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Noe-Steinmüller N, Scherbakov D, Zhuravlyova A, Wager TD, Goldstein P, Tesarz J. Defining suffering in pain: a systematic review on pain-related suffering using natural language processing. Pain 2024; 165:1434-1449. [PMID: 38452202 PMCID: PMC11190900 DOI: 10.1097/j.pain.0000000000003195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 03/09/2024]
Abstract
ABSTRACT Understanding, measuring, and mitigating pain-related suffering is a key challenge for both clinical care and pain research. However, there is no consensus on what exactly the concept of pain-related suffering includes, and it is often not precisely operationalized in empirical studies. Here, we (1) systematically review the conceptualization of pain-related suffering in the existing literature, (2) develop a definition and a conceptual framework, and (3) use machine learning to cross-validate the results. We identified 111 articles in a systematic search of Web of Science, PubMed, PsychINFO, and PhilPapers for peer-reviewed articles containing conceptual contributions about the experience of pain-related suffering. We developed a new procedure for extracting and synthesizing study information based on the cross-validation of qualitative analysis with an artificial intelligence-based approach grounded in large language models and topic modeling. We derived a definition from the literature that is representative of current theoretical views and describes pain-related suffering as a severely negative, complex, and dynamic experience in response to a perceived threat to an individual's integrity as a self and identity as a person. We also offer a conceptual framework of pain-related suffering distinguishing 8 dimensions: social, physical, personal, spiritual, existential, cultural, cognitive, and affective. Our data show that pain-related suffering is a multidimensional phenomenon that is closely related to but distinct from pain itself. The present analysis provides a roadmap for further theoretical and empirical development.
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Affiliation(s)
- Niklas Noe-Steinmüller
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Tanzi S, Artioli G, De Panfilis L, Ghirotto L, Rabitti E, Sacchi S. A qualitative study with Italian patients exploring the spiritual dimension during a chronic disease. Chronic Illn 2024; 20:335-348. [PMID: 37248628 DOI: 10.1177/17423953231178236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Spirituality is a vast dimension influenced by cultural and personal differences. Little is known about the spirituality of patients suffering from a chronic disease in Italy from palliative care hospital settings. AIM To investigate patients' perspectives about their spirituality during their illness. METHOD The research question was: 'How does living with chronic disease inform/shape the spiritual dimension of patients?'. To address it, we conducted a qualitative interview study with thematic analysis. RESULTS We enrolled 21 participants among patients suffering from rheumatic, haematologic, neurodegenerative and respiratory chronic diseases. Participants generally had great difficulty answering the questions researchers posed and often could not define 'spirituality'. We found different topics grouped under four main themes: definition of spirituality, internal dialogue, expression of spirituality in everyday life and take stock. Religion is not reported as an answer to spiritual suffering, even in a country that is felt religious-driven like Italy. DISCUSSION Patients are generally not cognizant of this dimension even living with a chronic disease; consequently, they cannot express spiritual needs because they can't recognise them. Health professionals should identify this dimension and its characteristics to recognise potential spiritual suffering.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Rabitti
- Psycho-oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Sacchi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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3
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Petrillo LA, Jones KF, El-Jawahri A, Sanders J, Greer JA, Temel JS. Why and How to Integrate Early Palliative Care Into Cutting-Edge Personalized Cancer Care. Am Soc Clin Oncol Educ Book 2024; 44:e100038. [PMID: 38815187 DOI: 10.1200/edbk_100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Early palliative care, palliative care integrated with oncology care early in the course of illness, has myriad benefits for patients and their caregivers, including improved quality of life, reduced physical and psychological symptom burden, enhanced prognostic awareness, and reduced health care utilization at the end of life. Although ASCO and others recommend early palliative care for all patients with advanced cancer, widespread implementation of early palliative care has not been realized because of barriers such as insufficient reimbursement and a palliative care workforce shortage. Investigators have recently tested several implementation strategies to overcome these barriers, including triggers for palliative care consultations, telehealth delivery, navigator-delivered interventions, and primary palliative care interventions. More research is needed to identify mechanisms to distribute palliative care optimally and equitably. Simultaneously, the transformation of the oncology treatment landscape has led to shifts in the supportive care needs of patients and caregivers, who may experience longer, uncertain trajectories of cancer. Now, palliative care also plays a clear role in the care of patients with hematologic malignancies and may be beneficial for patients undergoing phase I clinical trials and their caregivers. Further research and clinical guidance regarding how to balance the risks and benefits of opioid therapy and safely manage cancer-related pain across this wide range of settings are urgently needed. The strengths of early palliative care in supporting patients' and caregivers' coping and centering decisions on their goals and values remain valuable in the care of patients receiving cutting-edge personalized cancer care.
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Affiliation(s)
- Laura A Petrillo
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Katie Fitzgerald Jones
- Harvard Medical School, Boston, MA
- New England Geriatrics Research, Education, and Clinical Center (GRECC), Jamaica Plain, MA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Justin Sanders
- Division of Supportive and Palliative Care, McGill University Health Centre, Montreal, CA
- Department of Family Medicine, McGill University, Montreal, CA
| | - Joseph A Greer
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Temel
- Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
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Batzler YN, Stricker N, Bakus S, Schallenburger M, Schwartz J, Neukirchen M. Implementing spiritual care education into the teaching of palliative medicine: an outcome evaluation. BMC MEDICAL EDUCATION 2024; 24:411. [PMID: 38622620 PMCID: PMC11017578 DOI: 10.1186/s12909-024-05415-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The concept of "total pain" plays an important role in palliative care; it means that pain is not solely experienced on a physical level, but also within a psychological, social and spiritual dimension. Understanding what spirituality entails, however, is a challenge for health care professionals, as is screening for the spiritual needs of patients. OBJECTIVE This is a novel, interprofessional approach in teaching undergraduate medical students about spiritual care in the format of a seminar. The aim of this study is to assess if an increase in knowledge about spiritual care in the clinical context is achievable with this format. METHODS In a mandatory seminar within the palliative care curriculum at our university, both a physician and a hospital chaplain teach strategies in symptom control from different perspectives (somatic domain - spiritual domain). For evaluation purposes of the content taught on the spiritual domain, we conducted a questionnaire consisting of two parts: specific outcome evaluation making use of the comparative self-assessment (CSA) gain and overall perception of the seminar using Likert scale. RESULTS In total, 52 students participated. Regarding specific outcome evaluation, the greatest gain was achieved in the ability to define total pain (84.8%) and in realizing its relevance in clinical settings (77.4%). The lowest, but still fairly high improvement was achieved in the ability to identify patients who might benefit from spiritual counselling (60.9%). The learning benefits were all significant as confirmed by confidence intervals. Overall, students were satisfied with the structure of the seminar. The content was delivered clearly and comprehensibly reaching a mean score of 4.3 on Likert scale (4 = agree). The content was perceived as overall relevant to the later work in medicine (mean 4.3). Most students do not opt for a seminar solely revolving around spiritual care (mean 2.6). CONCLUSIONS We conclude that implementing spiritual care education following an interprofessional approach into existing medical curricula, e.g. palliative medicine, is feasible and well perceived among medical students. Students do not wish for a seminar which solely revolves around spiritual care but prefer a close link to clinical practice and strategies.
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Affiliation(s)
- Yann-Nicolas Batzler
- Interdisciplinary Center for Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
| | - Nicola Stricker
- Evangelical Church in the Rhineland, Duesseldorf, Germany
- Institut Protestant de Théologie, Paris, France
| | - Simone Bakus
- Evangelical Hospital Chaplaincy (Pastoral Care), University Hospital, Heinrich Heine University, Duesseldorf, Germany
| | - Manuela Schallenburger
- Interdisciplinary Center for Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany.
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Jacqueline Schwartz
- Interdisciplinary Center for Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
| | - Martin Neukirchen
- Interdisciplinary Center for Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
- Department of Anesthesiology, University Hospital, Heinrich Heine University, Düsseldorf, Germany
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Mascio R, Lynch S, Phillips JL, Hosie A, Best M. Nurses' models of spiritual care: A cross-sectional survey of American nurses. Palliat Support Care 2024; 22:314-324. [PMID: 37435660 DOI: 10.1017/s1478951523000676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Despite there being many models for how spiritual care should be provided, the way nurses actually provide spiritual care often differs from these models. Based on the premise that the way a person enacts their work role is related to how they understand that role, this study aims to describe the qualitatively different ways that nurses understand their spiritual care role. METHODS A convenience sample of 66 American nurses completed an anonymous, online questionnaire about what spiritual care means for them and what they generally do to provide spiritual care. Their responses were analyzed phenomenographically. RESULTS Four qualitatively different ways of understanding emerged: active management of the patient's experience, responsive facilitation of patient's wishes, accompaniment on the patient's dying journey, and empowering co-action with the patient. Each understanding was found to demonstrate a specific combination of 5 attributes that described the spiritual care role: nurse directivity, the cues used for spiritual assessment, and the nurse's perception of intimacy, the patient, and the task. SIGNIFICANCE OF RESULTS The findings of this study may explain why nurses vary in their spiritual care role and can be used to assess and develop competence in spiritual care.
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Affiliation(s)
- Rita Mascio
- Institute of Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
| | - Sandra Lynch
- Institute of Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Annmarie Hosie
- Palliative Care Nursing, University of Notre Dame, Broadway, NSW, Australia
| | - Megan Best
- Institute of Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
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Wilhøft Kristensen A, Lunde Jensen A, Jensen K, Oksbjerre Dalton S, Friborg J, Grau C. Exploring patient-reported barriers to participating in proton therapy clinical trials. Tech Innov Patient Support Radiat Oncol 2024; 29:100230. [PMID: 38186677 PMCID: PMC10767209 DOI: 10.1016/j.tipsro.2023.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/07/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Clinical trials lead the progress in healthcare. To ensure reliable research conclusions, it is essential to enroll diverse patient groups. Identifying and understanding patient-reported barriers to clinical trials may help enhance recruitment among diverse patient groups.The clinical potential of proton therapy (PT) to reduce late effects is being investigated in clinical trials worldwide. Thus, for some patients, PT is only accessible by participating in clinical trials.Individuals with smoking-related head and neck cancer (HNC) are sometimes socioeconomically deprived, leading to barriers to trial participation. This study aims to identify barriers to their participation in a randomised controlled trial (RCT) involving PT. Method Interviews were conducted with 14 HNC patients declining participation in an RCT involving PT. The interviews were transcribed and systematically analysed using an inductive approach identifying categories and themes. Results The identified barriers to RCT-participation are: (1) existential distress, which influenced participants' mental and cognitive capacities, (2) insufficient RCT-related knowledge arising from information overload during clinical consultations, (3) the wish for safety and familiarity during the treatment trajectory, particularly for participants needing accommodation during radiotherapy, and (4) the motivation for study participation was impacted by uncertainty due to randomisation and clinical equipoise. Existential distress is identified as an overarching theme because it influences and amplifies the other three themes. Conclusion Existential distress is a central theme that influences and amplifies other participation barriers in PT RCTs. It affects participants' comprehension of trial information, their preference for familiar environments, and their motivation to participate in clinical trials.
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Affiliation(s)
- Anne Wilhøft Kristensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Annesofie Lunde Jensen
- Steno Diabetes Centre, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kenneth Jensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | | | - Jeppe Friborg
- Department of Clinical Oncology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
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Ichihara K, Nishiyama C, Kiyohara K, Morita T, Tamura K. Nursing Care for Spiritual Pain in Terminal Cancer Patients: A Non-Randomized Controlled Trial. J Pain Symptom Manage 2024; 67:126-137. [PMID: 37852454 DOI: 10.1016/j.jpainsymman.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT Spiritual well-being is important for terminal cancer patients; however, appropriate interventions remain to be established. OBJECTIVES To evaluate the effectiveness of nursing care to alleviate spiritual pain in daily clinical practice using a Spiritual Pain Assessment Sheet-based spiritual care program for nurses (SpiPas-SCP-N). METHODS A nonrandomized controlled trial was conducted in five palliative care units in Japan. The intervention group received spiritual care based on SpiPas-SCP-N by ward nurses. The primary outcome was the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp). Secondary outcomes included: Hospital Anxiety and Depression Scale (HADS), Comprehensive Quality of life Outcome (CoQoLo), and the Japanese version of the M.D. Anderson Symptom Inventory (MDASI-J). Propensity score matching was used for adjustment. RESULTS Terminal cancer patients were assigned to the control and intervention groups (n = 140 and 157, respectively); of whom, 97 (69.8%) and 106 (68.0%), respectively, completed two weeks. Seventy-three patients were matched in each group. The total score of FACIT-Sp increased in the intervention group and decreased in the control group; however, there was no significant difference (95% CI, -3.98, 1.41, P = 0.347). HADS total score significantly increased (95% CI, 0.15, 3.87, P = 0.035), whereas there were no significant changes in CoQoLo and MDASI-J scores. The effect size of changes in FACIT-Sp subscales were 0.25 in the meaning/peace subscale and 0.04 in the faith subscale. CONCLUSION SpiPas-SCP-N for spiritual pain may have a positive impact on terminal cancer patients. Future research using larger samples, randomized design, and the meaning/peace subscale of FACIT-Sp as the primary outcome is necessary as well as supervision and continuous training in daily nursing practice.
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Affiliation(s)
- Kaori Ichihara
- Department of Nursing (K.I.), Yodogawa Christian Hospital, Osaka, Japan; Department of Palliative Nursing (K.I., K.T.), Kyoto University Graduate School of Human Health Science, Kyoto, Japan.
| | - Chika Nishiyama
- Department of Critical Care Nursing (C.N.), Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Kosuke Kiyohara
- Department of Food Science (K.K.), Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care and Seirei Hospice (T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Keiko Tamura
- Department of Palliative Nursing (K.I., K.T.), Kyoto University Graduate School of Human Health Science, Kyoto, Japan; Division of Regional Medical Cooperation (K.T.), Center for Industrial Research and Innovation, Translational Research Institute for Medical Innovation, Osaka Dental University, Osaka, Japan
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8
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Zaporowska-Stachowiak I, Springer M, Stachowiak K, Oduah M, Sopata M, Wieczorowska-Tobis K, Bryl W. Interleukin-6 Family of Cytokines in Cancers. J Interferon Cytokine Res 2024; 44:45-59. [PMID: 38232478 DOI: 10.1089/jir.2023.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Nine soluble ligands [interleukin-6 (IL-6), interleukin-11 (IL-11), leukemia inhibitory factor (LIF), oncostatin M (OSM), ciliary neurotrophic factor (CNTF), cardiotrophin-1 (CT-1), cardiotrophin-like cytokine, interleukin-27 (IL-27), and interleukin-31] share the ubiquitously expressed transmembrane protein-glycoprotein-130 beta-subunit (gp130) and thus form IL-6 family cytokines. Proteins that may be important for cancerogenesis, CT-1, IL-11, IL-27, LIF, OSM, and CNTF, belong to the superfamily of IL-6. Cytokines such as IL-6, IL-11, and IL-27 are better investigated in comparison with other members of the same family of cytokines, eg, CT-1. Gp130 is one of the main receptors through which these cytokines exert their effects. The clinical implication of understanding the pathways of these cytokines in oncology is that targeted therapy to inhibit or potentiate cytokine activity may lead to remission in some cases.
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Affiliation(s)
- Iwona Zaporowska-Stachowiak
- Department and Clinic of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
- Palliative Medicine In-Patient Unit, University Hospital of Lord's Transfiguration, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Springer
- Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Mary Oduah
- English Students' Research Association, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Sopata
- Department and Clinic of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
- Palliative Medicine In-Patient Unit, University Hospital of Lord's Transfiguration, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Wieczorowska-Tobis
- Department and Clinic of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
- Palliative Medicine In-Patient Unit, University Hospital of Lord's Transfiguration, Poznan University of Medical Sciences, Poznan, Poland
| | - Wiesław Bryl
- Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, Poznan, Poland
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McGrath RL, Parnell T, Verdon S, Pope R. "We take on people's emotions": a qualitative study of physiotherapists' experiences with patients experiencing psychological distress. Physiother Theory Pract 2024; 40:304-326. [PMID: 36062922 DOI: 10.1080/09593985.2022.2116964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Previous research suggests that physiotherapists frequently engage with patients who experience psychological distress (e.g. feelings of depression and anxiety) and that physiotherapists find supporting these patients challenging. OBJECTIVE The aim of this study was to explore the experiences of Australian physiotherapists with patients they perceived were experiencing psychological distress. METHODS A 'Big Q' qualitative research approach was used. Twenty-three interviews with physiotherapists were conducted. The data were then analyzed using iterative thematic inquiry. RESULTS The analysis produced four interrelated themes: 1) encounters with patients in distress are common and varied; 2) becoming emotionally attuned with their patients meant that distress could invoke empathetic distress; 3) physiotherapists use emotional shields to protect themselves; and 4) physiotherapists found frequent encounters with patient distress to be emotionally exhausting. Viewed together, the themes highlight how patient distress can invoke transient empathetic distress in a physiotherapist; repeated experiences of empathetic distress may lead to empathetic distress fatigue. CONCLUSION While physiotherapists are sometimes viewed as 'physical' health professionals, the experiences of these physiotherapists suggest that patient psychological distress is highly relevant to physiotherapy practice. We recommend future research explores the relationships between patient distress, physiotherapists' empathy, and physiotherapists' wellbeing.
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Affiliation(s)
- Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Tracey Parnell
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Sarah Verdon
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Rodney Pope
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
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10
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Best MC, Jones K, Merritt F, Casey M, Lynch S, Eisman JA, Cohen J, Mackie D, Beilharz K, Kearney M. Australian Patient Preferences for Discussing Spiritual Issues in the Hospital Setting: An Exploratory Mixed Methods Study. JOURNAL OF RELIGION AND HEALTH 2024; 63:238-256. [PMID: 36807254 PMCID: PMC10861658 DOI: 10.1007/s10943-023-01767-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
While there is high patient acceptance for clinical staff discussing issues regarding spirituality with hospital inpatients, it is not clear which staff member patients prefer for these discussions. This unique exploratory study investigated inpatient preferences regarding which staff member should raise the topic of spirituality. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). Pastoral care staff (32.9%) were the preferred staff members with whom to discuss spiritual issues, followed by doctors (22.4%). Qualitative findings indicated that individual characteristics of the staff member are more important than their role.
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Affiliation(s)
- Megan C Best
- Institute for Ethics and Society, University of Notre Dame Australia, Broadway, PO Box 944, Sydney, NSW, 2007, Australia.
| | - Kate Jones
- Institute for Ethics and Society, University of Notre Dame Australia, Broadway, PO Box 944, Sydney, NSW, 2007, Australia
| | - Frankie Merritt
- The School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
| | - Michael Casey
- The School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
| | - Sandra Lynch
- Institute for Ethics and Society, University of Notre Dame Australia, Broadway, PO Box 944, Sydney, NSW, 2007, Australia
| | - John A Eisman
- The School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
- St Vincent's Private Hospital, Sydney, Australia
- St Vincent's Hospital, Sydney, Australia
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia
| | - Jeffrey Cohen
- The School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
- St Vincent's Private Hospital, Sydney, Australia
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11
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Tan SB, Chee CH, Ngai CF, Hii SL, Tan YW, Ng CG, Capelle DP, Zainuddin SI, Loh EC, Lam CL, Chai CS, Ng DLC. Mindfulness-based supportive therapy on reducing suffering in patients with advanced cancer: randomised controlled trial. BMJ Support Palliat Care 2024; 13:e1117-e1125. [PMID: 35459688 DOI: 10.1136/bmjspcare-2021-003349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Suffering is common among patients with advanced cancer. The practice of mindfulness during patient care can potentially reduce suffering. We aimed to examine the efficacy of mindfulness-based supportive therapy (MBST) on reducing suffering in patients with advanced cancer. METHODS We conducted a parallel-group, single-blinded, randomised controlled trial at the University of Malaya Medical Centre, Malaysia. Seventy-three patients with advanced cancer with an overall suffering score ≥4/10 based on the Suffering Pictogram were recruited and randomly assigned into either the MBST group (n=34) or the control group (n=39). RESULTS There was a statistically significant reduction in the overall suffering score in the MBST group compared with the control group (U=432.5, median1=-2.0, median2=-1.0, z=-2.645, p=0.008). There was also significant improvement in the total Hospital Anxiety and Depression Scale score (U=483.5, median1=-4.0, median2=-3.0, z=-1.994, p=0.046), and the total Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being score (U=252.0, median1=+14.5, median2=+5.0, z=-4.549, p=0.000) in the MBST group compared with the control group. CONCLUSIONS The results provided evidence that the practice of MBST during patient care could promote positive psychosocial outcomes.
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Affiliation(s)
- Seng Beng Tan
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chin Fei Ngai
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siew Lin Hii
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi Wen Tan
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Guan Ng
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Ee Chin Loh
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chee Shee Chai
- Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
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12
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Clark CM. Concept building: Choosing to retreat from suffering. Appl Nurs Res 2023; 71:151675. [PMID: 37179067 DOI: 10.1016/j.apnr.2023.151675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/09/2023] [Accepted: 03/08/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Cynthia M Clark
- School of Nursing, West Virginia University, Beckley Campus, Life Science Building, 410 Neville Street, Beckley, WV 25801, United States of America.
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13
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Best MC, Jones K, Bradford K, Kearney M. Chaplaincy Perspectives on the Role of Spirituality in Australian Health and Aged Care. JOURNAL OF RELIGION AND HEALTH 2023; 62:1473-1490. [PMID: 36738395 PMCID: PMC9898848 DOI: 10.1007/s10943-023-01752-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 06/13/2023]
Abstract
The aim of this study was to explore Australian chaplains' views of spirituality. Semi-structured online interviews were conducted with 16 participants. Participants relied heavily on metaphors and analogies to describe spirituality. Four inter-related themes were identified through reflexive thematic analysis: (1) The core of spirituality: spirituality as a source of meaning or belief which leads to connectedness with something greater than oneself; (2) A function of spirituality: spirituality empowers people to cope in a crisis, by providing motivation, hope and comfort; (3) The experience of spiritual crisis: admission to hospital or residential care can lead to existential struggle; and (4) The spiritual practice: of holding space between struggle and growth. Greater understanding of the theoretical basis of their work may allow chaplains to offer more in the therapeutic space.
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Affiliation(s)
- Megan C Best
- Institute for Ethics and Society, University of Notre Dame Australia, Broadway NSW 2007, P.O. Box 944, Sydney, Australia.
| | - Kate Jones
- Institute for Ethics and Society, University of Notre Dame Australia, Broadway NSW 2007, P.O. Box 944, Sydney, Australia
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14
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Iseki C. The process of reaching psychological adjustment among adult women diagnosed with metastatic breast cancer and receiving cancer pharmacotherapy. Asia Pac J Oncol Nurs 2023; 10:100184. [PMID: 36844250 PMCID: PMC9944287 DOI: 10.1016/j.apjon.2023.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023] Open
Abstract
Objective This study clarified the process by which adult women diagnosed with metastatic breast cancer (MBC) and undergoing cancer pharmacotherapy reach psychological adjustment. Methods A semistructured interview was conducted with adult women who had received their MBC diagnosis. The data collected were analyzed using Kinoshita's modified grounded theory approach. Results A total of 21 women with an average age of 50 years participated in the study. Seven categories and 21 concepts were generated through the analysis. Upon being diagnosed with MBC by a doctor, the participants felt the "threat of death" and "conflict with painful cancer pharmacotherapy." Thereafter, they received "encouragement from strong supporters," consolidated their "resolve to save their life," and began cancer pharmacotherapy. During the therapy, they made "efforts to internalize MBC" to overcome the distress arising from the "struggle to internalize MBC," and this led to the "expansion of self-awareness." Conclusions Despite finding themselves in harsh circumstances, the participants remained focused on the big picture and realized that cancer had changed their values and outlook on life, leading to psychological growth. It is important for nurses to provide systematic and continuous support from the time of MBC diagnosis.
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Affiliation(s)
- Chihiro Iseki
- Osaka Medical and Pharmaceutical University Graduate School of Nursing, Takatsuki-shi, Osaka, Japan.,Hyogo Prefectural Nishinomiya Hospital, Nishinomiya-shi, Hyogo, Japan
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15
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Evaluation of the Interprofessional Spiritual Care Education Curriculum in Australia: Online. Palliat Support Care 2023; 21:65-73. [PMID: 35301965 DOI: 10.1017/s1478951522000244] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spiritual care is a component of quality palliative care, but healthcare providers have reported lack of training as a barrier to its provision. This paper describes the evaluation of the Interprofessional Spiritual Care Educational Curriculum (ISPEC)© which is a six-module evidence-based curriculum developed for teaching interprofessional spiritual care based on a generalist-specialist model of spiritual care. METHOD The course was run online in 2020 and attended by 20 healthcare workers who were invited to join the evaluation. Questionnaires were completed by participants before the training program (baseline), immediately after the training (post), and 3 months following the end of the program (follow-up). After the follow-up questionnaires, participants were invited to join a Focus Group to expand on their responses. Descriptive and exploratory statistical analysis was performed on quantitative data, and qualitative data was subjected to Thematic Analysis. RESULTS Exploratory data analysis showed that self-reported competence, confidence, and comfort in providing spiritual care significantly improved following training (p = 0.002) and were maintained over time (p = 0.034). In qualitative analysis, the main themes were: (1) overwhelmed by content; (2) the importance of practical training; (3) spiritual care is for everyone; (4) spiritual care should come from the heart; (5) training needs to be inclusive; and (6) spirituality is culturally specific. SIGNIFICANCE OF RESULTS This article describes an evaluation of the ISPEC© spiritual care training course administered to an Australian healthcare cohort using an online format. These preliminary findings suggest that the ISPEC© program is effective in improving the ability of healthcare professionals to provide spiritual care. More work is needed to improve the cultural relevance of the program in Australia.
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16
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Namisango E, Luyirika EBK, Matovu L, Berger A. The Meaning of Healing to Adult Patients with Advanced Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1474. [PMID: 36674226 PMCID: PMC9861899 DOI: 10.3390/ijerph20021474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND This study aimed to explore the meaning of healing from the perspective of adult patients with advanced cancer. METHODS We conducted a secondary analysis of data from a primary study which used a cognitive interview approach to assess the face and content validity of a spiritual and psychological healing measure (NIH-HEALS). This analysis focused on responses to the question, "What does the term 'healing' mean to you?" Data were de-identified, transcribed verbatim, and imported in NVivo for thematic analysis in line with interpretive phenomenological methods. RESULTS Thirty-five adults with advanced cancer participated in the study. We identified nine major themes: acceptance, surrender, faith, hope, peace, freedom from suffering (e.g., pain, problems, or other bothersome factors), overcoming/transcending disease, positive emotions (e.g., happiness), recovery from illness or disease. One participant discussed healing as synonymous with death, and two associated it with social relations and social support. CONCLUSION Themes from patients' responses suggest subjective and varied definitions of healing which encompass physical, social, spiritual, and psychological domains of well-being, distinct from the physical cure of disease. Clinicians should adopt a holistic, person-centered approach to care, attending to bodily, psychosocial, spiritual, and emotional needs to help patients find meaning in their experiences, nourish resilience, and experience a sense of healing-as they define it.
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala P.O. Box 72518, Uganda
- Department of Palliative Care and Rehabilitation, Cicely Saunders Institute King’s College London, London SE5 9RS, UK
| | | | - Lawrence Matovu
- Formerly-Department of Clinical Services, Hospice Africa Uganda, Kampala P.O. Box 7757, Uganda
| | - Ann Berger
- National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA
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17
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Bradley NM, Dowrick CF, Lloyd-Williams M. A survey of hospice day services in the United Kingdom & Republic of Ireland : how did hospices offer social support to palliative care patients, pre-pandemic? Palliat Care 2022; 21:170. [PMID: 36195870 PMCID: PMC9532229 DOI: 10.1186/s12904-022-01061-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Social support is described by patients and other stakeholders to be a valuable component of palliative day care. Less is known about the range of hospice services that have been used in practice that facilitate social support. An online survey aimed to gain an overview of all hospice day services that facilitated social support for adults outside of their own homes. METHODS An online survey was distributed via email to people involved in managing hospice day services. Questions were asked on hospice characteristics, including staff and volunteer roles. Respondents were asked to identify services they felt offered social support to patients. Data collection took place between August 2017 and May 2018. RESULTS Responses were received from 103 hospices in the UK and ROI (response rate 49.5%). Results provide an overview of hospice day and outpatient services that offer social support to patients. These are: multi-component interventions, activity groups, formal support groups, befriending, and informal social activities. Multi-component interventions, such as palliative day care, were the most commonly reported. Their stated aims tend to focus on clinical aspects, but many survey respondents considered these multicomponent interventions to be the 'most social' service at their hospice. The survey also identified a huge variety of activity groups, as well as formal therapeutic support groups. Informal 'social-only' activities were present, but less common. Over a third of all the services were described as 'drop in'. Most responding hospices did not routinely use patient reported outcome measures in their 'most social' services. CONCLUSIONS The survey documents hospice activity in facilitating social support to be diverse and evolving. At the time of data collection, many hospices offered multiple different services by which a patient might obtain social support outside of their own home and in the presence of other patients.
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Affiliation(s)
- N M Bradley
- Research Fellow in Realist Evaluation, Centre for Health & Clinical Research, University of the West of England, Glenside Campus, BS16 1DD., Bristol, United Kingdom.
| | - C F Dowrick
- Emeritus Professor, Department of Primary Care and Mental Health, University of Liverpool, Waterhouse Building, L69 3BX., Liverpool, United Kingdom
| | - M Lloyd-Williams
- Professor & Honorary Consultant in Palliative Medicine, Department of Primary Care and Mental Health, University of Liverpool, Waterhouse Building, L69 3BX, Liverpool, United Kingdom
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18
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Cowden RG, Wȩziak-Białowolska D, McNeely E, VanderWeele TJ. Are depression and suffering distinct? An empirical analysis. Front Psychol 2022; 13:970466. [PMID: 36186371 PMCID: PMC9518749 DOI: 10.3389/fpsyg.2022.970466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Depression and the subjective experience of suffering are distinct forms of distress, but they are sometimes commingled with one another. Using a cross-sectional sample of flight attendants (n = 4,652), we tested for further empirical evidence distinguishing depression and suffering. Correlations with 15 indices covering several dimensions of well-being (i.e., physical health, emotional well-being, psychological well-being, character strengths, social well-being, financial/material well-being) indicated that associations with worse well-being were mostly stronger for depression than suffering. There was a large positive correlation between depression and suffering, but we also found evidence of notable non-concurrent depression and suffering in the sample. After dividing participants into four groups that varied based on severity of depression and suffering, regression analyses showed higher levels of well-being among those with both none-mild depression and none-mild suffering compared to those with moderate-severe depression, moderate-severe suffering, or both. All indices of well-being were lowest among the group of participants with moderate-severe depression and moderate-severe suffering. In addition to providing further evidence supporting a distinction between depression and suffering, our findings suggest that concurrent depression and suffering may be more disruptive to well-being than when either is present alone.
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Affiliation(s)
- Richard G. Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States
- *Correspondence: Richard G. Cowden,
| | - Dorota Wȩziak-Białowolska
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Centre for Evaluation and Analysis of Public Policies, Faculty of Philosophy, Jagiellonian University, Cracow, Poland
| | - Eileen McNeely
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Tyler J. VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States
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19
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Sauer C, Grapp M, Bugaj TJ, Maatouk I. Suicidal ideation in patients with cancer: Its prevalence and results of structural equation modelling. Eur J Cancer Care (Engl) 2022; 31:e13650. [PMID: 35801643 DOI: 10.1111/ecc.13650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patients with cancer have a higher risk of suicidal ideation (SI) and suicidality than the general population. This study was designed to investigate the prevalence of SI and its association with psychosocial and sociodemographic factors and tumour entity. METHODS In this observational cross-sectional study, 4372 adult patients with different cancer entities were enrolled. We assessed the outcome variables (i.e. SI, depressive and anxiety symptoms, mental and physical fatigue and sociodemographic data) using self-report questionnaires. Data were analysed via descriptive statistics, binomial logistic regression and structural equation modelling (SEM). RESULTS Among all patients, 627 (14.3%) reported SI, of whom 12.8% reported SI on several days, 0.9% on half of the days and 0.6% nearly every day. Age, anxiety, mental fatigue and the Patient Health Questionnaire-9 items 'feeling down, depressed and hopeless', 'feeling bad about oneself' and 'slowing or agitation' were significant predictors of SI. SEM, including all significant predictors with a latent depressiveness-demoralisation variable, explained 30.3% variance of SI, showing a good fit. CONCLUSIONS Our results showed that a significant number of patients with cancer show SI. Future long-term studies are needed to address the differential contribution of depression and demoralisation on SI in patients with cancer.
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Affiliation(s)
- Christina Sauer
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Miriam Grapp
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Till J Bugaj
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian University Würzburg, Würzburg, Germany
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20
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Stilwell P, Hudon A, Meldrum K, Pagé MG, Wideman TH. What is Pain-Related Suffering? Conceptual Critiques, Key Attributes, and Outstanding Questions. THE JOURNAL OF PAIN 2022; 23:729-738. [PMID: 34852304 DOI: 10.1016/j.jpain.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022]
Abstract
Suffering holds a central place within pain research, theory, and practice. However, the construct of pain-related suffering has yet to be operationalized by the International Association for the Study of Pain and is largely underdeveloped. Eric Cassell's seminal work on suffering serves as a conceptual anchor for the limited pain research that specifically addresses this construct. Yet, important critiques of Cassell's work have not been integrated within the pain literature. This Focus Article aims to take a preliminary step towards an updated operationalization of pain-related suffering by 1) presenting key attributes of pain-related suffering derived from a synthesis of the literature and 2) highlighting key challenges associated with Cassell's conceptualization of suffering. We present 4 key attributes: 1) pain and suffering are inter-related, but distinct experiences, 2) suffering is a subjective experience, 3) the experience of suffering is characterized by a negative affective valence, and 4) disruption to one's sense of self is an integral part of suffering. A key outstanding challenge is that suffering is commonly viewed as a self-reflective and future-oriented process, which fails to validate many forms of suffering and marginalizes certain populations. Future research addressing different modes of suffering - with and without self-reflection - are discussed. PERSPECTIVE: This article offers a preliminary step toward operationalizing the construct of pain-related suffering and proposes priorities for future research. A robust operationalization of this construct is essential to developing clinical strategies that aim to better recognize and alleviate suffering among people living with pain.
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Affiliation(s)
- Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Anne Hudon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada; School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada; Ethics Research Center (CRÉ), Montreal, Quebec, Canada
| | | | - M Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Psychology, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du Centre hospitalier de l'Universite de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.
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21
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Daneault S, Azri M, Ummel D, Vinit F, Côté A, Leclerc-Loiselle J, Laperle P, Gendron S. Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives. J Palliat Care 2022; 37:518-525. [PMID: 35234108 PMCID: PMC9465553 DOI: 10.1177/08258597221083421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Suffering is intimately linked to the experience of
illness, and its relief is a mandate of medicine. Advances in knowledge around
terminal illness have enabled better management of the somatic dimension.
Nevertheless, there is what can be called “non-somatic” suffering which in some
cases may take precedence. Inspired by Paul Ricoeur's thinking on human
suffering, our aim in this qualitative study was to better understand the
experience of non-somatic suffering. Methods: Semi-structured
interviews were conducted with 19 patients. The results were qualitatively
analyzed following a continuous comparative analysis approach inspired by
grounded theory. Results: Three key themes synthesize the
phenomenon: “the being enduring the suffering”, “the being whose agency is
constrained”, and “the being in relationship with others.” The first describes
what patients endure, the shock and fears associated with their own finitude,
and the limits of what can be tolerated. The second refers to the experience of
being restricted and of mourning the loss of their capacity to act. The last
describes a residual suffering related to their interactions with others, that
of loneliness and of abandoning their loved ones, two dimensions that persist
even when they have accepted their own death. Conclusions:
Non-somatic suffering can be multifarious, even when minimized by the patient.
When evaluating suffering, we must keep in mind that patients can reach a
“breaking point” that signals the state of unbearable suffering. In managing it,
we probably need to make more room for family and friends, as well as a posture
of caring based more on presence and listening.
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Affiliation(s)
- Serge Daneault
- Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - Mehdi Azri
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Deborah Ummel
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Canada
| | - Florence Vinit
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Andréanne Côté
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Philippe Laperle
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Sylvie Gendron
- Faculty of Nursing Science, Université de Montréal, Montreal, Canada
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22
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Vallath N, Salins N, Ghoshal A, Daniel SM, Damani A, Rajagopal MR, Rewati RR, Bhatnagar S, Pramesh CS. Developing a Screening Tool for Serious Health-related Suffering for Low- and Middle-Income Countries – Phase-1: Domain Identification and Item Generation. Indian J Palliat Care 2022; 28:51-63. [PMID: 35673368 PMCID: PMC9165456 DOI: 10.25259/ijpc_25_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives: The Lancet Commission on Global Access to Palliative Care and Pain Relief reported significant levels of health-related suffering globally, with the highest incidence in the low- and middle-income countries. The report describes suffering as health-related when it is associated with illness or injury of any kind and suffering as serious when it cannot be relieved without professional intervention and when it compromises physical, social, spiritual, and/or emotional functioning. This paper describes the preliminary development phase of a tool for screening Serious Health-related Suffering (SHS) at individual patient level, suitable to the healthcare settings in India. The study was conducted by the National Cancer Grid-India, with support from the Indian Association of Palliative Care. Materials and Methods: Domain identification and item generation were conducted according to the recommendations for tool development by the American Psychological Association and World Health Organisation quality of life instrument. The consensus for domain questions and associated items was achieved using Delphi, nominal group technique, expert review, and polling. Results: The Phase-1 study for developing the screening tool for SHS contextualised to resource-limited settings generated a bilevel questionnaire. The initial level assesses and scores the physical, emotional, social, spiritual, and financial domains of health-related suffering. The next level assesses seriousness, through functional limitation and patient’s preference. Conclusion: The generation of domains, items, and screening questions for health-related suffering and its seriousness completes the preliminary phase of developing the SHS screening tool applicable to a resource-limited healthcare setting. Field testing of the tool is being conducted as Phase-2 of this study, to validate it in clinical settings.
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Affiliation(s)
- Nandini Vallath
- Division of Palliative Care, National Cancer Grid, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, India,
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Sunitha M. Daniel
- Department Palliative Medicine, Ernakulam General Hospital, Kochi, Kerala, India,
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - M. R. Rajagopal
- Trivandrum Institute of Palliative Sciences, Thiruvananthapuram, Kerala, India,
| | - Rahul Raman Rewati
- Palliative Care Division, Tata Trusts Cancer Care Program, Alamelu Charitable Foundation, Mumbai, Maharashtra, India,
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - C. S. Pramesh
- Director, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
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"You begin to give more value in life, in minutes, in seconds": spiritual and existential experiences of family caregivers of patients with advanced cancer receiving end-of-life care in Brazil. Support Care Cancer 2021; 30:2631-2638. [PMID: 34817692 PMCID: PMC8611251 DOI: 10.1007/s00520-021-06712-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022]
Abstract
Purpose Facing the end of life may trigger significant distress in family caregivers of patients with advanced cancer. However, few studies have addressed the spiritual and existential concerns of these family caregivers in their end-of-life care journey. This study aimed to understand the spiritual and existential experience of family caregivers of patients with advanced cancer facing the end of life in Brazil. Methods A purposive sample of 16 family caregivers of hospitalized terminally ill cancer patients in Brazil participated in in-depth interviews. Data collection and analysis were based on interpretative phenomenological analysis. Results Three superordinate themes in their spiritual and existential experience were identified: (i) connectedness through caregiving, personal relationships, and spiritual beliefs; (ii) shifting hope: from death as a possibility to preparation for impending death; (iii) reframing suffering and meaning. For these caregivers, the relationship with the patient and with others, their spiritual beliefs, and hope were significant sources of meaning. Hope was sustained by death avoidance, oscillating with death acceptance and hope that it would occur with comfort. Family caregivers also experienced existential and spiritual suffering in the form of guilt, suppressed emotions, and loneliness. Conclusion Health care providers should address and support caregivers’ spiritual needs and their relationships with the patient and others during end-of-life care and facilitate reflection regarding existential concerns, meaning, and preparation for impending death.
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Iskandar AC, Rochmawati E, Wiechula R. Experiences and perspectives of suffering in cancer: A qualitative systematic review. Eur J Oncol Nurs 2021; 54:102041. [PMID: 34610535 DOI: 10.1016/j.ejon.2021.102041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Suffering refers to a situation in which a person's illness and condition threaten their integrity. The aim of this systematic review was to synthesize qualitative studies that explored suffering of persons with cancer. METHOD A qualitative systematic review was conducted. Psych Info, PubMed, and CINAHL were searched for relevant studies. Methodological quality was independently assessed using the Critical Appraisal Checklist from Joanna Briggs Institute (JBI). A meta-aggregative approach was utilized to analyze and synthesize the data that focused on how persons with cancer perceive suffering across their illness trajectory. RESULTS Twelve articles reporting the experiences of 230 participants were synthesized. Three synthesized findings were generated from the articles: suffering the loss of normality, suffering in relation to others and existential suffering. Suffering affects the person's normal activities of life and cause the loss of normality. Suffering in relation to others refers patients' suffering also impacts on and is impacted by those around them. The last synthesized finding refers to impact of suffering on patients' whole sense of being. In addition, feelings of hopelessness, and other mental anguish are inevitable responses that lead the patients to think about death. The overall methodological quality resulted in a ConQual rating of moderate for the synthesized findings. CONCLUSION The persons' suffering not only affects themselves but also others, particularly close relatives. The suffering experienced is complex and goes well beyond the immediate impact of physical symptoms and treatment.
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Affiliation(s)
| | - Erna Rochmawati
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Indonesia.
| | - Rick Wiechula
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Indonesia; Adelaide Nursing School, University of Adelaide, Australia; Centre for Evidence-based Practice South Australia: A Joanna Briggs Institute Centre of Excellence, Australia
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25
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Guité-Verret A, Vachon M. The incurable metastatic breast cancer experience through metaphors: the fight and the unveiling. Int J Qual Stud Health Well-being 2021; 16:1971597. [PMID: 34455941 PMCID: PMC8409930 DOI: 10.1080/17482631.2021.1971597] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: War metaphors are omnipresent in public and medical discourse on cancer . If some studies suggest that cancer patients may view their experiences as afight, few studies focus on the metaphors that patients create from their subjective experiences. The aim was to better understand the experience of four women with incurabale metastatic breast cancer from the metaphors they used in personal cancer blogs.Methods: An interpretive phenomenological analysis (IPA) was used to analyze these women's experience and metaphors of cancer.Results: Two metaphors carried the meaning of metastatic breast cancer experience: the fight and the unveiling. The results show that the war metaphor had a unique meaning for the bloggers who lived with incurable breast cancer: they revealed the difficulty of fighting cancer and eventually collapsing in battle, although a renewed look at life had developed in parallel to their struggle. The bloggers thus tried to lift the veil on this complex experience.Conclusion: The results highlight the need for women with metastatic breast cancer to be able to tell and share their experience in a supportive context and to reinvest the war metaphor in order to express themselves in a more authentic way.
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Affiliation(s)
- Alexandra Guité-Verret
- Psychology Department, Université Du Québec À Montréal, Montréal, Canada.,Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Montreal, Canada.,Réseau Québécois De Recherche En Soins Palliatifs Et De Fin De Vie (Rqspal), Quebec, Canada
| | - Melanie Vachon
- Psychology Department, Université Du Québec À Montréal, Montréal, Canada.,Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Montreal, Canada.,Réseau Québécois De Recherche En Soins Palliatifs Et De Fin De Vie (Rqspal), Quebec, Canada
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26
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Cowden RG, Davis EB, Counted V, Chen Y, Rueger SY, VanderWeele TJ, Lemke AW, Glowiak KJ, Worthington EL. Suffering, Mental Health, and Psychological Well-being During the COVID-19 Pandemic: A Longitudinal Study of U.S. Adults With Chronic Health Conditions. WELLBEING, SPACE AND SOCIETY 2021; 2:100048. [PMID: 34746895 PMCID: PMC8562865 DOI: 10.1016/j.wss.2021.100048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/10/2021] [Accepted: 07/13/2021] [Indexed: 05/24/2023]
Abstract
Suffering has been a topic of considerable discussion in the fields of medicine and palliative care, yet few studies have reported causal evidence linking the experience of suffering to health and well-being. In this three-wave prospective cohort study, we explore the potential psychological implications of suffering during the COVID-19 pandemic by examining relations among suffering, mental health, and psychological well-being in a sample of U.S. adults living with chronic health conditions. We analyzed data from n = 184 participants who completed assessments one month before the SARS-CoV-2 outbreak was declared a pandemic by the World Health Organization (February 2020) and then two months (April 2020) and four months later (May/June 2020). Analyses controlled for a range of factors, including sociodemographic characteristics, physical health, religious/spiritual factors, psychological characteristics, and prior values of the predictor and each of the outcomes assessed one month before the COVID-19 pandemic. Results of the primary analysis indicated that greater overall suffering assessed one month into the COVID-19 pandemic was associated with lower psychological well-being (β = -.17, 95% CI: -.29, -.05) and higher levels of anxiety (β = .27, 95% CI: .13, .41) and depression (β = .16, 95% CI: .03, .29) two months later. In a secondary analysis that explored anxiety, depression, and psychological well-being as candidate antecedents of suffering, depression assessed one month into the COVID-19 pandemic was most strongly associated with worse overall suffering two months later. We highlight the implications of the findings for high-risk populations who are suffering amidst the challenges of the COVID-19 pandemic. Potential benefits of both integrating assessments of suffering into screening procedures and addressing experiences of suffering in mental health service settings are discussed.
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Affiliation(s)
- Richard G Cowden
- Harvard University, Human Flourishing Program, Institute for Quantitative Social Science
| | - Edward B Davis
- Wheaton College, School of Psychology, Counseling, and Family Therapy
| | | | - Ying Chen
- Harvard University, Human Flourishing Program, Institute for Quantitative Social Science
| | - Sandra Y Rueger
- Wheaton College, School of Psychology, Counseling, and Family Therapy
| | - Tyler J VanderWeele
- Harvard University, Human Flourishing Program, Institute for Quantitative Social Science
- Harvard T. H. Chan School of Public Health, Department of Epidemiology
| | - Austin W Lemke
- Wheaton College, School of Psychology, Counseling, and Family Therapy
| | - Kevin J Glowiak
- Wheaton College, School of Psychology, Counseling, and Family Therapy
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Mendonça AB, Pereira ER, Magnago C, Medeiros AYBBV, Silva RMCRA, Martins ADO, Meira KC. Suffering experiences of people with cancer undergoing chemotherapy: A meta-ethnographic study. Nurs Health Sci 2021; 23:586-610. [PMID: 33817939 DOI: 10.1111/nhs.12839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022]
Abstract
This meta-ethnography had the objectives of identifying, evaluating, and summarizing the findings of qualitative studies regarding the suffering experiences of people undergoing chemotherapy, as well as developing an explanatory conceptual structure regarding what affects these experiences. A systematic literature review was carried out, covering the past 10 years, in the following databases: CINAHL, Embase, Medline, LILACS and Scopus. By using meta-ethnographic synthesis methods, the following themes were found: the pain of loss; evaluating, measuring, and neutralizing the threat; and social contours of suffering. The experience of living with cancer and undergoing chemotherapy was synthesized into a theoretical-explanatory model with a structure that resembles barbed-wire loops. The model expresses people's suffering experiences as marked by the feeling of loss, restraint of emotions, and resilience. While transcendent movements broke the cycle of suffering, resilience emerged as a learning experience that made patients more resistant to the pain of loss. The results indicated a complex and diverse set of factors that influence suffering, which confirmed that experiences are individual, comprehensive, and continuously reinterpreted.
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Affiliation(s)
- Angelo Braga Mendonça
- Healthcare Sciences Program, School of Nursing, Universidade Federal Fluminense, Niterói, Brazil
| | - Eliane Ramos Pereira
- Healthcare Sciences Program, School of Nursing, Universidade Federal Fluminense, Niterói, Brazil
| | - Carinne Magnago
- Public Health Faculty, Universidade de São Paulo, Niterói, Brazil
| | | | | | | | - Karina Cardoso Meira
- Health Sciences School, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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28
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Philipp R, Kalender A, Härter M, Bokemeyer C, Oechsle K, Koch U, Vehling S. Existential distress in patients with advanced cancer and their caregivers: study protocol of a longitudinal cohort study. BMJ Open 2021; 11:e046351. [PMID: 33895716 PMCID: PMC8074557 DOI: 10.1136/bmjopen-2020-046351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION At the end of life, patients with advanced cancer and their informal caregivers may confront multiple existential concerns. Despite the strong potential to alleviate existential distress through psychosocial interventions, existential distress and its impact on healthcare outcomes have not yet been studied systematically. We aim to investigate the frequency, longitudinal trajectory and predictive impact of existential distress on end-of-life outcomes. We further aim to determine patients' and caregivers' specific need for and utilisation of psychosocial support for existential distress. METHODS This longitudinal cohort study will consecutively recruit 500 patients with advanced cancer and 500 caregivers from oncological outpatient and inpatient clinics. Participants will complete self-report questionnaires (sociodemographic and disease-related characteristics, existential distress, end-of-life outcomes, resources and support needs) at five points of assessment (at baseline and after 3, 6, 9 and 12 months). At baseline and 6-month follow-up, we will conduct structured diagnostic interviews to assess mental disorders. Statistical analyses will include descriptive statistics to determine the prevalence of existential distress, mental disorders and end-of-life outcomes; multiple linear and logistic regression analyses to calculate the predictive impact of existential distress on end-of-life outcomes; and growth mixture models to analyse longitudinal trajectories of existential distress. DISCUSSION This study will provide comprehensive knowledge about patients' and caregivers' existential concerns. The longitudinal empirical data will allow for conclusions concerning the frequency and course of existential distress throughout 1 year. This important extension of existing cross-sectional research will contribute to further develop targeted psychosocial interventions. Profiles of existential distress may be applied by clinicians from multiple professions and help to address existential concerns effectively. ETHICS AND DISSEMINATION The study was approved by the institutional research ethics committee (reference number LPEK-0177). Results will be presented at scientific conferences and published in peer-reviewed journals. Other forms of dissemination will include sharing results on the psychometric properties of the structured demoralisation interview with international research groups and communication with healthcare professionals providing psychosocial treatment for patients and caregivers. Following scientific standards, our progress will be regularly updated on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04600206.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Kalender
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Iskandar AC, Rochmawati E, Wiechula R. Patient's experiences of suffering across the cancer trajectory: A qualitative systematic review protocol. J Adv Nurs 2020; 77:1037-1042. [PMID: 33210384 DOI: 10.1111/jan.14628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/01/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify, appraise and synthesize the available evidence from qualitative research exploring the suffering of patients with cancer during their illness trajectories. DESIGN Protocol for a qualitative systematic review. DATA SOURCES The database will include PubMed, CINAHL and Psych Info were searched in May 2020. METHODS The review protocol has been registered in International Prospective Register for Systematic Review (CRD42020165405). This review will systematically search qualitative research studies in databases from 1982-May 2020, with predetermined search terms. Searches are limited to studies in English. Two reviewers will independently appraise the methodological quality of the selected studies using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Disagreements can be settled through discussion which includes a third reviewer, if necessary. This review will use the meta-aggregative approach to analyze and synthesize data. A summary of findings from selected studies will be presented. DISCUSSION Suffering is a complex dimension that included physical psychological, existential and social dimensions. This review will enable nurses to gain an in-depth understanding of suffering that not only worsens at the end of life that can deliver comprehensive care. IMPACT This review is designed to systematically identify and explore the suffering that patients with cancer experience during their illness trajectory. Often suffering is highlighted at the end of life phase. This review will synthesize the evidence of suffering from the beginning of the patient's diagnosis to the end of life. The results of this review provide evidence to support nursing developments in education and clinical practice so that understanding of cancer can be optimized. The findings of the proposed review will contribute as a basis for recommendations for future research regarding suffering.
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Affiliation(s)
| | - Erna Rochmawati
- School of Master in Nursing, Universitas of Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Rick Wiechula
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia.,Centre for Evidence-based Practice South Australia: A Joanna Briggs Institute Centre of Excellence, Adelaide, SA, Australia.,School of Master in Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
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30
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Dordoni P, Badenchini F, Alvisi MF, Menichetti J, De Luca L, Di Florio T, Magnani T, Marenghi C, Rancati T, Valdagni R, Bellardita L. How do prostate cancer patients navigate the active surveillance journey? A 3-year longitudinal study. Support Care Cancer 2020; 29:645-651. [PMID: 32424643 DOI: 10.1007/s00520-020-05524-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether prostate cancer (PCa) patients' coping strategies (i.e., fighting spirit, anxious preoccupation, fatalism, helplessness/hopelessness, and avoidance) significantly change during the first 3-year follow-up period of active surveillance (AS). MATERIALS AND METHODS Altogether, 104 patients on AS completed the Mini-Mental Adjustment to Cancer (Mini-MAC) at baseline (T0), at 10 and 12 months after diagnostic biopsy (T1 and T2, respectively) and then at 24- (T3) and 36-month (T4) follow-up. Paired samples T test was used to detect statistically significant changes over time. Changes ≥ 1 point (or ≤ - 1) were hypothesized to be clinically relevant. RESULTS During the first 3 years on AS, men experienced decreased anxiety, avoidance thoughts/behaviors, and fight-against-cancer attitudes, and these changes were found to be statistically significant. When considering clinically significant changes between inclusion in AS (T0) and 3-year follow-up (T4), avoidance decreased in 19% of patients. CONCLUSIONS Most patients were observed to have adopted functional coping strategies at baseline, which were maintained through the first 3 years on AS. Overall, men on AS may perceive increasing control over their cancer and comfort with the AS protocol over time and experience slight decreases in anxious preoccupation, cancer-related avoidance thoughts and behaviors, and fight-against-cancer reactions. For those men who find it difficult to cope with AS, psychological monitoring and interventions could be helpful throughout the monitoring journey.
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Affiliation(s)
- Paola Dordoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy.
| | - Fabio Badenchini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | | | - Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Letizia De Luca
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Teresa Di Florio
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Tiziana Magnani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Cristina Marenghi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Riccardo Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lara Bellardita
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
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Crespo I, Rodríguez-Prat A, Monforte-Royo C, Wilson KG, Porta-Sales J, Balaguer A. Health-related quality of life in patients with advanced cancer who express a wish to hasten death: A comparative study. Palliat Med 2020; 34:630-638. [PMID: 32103705 DOI: 10.1177/0269216320904607] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some evidence suggests the wish to hasten death is related to poor health-related quality of life. Deficits in perceived dignity and self-efficacy are risk factors for wish to hasten death that also impact health-related quality of life. AIM To compare perceived health-related quality of life, dignity and self-efficacy in patients with advanced cancer who either do (case group) or do not (control group) express a wish to hasten death. Cases and controls were matched on sociodemographic and functional characteristics. DESIGN A comparative cross-sectional study. PARTICIPANTS A total of 153 adult patients with advanced cancer were assessed for wish to hasten death using the Desire for Death Rating Scale. Scores ⩾1 indicate some degree of wish to hasten death (case group, n = 51), and score = 0 implies no wish to hasten death (control group, n = 102). Assessments included health-related quality of life using the European Organization for Research and Treatment of Cancer Quality-of-Life Core 15-Item Palliative Questionnaire, perceived loss of dignity using the Patient Dignity Inventory and self-efficacy using the General Self-Efficacy Scale. RESULTS Patients with a wish to hasten death had worse emotional functioning (p < 0.001), greater perceived loss of dignity (p < 0.001) and lower self-efficacy (p = 0.001). There was no difference in most physical symptoms. Perceived overall health-related quality of life was significantly worse for those with a clinically relevant wish to hasten death (p = 0.023) and marginally worse for the case group than the control group (p = 0.052). CONCLUSION Patients with wish to hasten death showed lower perceived dignity, self-efficacy and emotional quality of life than patients without wish to hasten death without necessarily perceiving worse physical symptoms.
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Affiliation(s)
- Iris Crespo
- 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
| | - Keith G Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Josep Porta-Sales
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,Palliative Care Service, Institut Català d'Oncologia, Barcelona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Abstract
To practice compassion, the recognition, understanding, and alleviation of patient suffering are of utmost importance. Nursing literature provides ample guidance about the nature and meaning and patients' views about compassion and physical and psychological suffering. However, missing is the discussion about how nurses can achieve a deeper awareness of patients' suffering to practice compassion. This paper aims to describe the relational inquiry nursing approach and illustrate how this approach can enable nurses to develop a deeper awareness of patient suffering. The relational inquiry approach encompasses two components: a relational consciousness and inquiry as a form of action. Relational consciousness requires the nurses to focus on the concrete situations and relationships as well as recognize the intrapersonal, interpersonal, and contextual factors affecting the situations. The interpersonal factors are among and between the individuals, intrapersonal factors are within the individuals, and contextual factors are the hidden factors influencing the individuals and situations. Inquiry as an action requires a critical analysis of the experiences of individuals, situational contexts, and knowledge to inform the nursing care modalities and actions. This approach encourages nurses to use the philosophies of hermeneutic phenomenology, critical theory, and pragmatism. The phenomenological worldview allows nurses to interpret their own and patients' experiences, the critical theory worldview allows nurses to examine the influence of social and cultural factors, and pragmatism allows nurses to question their prior knowledge and develop new knowledge in each situation. The relational inquiry approach allows nurses to develop a deeper understanding of patient suffering through building a therapeutic and trustworthy relationship, active listening, focusing on the details, and engaging in broad and situations specific inquiries to understand the patient narrative of suffering. Two case exemplars are shared to demonstrate how relational inquiry allowed nurses to move beyond recognizing physical suffering and understand patients' emotional and psychological suffering.
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Best M, Leget C, Goodhead A, Paal P. An EAPC white paper on multi-disciplinary education for spiritual care in palliative care. BMC Palliat Care 2020; 19:9. [PMID: 31941486 PMCID: PMC6964109 DOI: 10.1186/s12904-019-0508-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The EAPC White Paper addresses the issue of spiritual care education for all palliative care professionals. It is to guide health care professionals involved in teaching or training of palliative care and spiritual care; stakeholders, leaders and decision makers responsible for training and education; as well as national and local curricula development groups. METHODS Early in 2018, preliminary draft paper was written by members of the European Association for Palliative Care (EAPC) spiritual care reference group inviting comment on the four core elements of spiritual care education as outlined by Gamondi et al. (2013) in their paper on palliative care core competencies. The preliminary draft paper was circulated to experts from the EAPC spiritual care reference group for feedback. At the second stage feedback was incorporated into a second draft paper and experts and representatives of national palliative care organizations were invited to provide feedback and suggest revisions. The final version incorporated the subsequent criticism and as a result, the Gamondi framework was explored and critically revised leading to updated suggestions for spiritual care education in palliative care. RESULTS The EAPC white paper points out the importance of spiritual care as an integral part of palliative care and suggests incorporating it accordingly into educational activities and training models in palliative care. The revised spiritual care education competencies for all palliative care providers are accompanied by the best practice models and research evidence, at the same time being sensitive towards different development stages of the palliative care services across the European region. CONCLUSIONS Better education can help the healthcare practitioner to avoid being distracted by their own fears, prejudices, and restraints and attend to the patient and his/her family. This EAPC white paper encourages and facilitates high quality, multi-disciplinary, academically and financially accessible spiritual care education to all palliative care staff.
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Affiliation(s)
- Megan Best
- Senior Lecturer, Institute for Ethics and Society, University of Notre Dame, Fremantle, Australia
- Post-doctoral research fellow, PoCoG and Sydney Health Ethics, University of Sydney, PO Box, 944, Broadway NSW 2007, Sydney, Australia
| | - Carlo Leget
- Professor in Care Ethics at the University of Humanistic Studies, Kromme Nieuwegracht 29, Utrecht, 3512 HD The Netherlands
| | - Andrew Goodhead
- Spiritual Care Lead, St Christopher’s Hospice, 51/59 Lawrie Park Road, London, Sydenham SE26 6DZ UK
| | - Piret Paal
- Researcher at the Palliative Care Research Hub, Institute of Nursing Science and Practice, Paracelsus Medical Private University, Strubergasse 21, 5020 Salzburg, Austria
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Best M, McArdle MB, Huang YJ, Clayton J, Butow P. How and how much is spirituality discussed in palliative care consultations for advanced cancer patients with and without a question prompt list? PATIENT EDUCATION AND COUNSELING 2019; 102:2208-2213. [PMID: 31235394 DOI: 10.1016/j.pec.2019.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Patients want to discuss spirituality more with their doctors but feel disempowered. Question prompt lists (QPLs) assist conversations. This study assessed the impact of a QPL on spirituality discussions in Palliative Care (PC). METHODS This was a sub-study of a trial in which PC patients were randomised to either receive a QPL prior to a consultation or not, to see whether its provision influenced advanced cancer patients'/caregivers' questions and discussion of topics relevant to end-of-life care during consultations with a PC physician. Consultations were recorded and transcribed. Transcriptions were analysed to examine the frequency and content of spirituality discussions. We conducted logistic regression to investigate the impact of the QPL and other predictors. RESULTS 174 patients participated. Spirituality was discussed in half the consultations. Patients receiving a QPL discussed spirituality 1.38 times more than controls. This finding did not reach statistical significance. First PC consultation and being asked about their concerns by the doctor were significant predictors of a spiritual discussion. CONCLUSION Patients are more likely to discuss spirituality in their first PC consultation, and when their doctor asks them about their concerns. PRACTICE IMPLICATIONS Doctors caring for patients at the end of life should routinely raise spiritual issues.
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Affiliation(s)
- Megan Best
- Psycho-Oncology Collaborative Research Group (PoCOG), University of Sydney, Sydney, Australia.
| | | | - Yi-Jing Huang
- Psycho-Oncology Collaborative Research Group (PoCOG), University of Sydney, Sydney, Australia
| | - Josephine Clayton
- Psycho-Oncology Collaborative Research Group (PoCOG), University of Sydney, Sydney, Australia; Centre for Learning & Research in Palliative Care, Greenwich Hospital, Sydney, Australia; Northern Clinical School, University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Collaborative Research Group (PoCOG), University of Sydney, Sydney, Australia
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35
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Renz M, Bueche D, Reichmuth O, Schuett Mao M, Renz U, Siebenrock R, Strasser F. Forgiveness and Reconciliation Processes in Dying Patients With Cancer. Am J Hosp Palliat Care 2019; 37:222-234. [DOI: 10.1177/1049909119867675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This article studies forgiveness and reconciliation (F/R) in patients with cancer. It focuses on the end of life, when family conflicts resurface and unfinished business challenges patients and causes spiritual distress. Forgiveness and reconciliation may intensify patient–family relationships and facilitate peace of mind and peaceful death. Existing forgiveness models and interventions focus on coping in life, yet no study has examined F/R processes until death. Our mixed-method exploratory study hypothesized that F/R processes occur in phases, repeatedly, and are spurred by approaching death. Three interdisciplinary units at a major Swiss hospital observed 50 dying patients with cancer experiencing severe conflicts with relatives, themselves, and/or with fate/God. Participant observation was combined with interpretative phenomenological analysis and descriptive statistical analysis. A semi-structured observation protocol was developed based on a 5-phase model. The protocol included space for notes (emotions, interventions, effects on dying processes). It was assessed by 20 professionals for 1 year. Analysis was supported by international interdisciplinary experts. We found that conflicts were complex and involved relational, biographical, and spiritual layers. In 62% of patients, F/R processes occurred repeatedly. Many patients died after finding F/R (22 within 48 hours). Patients indicated that imminent death, a mediating third party, acceptance, and experiences of hope motivated them to seek F/R. Although deep relationships may support F/R processes, our limited data on near-death experience/spiritual experiences restrict interpretation. Forgiveness and reconciliation processes oscillate between 5 phases: denial, crisis, experience of hope, decision, and finding F/R. Understanding F/R processes, empathy, hope, and a neutral third party may support patients in seeking forgiveness.
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Affiliation(s)
- M. Renz
- Psychooncology, Oncology, Cantonal Hospital, St Gallen, Switzerland
| | - D. Bueche
- Palliative Center, Cantonal Hospital, St Gallen, Switzerland
| | - O. Reichmuth
- Oncological Palliative Medicine, Cantonal Hospital, St Gallen, Switzerland
| | - M. Schuett Mao
- Psychooncology, Oncology, Cantonal Hospital, St Gallen, Switzerland
| | - U. Renz
- Faculty of Philosophy, University of Klagenfurt, Klagenfurt, Austria
| | - R. Siebenrock
- Systematic Theology, Faculty of Catholic Theology, University of Innsbruck, Innsbruck, Austria
| | - F. Strasser
- Integrated Cancer Rehabilitation, Cancer Fatigue Clinic, Klinik Gais AG, Switzerland
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Tricou C, Ruer M, Nekolaichuk C, Sigurdardottir K, Perceau-Chambard E, Bruera E, Filbet M. Transcultural Validation of the French Version of the Modified Edmonton Symptom Assessment Scale: The ESAS12-F. J Palliat Med 2019; 22:1553-1560. [PMID: 31287375 DOI: 10.1089/jpm.2018.0578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Cancer-related physical symptoms can decrease patients' overall quality of life and are often underdiagnosed. The Edmonton Symptom Assessment Scale (ESAS) is widely used in palliative care for cancer patients to easily assess cancer patients' symptoms. It has been often modified, adding symptoms and explanations, and translated into many languages. The European Association of Palliative Care research team developed a database, which included the modified 12-item ESAS-r as the symptom assessment tool. Objectives: The purpose of this study was to achieve the translation and cross-cultural validation in French of the 12-item ESAS-r, the ESAS12-F. Design: A French version of the ESAS-r was developed using a standardized forward and backward translation method. Patients completed the ESAS12-F and provided feedback on the translation. Setting/Subjects: Forty-five patients with advanced cancer, followed by the palliative care team from the Lyon Sud University Hospital in France, were recruited. Results: Eighty-nine percent of patients considered the ESAS easy to understand. They highlighted some concerns more about the tool itself than the translation: the time line "now," the difficulty to quantify a symptom in a numerical evaluation. Some items (sleep and appetite) needed to be reread and for some others (digestive and psychological symptoms, and well-being) to be reordered in the questionnaire. Conclusion: The ESAS12-F is well accepted and easy to use for the cancer patients. The next step is to carry out a psychometric validation of the definitive version of the ESAS12-F.
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Affiliation(s)
- Colombe Tricou
- Palliative Care Unit, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Murielle Ruer
- Palliative Care Unit, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.,Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada.,Palliative Institute, Covenant Health, Edmonton, Alberta, Canada
| | - Katrin Sigurdardottir
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian, University of Science and Technology (NTNU), Trondheim, Norway.,Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Elise Perceau-Chambard
- Palliative Care Unit, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | | | - Marilene Filbet
- Palliative Care Unit, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
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Abstract
OBJECTIVE To review literature on the relationship of pain, spirituality, and suffering as it relates to the patient with cancer who is experiencing pain. DATA SOURCES Peer-reviewed articles, textbooks, internet. CONCLUSION Pain and suffering are distinct and yet closely related in patients with cancer. Oncology nurses are important in assessing a patient's pain, including dimensions of spirituality and suffering. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are the front line of pain management for patients. This includes recognizing existential distress and suffering and responding to suffering.
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Affiliation(s)
- Shaunna Siler
- School of Medicine, University of Colorado, Aurora, CO
| | - Tami Borneman
- Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
| | - Betty Ferrell
- Nursing Research and Education, City of Hope National Medical Center, Duarte, CA.
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Sá E, Lopes MDAP, Basto ML. Antineoplastic therapy administration: Nursing intervention in the relief of suffering. Rev Bras Enferm 2019; 72:177-182. [DOI: 10.1590/0034-7167-2018-0639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/10/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To identify the nursing interventions with potential to act on the suffering and to evaluate the results of the nursing intervention designed. Method: We used a multi method study. After the identification of the scientific evidence and having found the supporting theory, the intervention process to relieve the suffering of hospitalized patients was modeled using the methodology of qualitative research. Then, training conditions were created for the implementation of the intervention Chemotherapy Administration as an Individualized Nursing Intervention, with a Quasi Experimental, longitudinal piloting study. Results: The patients of the experimental group showed values of suffering lower than the control group . Having finished the pilot study, we would return to qualitative research to understand the variation of some data. Final Considerations: The use of mixed methods of investigations allowed the understanding of the different components of drug chemotherapy administration as an individualized nursing intervention.
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Affiliation(s)
- Eunice Sá
- Escola Superior de Enfermagem de Lisboa, Portugal
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Ribeiro MDS, Borges MDS. Perceptions of aging and falling ill: a study with elderly persons in palliative care. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.180139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: to learn the perceptions of elderly persons in palliative care regarding coping with aging and illness. Method: an exploratory, descriptive, qualitative study was carried out. The study included 11 elderly persons in palliative care because of oncologic disease. Semi-structured interviews were carried out which were analyzed with the aid of the ALCESTE software. Results: two axes were identified from the content analysis. The first, Resist to Survive and Live, has two categories: the first, aging with integrity, portrays the positive perception of the participants regarding the aging process, and coping strategies used to deal with aging and with illness; the other category, resilient development, refers to the life trajectories of the participants and the adversities of the process of development and aging. The second axis, Resist to Die Well, has only one category and refers to the perceptions of the elderly about the stress related to illness. Conclusion: the results show that the perceptions of aging and falling ill involved resilience, as the participants focused on what they had gained rather than their losses. In this context, they used resilient coping strategies: spiritual support, cognitive restructuring, and acceptance.
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Monforte-Royo C, Crespo I, Rodríguez-Prat A, Marimon F, Porta-Sales J, Balaguer A. The role of perceived dignity and control in the wish to hasten death among advanced cancer patients: A mediation model. Psychooncology 2018; 27:2840-2846. [DOI: 10.1002/pon.4900] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Barcelona Spain
| | - Iris Crespo
- School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Barcelona Spain
| | | | - Frederic Marimon
- Faculty of Economics and Social Sciences; Universitat Internacional de Catalunya; Barcelona Spain
| | - Josep Porta-Sales
- School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Barcelona Spain
- Palliative Care Service; Hospital Universitari de Girona Dr. Josep Trueta; Girona Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Barcelona Spain
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Lo C, Sarker T, Canning O, Martin V, McCarthy MA, Granton J, Tan A. Clinical presentation of existential distress in pulmonary arterial hypertension. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2018. [DOI: 10.1080/24745332.2018.1507614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Chris Lo
- Psychology, University of Guelph-Humber, Toronto, Canada
- Psychiatry, University of Toronto, Toronto, Canada
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tasmie Sarker
- Psychology, University of Guelph-Humber, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Orla Canning
- Psychology, University of Guelph-Humber, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Vanessa Martin
- Psychology, University of Guelph-Humber, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Mary A. McCarthy
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network, Toronto, Canada
| | - John Granton
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Adrienne Tan
- Psychiatry, University of Toronto, Toronto, Canada
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network, Toronto, Canada
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Loeffler S, Poehlmann K, Hornemann B. Finding meaning in suffering?-Meaning making and psychological adjustment over the course of a breast cancer disease. Eur J Cancer Care (Engl) 2018; 27:e12841. [DOI: 10.1111/ecc.12841] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 01/07/2023]
Affiliation(s)
- S. Loeffler
- University Hospital Carl Gustav Carus; Dresden Germany
| | - K. Poehlmann
- Akademie für Allgemeine Psychotherapie (aap) private GmbH; Dresden Germany
| | - B. Hornemann
- University Hospital Carl Gustav Carus; University Cancer Center; Dresden Germany
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Silva RS, Caldeira S, Coelho AN, Apóstolo JLA. Forgiveness facilitation in palliative care: a scoping review protocol. ACTA ACUST UNITED AC 2017; 15:2469-2479. [DOI: 10.11124/jbisrir-2016-003337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Nekolaichuk C, Huot A, Gratton V, Bush SH, Tarumi Y, Watanabe SM. Development of a French Version of the Edmonton Symptom Assessment System-Revised: A Pilot Study of Palliative Care Patients' Perspectives. J Palliat Med 2017; 20:966-976. [DOI: 10.1089/jpm.2016.0510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
- Palliative Institute, Covenant Health, Edmonton, Alberta, Canada
| | - Ann Huot
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Valérie Gratton
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Montfort Hospital, Ottawa, Ontario, Canada
| | - Shirley H. Bush
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Palliative Care Unit, Élisabeth Bruyère Hospital, Ottawa, Ontario, Canada
| | - Yoko Tarumi
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Palliative Care Consult Service, Royal Alexandria Hospital, Edmonton, Alberta, Canada
| | - Sharon M. Watanabe
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton, Alberta, Canada
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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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Hannum SM. Meeting the Self at the Crossroads: Thoughts on Aging as a Young Cancer Survivor. THE GERONTOLOGIST 2016; 57:89-95. [PMID: 27507684 DOI: 10.1093/geront/gnw109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/27/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE STUDY With nearly 14.5 million cancer survivors currently alive in the United States, it is expected this will rise to roughly 19 million by 2024. As more people will age with a history of cancer than ever before, it is important to consider how experiences of cancer affect the life course through the bending of time and its interpretation. As such, aging as a cancer survivor must be at the forefront of health maintenance across the life course. DESIGN AND METHODS Through reference to my own cancer experiences in an auto-ethnographic format, this article interprets the illness experience as co-occurring in a young, aging body. This enhances our understanding of biographical reconstruction and individual liminality through descriptions of wisdom imparted by the cancer experience itself. Knowledge and wisdom are further interpreted as enhancing researchers' understandings of cancer and cancer survivorship. RESULTS In this article, I use my illness experiences as a young person to describe evolving interpretations of the life course, the aging body, and the self. IMPLICATIONS Concepts presented in this article aid researchers' understanding of how wisdom might be achieved through the experience of protracted illness over time. Such knowledge has important implications for the management of cancer as chronic, which may be most clearly described through the lens of the ill person.
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Affiliation(s)
- Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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47
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Palliative care specialists’ beliefs about spiritual care. Support Care Cancer 2016; 24:3295-306. [DOI: 10.1007/s00520-016-3135-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 02/22/2016] [Indexed: 11/24/2022]
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Best M, Aldridge L, Butow P, Olver I, Price MA, Webster F. Treatment of holistic suffering in cancer: A systematic literature review. Palliat Med 2015; 29:885-98. [PMID: 25895536 DOI: 10.1177/0269216315581538] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Holistic suffering is a debilitating problem for cancer patients. Although many treatments have been suggested for its alleviation, they have not been compared for effectiveness. AIM This literature review seeks to identify what interventions are effective in treatment of holistic suffering of cancer patients. DESIGN A systematic review was conducted to identify and evaluate studies of interventions for holistic suffering in adult cancer patients. Search terms were generated iteratively from the literature. DATA SOURCES MEDLINE, EMBASE, the Cochrane Library and PsycINFO databases were searched for the years 1992-2015. Included studies were peer-reviewed, English language reports of either a controlled trial or a randomised controlled trial focusing on therapies aimed at relieving suffering in adult cancer patients. Articles were excluded if focused predominantly on spiritual or existential issues or concerns not leading to suffering. Studies were graded for quality using the QualSyst quantitative checklist. Levels of evidence were ascertained by completing the National Health and Medical Research Council criteria. Results are reported according to AMSTAR guidelines. RESULTS The studies represented seven intervention types. Meaning-centred, hope-centred and stress-reduction interventions were found to be effective. Results of both psycho-educational and spiritual interventions in improving spiritual well-being were mixed. Supportive-expressive interventions - with the exception of forgiveness therapy - were not efficacious. There was little or no evidence for the efficacy of creative and healing arts and other assessed interventions such as animal therapy and haptotherapy. CONCLUSION This systematic review found that spiritual well-being, meaning, hope and benefit finding can be positively impacted by a variety of treatment modalities.
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Affiliation(s)
- Megan Best
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW, Australia
| | - Lynley Aldridge
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW, Australia
| | - Ian Olver
- Cancer Council Australia, Sydney, NSW, Australia
| | - Melanie A Price
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW, Australia
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Creating a safe space: A qualitative inquiry into the way doctors discuss spirituality. Palliat Support Care 2015; 14:519-31. [DOI: 10.1017/s1478951515001236] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Spiritual history taking by physicians is recommended as part of palliative care. Nevertheless, very few studies have explored the way that experienced physicians undertake this task.Method:Using grounded theory, semistructured interviews were conducted with 23 physicians who had experience in caring for advanced cancer patients. They were asked to describe the way they discuss spirituality with their patients.Results:We have described a delicate, skilled, tailored process whereby physicians create a space in which patients feel safe enough to discuss intimate topics. Six themes were identified: (1) developing the self: physicians describe the need to understand and be secure in one's own spirituality and be comfortable with one's own mortality before being able to discuss spirituality; (2) developing one's attitude: awareness of the importance of spirituality in the life of a patient, and the need to respect each patient's beliefs is a prerequisite; (3) experienced physicians wait for the patient to give them an indication that they are ready to discuss spiritual issues and follow their lead; (4) what makes it easier: spiritual discussion is easier when doctor and patient share spiritual and cultural backgrounds, and the patient needs to be physically comfortable and willing to talk; (5) what makes it harder: experienced physicians know that they will find it difficult to discuss spirituality when they are rushed and when they identify too closely with a patient's struggles; and (6) an important and effective intervention: exploration of patient spirituality improves care and enhances coping.Significance of results:A delicate, skilled, tailored process has been described whereby doctors endeavor to create a space in which patients feel sufficiently safe to discuss intimate topics.
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