Those concerned about burdening a caregiver wanted to make independent decisions. Persons who both executed a living will and appointed a durable power of attorney for health care preferred independent decision making. DISCUSSION Older adults cite personal and affiliative beliefs, not lack of autonomy, as reasons for their choice to decide independently or delegate.
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Chochinov HM. The culture of research in palliative care: you probably think this song is about you. J Palliat Med 2010; 12:215-7. [PMID: 19254193 DOI: 10.1089/jpm.2009.9662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Factors in the Short-term Life Review That Affect Spiritual Well-being in Terminally Ill Cancer Patients. J Hosp Palliat Nurs 2010. [DOI: 10.1097/njh.0b013e3181e53ae8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nilmanat K, Chailungka P, Phungrassami T, Promnoi C, Tulathamkit K, Noo-urai P, Phattaranavig S. Living with suffering as voiced by Thai patients with terminal advanced cancer. Int J Palliat Nurs 2010; 16:393-9. [DOI: 10.12968/ijpn.2010.16.8.393] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kittikorn Nilmanat
- Assistant Professor, Medical Nursing Department, Prince of Songkla University
| | - Pachariya Chailungka
- Assistant Professor and appointed Dean, Faculty of Nursing, Prince of Songkla University
| | - Temsak Phungrassami
- Associate Professor, Radiotherapy Department, Songklanagarind Hospital, Prince of Songkla University
| | - Chantra Promnoi
- Senior Lecturer, Surgical Nursing Department, Prince of Songkla University
| | - Kandawasri Tulathamkit
- Senior Nurses, Radiotherapy Department, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Prachuap Noo-urai
- Senior Nurses, Radiotherapy Department, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sasiwimon Phattaranavig
- Senior Nurses, Radiotherapy Department, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Akazawa T, Akechi T, Morita T, Miyashita M, Sato K, Tsuneto S, Shima Y, Furukawa TA. Self-perceived burden in terminally ill cancer patients: a categorization of care strategies based on bereaved family members' perspectives. J Pain Symptom Manage 2010; 40:224-34. [PMID: 20541903 DOI: 10.1016/j.jpainsymman.2009.12.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 12/18/2009] [Accepted: 01/04/2010] [Indexed: 01/19/2023]
Abstract
CONTEXT Terminally ill cancer patients often experience a self-perceived burden that affects their quality of life; however, no standard care strategy for coping with this form of suffering has ever been established. OBJECTIVES The objectives of this present study were 1) to investigate the prevalence of self-perceived burden among terminally ill cancer patients based on a survey of family members, 2) to assess the level of family perceived usefulness of expert-recommended care strategies, and 3) to categorize the care strategies. METHODS The subjects were bereaved family members of patients who had died in certified palliative care units throughout Japan. The Good Death Inventory was used to evaluate patients' self-perceived burden based on the proxy ratings of family members. The perceived usefulness of care was assessed using a 27-item questionnaire developed by a focus group of palliative experts and a systematic review. RESULTS A total of 429 responses (64%) received from a member of each of 666 bereaved families was analyzed. In their responses, 25% of the bereaved family members reported that the patient had experienced a mild self-perceived burden, whereas 25% reported that the patient had experienced a moderate to severe self-perceived burden. The family members recommended the following as particularly effective care strategies: "Eliminate pain and other symptoms that restrict patient activity (53%);" "Quickly dispose of urine and stools so that they are out of sight (52%);" and "Support patients' efforts to care for themselves (45%)." A factor analysis showed that the expert-recommended care strategies could be categorized into seven different components. CONCLUSION Many terminally ill cancer patients suffer from a self-perceived burden. Family members recommended a variety of care strategies to alleviate patient-perceived burden. Palliative care specialists should have adequate knowledge of promising care strategies for alleviating patient-perceived burden.
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Affiliation(s)
- Terukazu Akazawa
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Survival Implications of Sudden Functional Decline as a Sentinel Event Using the Palliative Performance Scale. J Palliat Med 2010; 13:549-57. [DOI: 10.1089/jpm.2009.0299] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Downey L, Curtis JR, Lafferty WE, Herting JR, Engelberg RA. The Quality of Dying and Death Questionnaire (QODD): empirical domains and theoretical perspectives. J Pain Symptom Manage 2010; 39:9-22. [PMID: 19782530 PMCID: PMC2815047 DOI: 10.1016/j.jpainsymman.2009.05.012] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 05/07/2009] [Accepted: 05/14/2009] [Indexed: 11/18/2022]
Abstract
We used exploratory factor analysis within the confirmatory analysis framework, and data provided by family members and friends of 205 decedents in Missoula, Montana, to construct a model of latent-variable domains underlying the Quality of Dying and Death questionnaire (QODD). We then used data from 182 surrogate respondents, who were survivors of Seattle decedents, to verify the latent-variable structure. Results from the two samples suggested that survivors' retrospective ratings of 13 specific aspects of decedents' end-of-life experience served as indicators of four correlated, but distinct, latent-variable domains: Symptom Control, Preparation, Connectedness, and Transcendence. A model testing a unidimensional domain structure exhibited unsatisfactory fit to the data, implying that a single global quality measure of dying and death may provide insufficient evidence for guiding clinical practice, evaluating interventions to improve quality of care or assessing the status or trajectory of individual patients. In anticipation of possible future research tying the quality of dying and death to theoretical constructs, we linked the inferred domains to concepts from identity theory and existential psychology. We conclude that research based on the current version of the QODD might benefit from the use of composite measures representing the four identified domains, but that future expansion and modification of the questionnaire are in order.
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Affiliation(s)
- Lois Downey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA.
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Thompson GN, Chochinov HM, Wilson KG, McPherson CJ, Chary S, O'Shea FM, Kuhl DR, Fainsinger RL, Gagnon PR, Macmillan KA. Prognostic Acceptance and the Well-Being of Patients Receiving Palliative Care for Cancer. J Clin Oncol 2009; 27:5757-62. [DOI: 10.1200/jco.2009.22.9799] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To identify the impact of prognostic acceptance/nonacceptance on the physical, psychological, and existential well-being of patients with advanced cancer. Patients and Methods A Canadian multicenter prospective national survey was conducted of patients diagnosed with advanced cancer with an estimated survival duration of 6 months or less (n = 381) receiving palliative care services. Results Of the total number of participants, 74% reported accepting their situation and 8.6% reported accepting with “moderate” to “extreme” difficulty. More participants with acceptance difficulties than without acceptance difficulties met diagnostic criteria for a depressive or anxiety disorder (χ2 = 8.67; P < .01). Nonacceptors were younger (t = 4.13; P < .000), had more than high school education (χ2 = 4.69; P < .05), and had smaller social networks (t = 2.53; P < .05) than Acceptors. Of the Nonacceptors, 42% described their experience as one of “moderate” to “extreme” suffering compared with 24.1% of Acceptors (χ2 = 5.28; P < .05). More than one third (37.5%) of Nonacceptors reported feeling hopeless compared with 8.6% who had no difficulty accepting (χ2 = 24.76; P < .000). Qualitatively, participants described active and passive coping strategies that helped them accept what was happening to them, as well as barriers that made it difficult to come to terms with their current situation. Conclusion The challenge of coming to terms with a terminal prognosis is a complex interplay between one's basic personality, the availability of social support, and one's spiritual and existential views on life. Nonacceptance appears to be highly associated with feelings of hopelessness, a sense of suffering, depression, and anxiety, along with difficulties in terms of social–relational concerns.
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Affiliation(s)
- Genevieve N. Thompson
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
| | - Harvey M. Chochinov
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
| | - Keith G. Wilson
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
| | - Christine J. McPherson
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
| | - Srini Chary
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
| | - Fiona M. O'Shea
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
| | - David R. Kuhl
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
| | - Robin L. Fainsinger
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
| | - Pierre R. Gagnon
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
| | - Karen A. Macmillan
- From the Department of Psychiatry; Manitoba Palliative Care Research Unit, CancerCare Manitoba and Faculty of Nursing, University of Manitoba, Winnipeg, MB; Department of Medicine (Division of Physical Medicine and Rehabilitation) and School of Psychology; Faculty of Health Sciences, University of Ottawa, Ottawa, ON; Department of Oncology, University of Calgary, Calgary; Palliative Care Medicine, Department of Oncology, University of Alberta; Grey Nuns Community Hospital, Covenant Health, Edmonton, AB
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Chochinov HM, Hassard T, McClement S, Hack T, Kristjanson LJ, Harlos M, Sinclair S, Murray A. The landscape of distress in the terminally ill. J Pain Symptom Manage 2009; 38:641-9. [PMID: 19713069 DOI: 10.1016/j.jpainsymman.2009.04.021] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 03/20/2009] [Accepted: 04/01/2009] [Indexed: 01/11/2023]
Abstract
Understanding the complexities of distress and knowing who is most vulnerable is foundational to the provision of quality, palliative end-of-life care. Although prior studies have examined the prevalence of symptom distress among patients nearing death, these studies have tended to largely focus on physical and, to a lesser extent, psychological challenges. The aim of this study was to use the Patient Dignity Inventory (PDI), a novel, reliable, and validated measure of end-of-life distress, to describe a broad landscape of distress in patients who are terminally ill. The PDI, a 25-item self-report, was administered to 253 patients receiving palliative care. Each PDI item is rated by patients to indicate the degree to which they experience various kinds of end-of-life distress. Palliative care patients reported an average of 5.74 problems (standard deviation, 5.49; range, 0-24), including physical, psychological, existential, and spiritual challenges. Being an inpatient, being educated, and having a partner were associated with certain kinds of end-of-life problems, particularly existential distress. Spirituality, especially its existential or "sense of meaning and purpose" dimension, was associated with less distress for terminally ill patients. A better appreciation for the nature of distress is a critical step toward a fuller understanding of the challenges facing the terminally ill. A clear articulation of the landscape of distress, including insight regarding those who are most at risk, should pave the way toward more effective, dignity-conserving end-of-life care.
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Affiliation(s)
- Harvey Max Chochinov
- Manitoba Palliative Care Research Unit, University of Manitoba, Manitoba, Canada.
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Akechi T, Ietsugu T, Sukigara M, Okamura H, Nakano T, Akizuki N, Okamura M, Shimizu K, Okuyama T, Furukawa TA, Uchitomi Y. Symptom indicator of severity of depression in cancer patients: a comparison of the DSM-IV criteria with alternative diagnostic criteria. Gen Hosp Psychiatry 2009; 31:225-32. [PMID: 19410101 DOI: 10.1016/j.genhosppsych.2008.12.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/01/2008] [Accepted: 12/10/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study was to explore the performances of several diagnostic criteria items for judging the severity of major depression among cancer patients. METHOD Using modern item response theory, we examined the performances of the diagnostic criteria outlined by the DSM-IV and two sets of conceptual diagnostic criteria (the Endicott and the Cavanaugh criteria) in a series of 728 cancer patients who had been diagnosed with major depression using an inclusive approach. RESULTS While all the DSM-IV diagnostic criteria, including feelings of worthlessness and suicidal ideation, had a low ability for discriminating the severity of depression, two proposed items (not participating in medical care and social withdrawal) appeared to be good markers of moderately severe major depressive disorder among cancer patients. In addition, the items "fearfulness or depressed appearance in face or body posture" and "brooding, self-pity or pessimism" may be good markers for mild major depressive disorders, while the item "cannot be cheered up, doesn't smile, no response to good news or funny situations" may be a good marker for severe major depressive disorder. CONCLUSIONS The findings of the present study suggest that alternative criteria may have utility in diagnosing depression severity in cancer patients.
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Affiliation(s)
- Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Schleinich MA, Warren S, Nekolaichuk C, Kaasa T, Watanabe S. Palliative care rehabilitation survey: a pilot study of patients' priorities for rehabilitation goals. Palliat Med 2008; 22:822-30. [PMID: 18772213 DOI: 10.1177/0269216308096526] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rehabilitation in palliative care is often overlooked. Settings that do consider occupational or physical therapy for palliative care patients often consult to therapists with competing caseloads. Few therapists specialise in palliative care, but nearly all ask, 'What needs doing'? and 'How well am I doing that'? No existing instruments address their questions. The objective is to develop and test a questionnaire for identifying patient goals and priorities for rehabilitation in palliative care. A questionnaire representing 11 domains of the Canadian Model of Occupational Performance was designed and pilot tested at four palliative care sites. Each question reflected a typical rehabilitation intervention in palliative care. Patients were asked to rate how important each of these interventions was on a numerical rating scale (0, not important-10, extremely important). Open-ended questions captured verbatim comments regarding thoughts of rehabilitation. The questionnaire was tested for test-retest reliability with two interviews approximately 1 week apart. Forty patients participated in the first interview and 32 in the second. Eight of eleven domain sub-scores achieved an intra-class correlation coefficient of 0.6 or higher. The highest means were for the physical (8.2), institutional (7.8) and self-care (7.8) domains on the first interview and for the spiritual domain (7.9) on the second interview. Suggestions are provided to shorten the questionnaire and strengthen validity. This work furthers the understanding of the role of rehabilitation in palliative care. It also illustrates the feasibility of involving palliative care patients in research that contributes to setting standards and measuring quality of service.
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Affiliation(s)
- M A Schleinich
- Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada.
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