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Bellido-Pérez M, Crespo I, Wilson KG, Porta-Sales J, Balaguer A, Monforte-Royo C. Assessment of the wish to hasten death in patients with advanced cancer: A comparison of 2 different approaches. Psychooncology 2018; 27:1538-1544. [DOI: 10.1002/pon.4689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Mercedes Bellido-Pérez
- Department of Nursing; School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Barcelona Spain
- Primary Health Care Center Esparreguera; Institut Català de la Salut; Barcelona Spain
| | - Iris Crespo
- School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Barcelona Spain
| | - Keith G. Wilson
- Department of Psychology; Ottawa Hospital Rehabilitation Centre; Ottawa Ontario Canada
| | - Josep Porta-Sales
- School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Barcelona Spain
- Palliative Care Service, Institut Català d'Oncologia; l'Hospitalet de Llobregat; Barcelona Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Barcelona Spain
| | - Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Barcelona Spain
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Delgado-Guay MO. Developing a Healing Environment for Broken Souls of Patients With Life-Threatening Illnesses and Their Caregivers. J Pain Symptom Manage 2018; 55:1231-1236. [PMID: 29253528 DOI: 10.1016/j.jpainsymman.2017.12.477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 12/16/2022]
Abstract
What a privilege it is to be able to touch those sacred spaces in the soul of each person that we encounter everyday. Patients with life-threatening illnesses can struggle with physical, emotional, and existential and spiritual concerns and the suffering of caregivers. A key goal of our supportive and palliative care teams is to alleviate patient and caregiver suffering. When caring for patients with advanced and terminal illness, the spirituality of each member of the palliative care team becomes a single collective spirituality or soul with common goals, values, and belonging, with a main goal of providing the best care for patients and caregivers in the alleviation of suffering. Embracing the spiritual care into our daily practice is a common effort and a service provided by each member of the team. Our role as members of the collective soul is to preserve human dignity and raise up the broken souls of patients living with life-threatening illness by creating healing environments.
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Affiliation(s)
- Marvin Omar Delgado-Guay
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Zhou K, Mao Y. Palliative care in heart failure : A meta-analysis of randomized controlled trials. Herz 2018; 44:440-444. [PMID: 29468259 DOI: 10.1007/s00059-017-4677-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/23/2017] [Accepted: 12/26/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Palliative care can play an important role in the management of heart failure. We conducted a systematic review and meta-analysis to compare the efficacy and safety of palliative care in patients with heart failure. METHODS PubMed, Embase, Web of Science, EBSCO, and the Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) on the impact of palliative care on heart failure were included. Two investigators independently searched the articles, extracted data, and assessed the quality of included studies. The primary outcome was mortality. RESULTS Seven RCTs were included in the meta-analysis. Compared with usual care for heart failure, palliative care was associated with a significantly increased quality of life (standardized mean difference = 1.46; 95% confidence interval [CI] = 0.12 to 2.79; p = 0.03) and reduced depression scores (standardized mean difference = -0.62; 95% CI = -0.99 to -0.25; p = 0.03), but demonstrated no impact on mortality (risk ratio [RR] = 1.28; 95% CI = 0.86 to 1.92; p = 0.22) and rehospitalization (RR = 0.84; 95% CI = 0.66 to 1.07; p = 0.16). CONCLUSION Palliative care can improve the quality of life and reduce the occurrence of depression in patients with heart failure.
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Affiliation(s)
- K Zhou
- Department Rehabilitation Medicine, Ningbo No. 2 Hospital, Ningbo, Zhejiang Province, China
| | - Y Mao
- Emergency Department, Ninghai First Hospital, Ninghai, Zhejiang Province, China.
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54
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Wilson KG, Kowal J, Caird SM, Castillo D, McWilliams LA, Heenan A. Self-perceived burden, perceived burdensomeness, and suicidal ideation in patients with chronic pain. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2017; 1:127-136. [PMID: 35005348 PMCID: PMC8730634 DOI: 10.1080/24740527.2017.1368009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background: Self-perceived burden and perceived burdensomeness are two apparently related constructs that have arisen independently from research in physical and mental health, respectively. Although both are associated with suicidal ideation in individuals with chronic pain, they have yet to be examined concurrently in the same group of patients. Aims: The aim of this study was to investigate the relationship between the two constructs and their differential prediction of suicidal ideation. Methods: Participants were 260 outpatients of an interdisciplinary chronic pain treatment program. Each participant completed the Self-Perceived Burden Scale (SPBS), the Interpersonal Needs Questionnaire Perceived Burdensomeness Scale (INQPBS), the Beck Scale for Suicide Ideation, and the thoughts of self-harm item of the Patient Health Questionnaire-9. Results: The SPBS and the INQPBS were both unifactorial measures with good internal consistency. They correlated significantly with one another (r = 0.50, P < 0.001), as well as with scores on the two measures of suicidal ideation (rs ranging from 0.29 to 0.62, Ps < 0.001). However, the INQPBS correlated more highly with suicidal ideation than did the SPBS. In regression analyses, the INQPBS predicted unique variance in suicidal ideation after adjusting for the SPBS. Conversely, the SPBS did not contribute uniquely when the INQPBS was entered first. Conclusions: Patients with chronic pain who believe that they have become “a burden to others” are at increased risk for suicidal ideation. The conceptual similarities and differences between the constructs of self-perceived burden and perceived burdensomeness are reviewed to explain why perceived burdensomeness is the stronger predictor of this increased risk.
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Affiliation(s)
- Keith G. Wilson
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - John Kowal
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anaesthesiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sara M. Caird
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dyana Castillo
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Lachlan A. McWilliams
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adam Heenan
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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55
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Bellido-Pérez M, Monforte-Royo C, Tomás-Sábado J, Porta-Sales J, Balaguer A. Assessment of the wish to hasten death in patients with advanced disease: A systematic review of measurement instruments. Palliat Med 2017; 31:510-525. [PMID: 28124578 PMCID: PMC5405817 DOI: 10.1177/0269216316669867] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with advanced conditions may present a wish to hasten death. Assessing this wish is complex due to the nature of the phenomenon and the difficulty of conceptualising it. AIM To identify and analyse existing instruments for assessing the wish to hasten death and to rate their reported psychometric properties. DESIGN Systematic review based on PRISMA guidelines. The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of validation studies and the measurement properties of the instrument described. DATA SOURCES The CINAHL, PsycINFO, Pubmed and Web of Science databases were searched from inception to November 2015. RESULTS A total of 50 articles involving assessment of the wish to hasten death were included. Eight concerned instrument validation and were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments criteria. They reported data for between two and seven measurement properties, with ratings between fair and excellent. Of the seven instruments identified, the Desire for Death Rating Scale or the Schedule of Attitudes toward Hastened Death feature in 48 of the 50 articles. The Schedule of Attitudes toward Hastened Death is the most widely used and is the instrument whose psychometric properties have been most often analysed. Versions of the Schedule of Attitudes toward Hastened Death are available in five languages other than the original English. CONCLUSION This systematic review has analysed existing instruments for assessing the wish to hasten death. It has also explored the methodological quality of studies that have examined the measurement properties of these instruments and offers ratings of the reported properties. These results will be useful to clinicians and researchers with an interest in a phenomenon of considerable relevance to advanced patients.
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Affiliation(s)
- Mercedes Bellido-Pérez
- 1 Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,2 Hospital Sagrat Cor, Barcelona, Spain
| | - Cristina Monforte-Royo
- 1 Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Joaquín Tomás-Sábado
- 3 Escola Universitària d'Infermeria Gimbernat, Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Porta-Sales
- 4 School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,5 Palliative Care Service, Institut Català d'Oncologia, Barcelona, Spain
| | - Albert Balaguer
- 4 School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Vehling S, Kissane DW, Lo C, Glaesmer H, Hartung TJ, Rodin G, Mehnert A. The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer 2017; 123:3394-3401. [PMID: 28472548 DOI: 10.1002/cncr.30749] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Demoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co-occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness. METHODS In a cross-sectional sample of 430 mixed cancer patients, we assessed demoralization with the Demoralization Scale (DS); the 4-week prevalence of mood, anxiety, and adjustment disorders and suicidal ideation with the standardized Composite International Diagnostic Interview-Oncology (CIDI-O); and depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). We compared the relative risk (RR) for mental disorders associated with demoralization to that associated with self-reported depression. RESULTS Clinically relevant levels of demoralization were present in 21% of the patients. Demoralization co-occurred with a mood/anxiety disorder in 7%; 14% were demoralized in absence of any mood/anxiety disorder. Demoralization and adjustment disorders co-occurred in 2%. The RR for any mood/anxiety disorder was 4.0 in patients with demoralization (95% confidence interval [CI], 2.5-6.2) and 3.0 in those with depression (95% CI, 1.9-4.6). Demoralization, but not depression, was associated with a significantly increased risk for suicidal ideation after controlling for mental disorders (RR, 2.0; 95% CI, 1.1-3.5). CONCLUSIONS Clinically relevant demoralization frequently occurs independently of a mental disorder in patients with cancer and has a unique contribution to suicidal ideation. Demoralization is a useful concept to identify profiles of psychological distress symptoms amenable to interventions improving psychological well-being in this population. Cancer 2017;123:3394-401. © 2017 American Cancer Society.
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Affiliation(s)
- Sigrun Vehling
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David W Kissane
- Department of Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Christopher Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Guelph-Humber, Toronto, Ontario, Canada
| | - Heide Glaesmer
- Department of Medical Psychology and Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Tim J Hartung
- Department of Medical Psychology and Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anja Mehnert
- Department of Medical Psychology and Sociology, University Medical Center Leipzig, Leipzig, Germany
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Lo C, Panday T, Zeppieri J, Rydall A, Murphy-Kane P, Zimmermann C, Rodin G. Preliminary psychometrics of the Existential Distress Scale in patients with advanced cancer. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12597] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/26/2022]
Affiliation(s)
- C. Lo
- Department of Supportive Care; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Department of Psychiatry; University of Toronto; Toronto ON Canada
- Department of Psychology; University of Guelph-Humber; Toronto ON Canada
| | - T. Panday
- Department of Supportive Care; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
| | - J. Zeppieri
- Psychiatry; Greenville Health System/University of South Carolina; Greenville SC USA
| | - A. Rydall
- Department of Supportive Care; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
| | - P. Murphy-Kane
- Department of Supportive Care; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
| | - C. Zimmermann
- Department of Supportive Care; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Department of Psychiatry; University of Toronto; Toronto ON Canada
- Department of Medicine; University of Toronto; Toronto ON Canada
| | - G. Rodin
- Department of Supportive Care; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Department of Psychiatry; University of Toronto; Toronto ON Canada
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Monforte-Royo C, González-de Paz L, Tomás-Sábado J, Rosenfeld B, Strupp J, Voltz R, Balaguer A. Development of a short form of the Spanish schedule of attitudes toward hastened death in a palliative care population. Qual Life Res 2016; 26:235-239. [PMID: 27671489 PMCID: PMC5243867 DOI: 10.1007/s11136-016-1409-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The schedule of attitudes toward hastened death (SAHD) is widely used to assess the wish to hasten death (WTHD) among patients with life-threatening conditions. A short form of the SAHD would increase its clinical applicability in this population. METHOD Rasch analysis of data from 101 Spanish palliative inpatients. Item reduction involved selecting items with a high discrimination index (point-biserials ≥0.70), removing items with inadequate fit statistics, and assessing unidimensionality and local dependency. We examined the test probability function to establish an empirical risk score for suffering a WTHD and tested convergence between the original and the reduced set of items. RESULTS A set of five items met all quality criteria. In this sample, 20.8 % of participants had a higher risk of a WTHD (p > 50 %) at a score of 3. Correlation analysis confirmed convergent validity between the original and reduced forms. Concurrent validity was confirmed by the similar correlations shown by both versions of the SAHD (5 and 20 items) with other measures. CONCLUSION This 5-item Spanish form of the SAHD could be a suitable alternative to the full instrument. The cut-off score derived from the Rasch analysis may be able to detect patients at risk of a WTHD.
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Affiliation(s)
- Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Luis González-de Paz
- Public Health Unit, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
- Centre d'Atenció Primària Les Corts. Transverse Group for Research in Primary Care, IDIBAPS, Barcelona, Spain
| | - Joaquín Tomás-Sábado
- Escola Universitària d'Infermeria Gimbernat, Autonomous University of Barcelona, Barcelona, Spain
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Julia Strupp
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain.
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Costello J. Research roundup. Int J Palliat Nurs 2016. [DOI: 10.12968/ijpn.2016.22.6.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- John Costello
- Senior Lecturer, University of Manchester School of Nursing, Midwifery and Social Work
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Pierre JM. Culturally sanctioned suicide: Euthanasia, seppuku, and terrorist martyrdom. World J Psychiatry 2015; 5:4-14. [PMID: 25815251 PMCID: PMC4369548 DOI: 10.5498/wjp.v5.i1.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/21/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Suicide is one of the greatest concerns in psychiatric practice, with considerable efforts devoted to prevention. The psychiatric view of suicide tends to equate it with depression or other forms of mental illness. However, some forms of suicide occur independently of mental illness and within a framework of cultural sanctioning such that they aren’t regarded as suicide at all. Despite persistent taboos against suicide, euthanasia and physician-assisted suicide in the context of terminal illness is increasingly accepted as a way to preserve autonomy and dignity in the West. Seppuku, the ancient samurai ritual of suicide by self-stabbing, was long considered an honorable act of self-resolve such that despite the removal of cultural sanctioning, the rate of suicide in Japan remains high with suicide masquerading as seppuku still carried out both there and abroad. Suicide as an act of murder and terrorism is a practice currently popular with Islamic militants who regard it as martyrdom in the context of war. The absence of mental illness and the presence of cultural sanctioning do not mean that suicide should not be prevented. Culturally sanctioned suicide must be understood in terms of the specific motivations that underlie the choice of death over life. Efforts to prevent culturally sanctioned suicide must focus on alternatives to achieve similar ends and must ultimately be implemented within cultures to remove the sanctioning of self-destructive acts.
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61
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Research roundup. Int J Palliat Nurs 2014. [DOI: 10.12968/ijpn.2014.20.3.150b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Brief synopses of a selection of recently published research articles of relevance to palliative care.
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