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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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Kirkwood J, Graham-Wisener L, McConnell T, Porter S, Reid J, Craig N, Dunlop C, Gordon C, Thomas D, Godsal J, Vorster A. The MusiQual treatment manual for music therapy in a palliative care inpatient setting. BRITISH JOURNAL OF MUSIC THERAPY 2019. [DOI: 10.1177/1359457519834533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents the treatment manual developed during the MusiQual feasibility study carried out in Belfast by Queen’s University Belfast, Every Day Harmony Music Therapy, and Marie Curie Northern Ireland. The MusiQual study considered the feasibility of a multicentre randomised trial to evaluate the effectiveness of music therapy in improving the quality of life of hospice inpatients (protocol: McConnell et al. results: Porter et al.). The procedures in the manual are based fully on those implemented by the Music Therapists during the feasibility study, and it also incorporates the theoretical model defined and published following the realist review of the literature (McConnell and Porter). The manual is presented in the format in which it would be used in the potential future phase III multicentre randomised control trial. It represents a flexible approach to provide enough scope for practicing therapists to adapt their interventions to individual clients as is best practice in music therapy. It aims to provide stable guidelines both to ensure treatment fidelity in a future trial of music therapy for palliative care inpatients and to act as a relevant guide for Music Therapists practicing in this field.
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Swinton M, Giacomini M, Toledo F, Rose T, Hand-Breckenridge T, Boyle A, Woods A, Clarke F, Shears M, Sheppard R, Cook D. Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit. Am J Respir Crit Care Med 2017; 195:198-204. [PMID: 27525361 DOI: 10.1164/rccm.201606-1102oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The austere setting of the intensive care unit (ICU) can suppress expressions of spirituality. OBJECTIVES To describe how family members and clinicians experience and express spirituality during the dying process in a 21-bed medical-surgical ICU. METHODS Reflecting the care of 70 dying patients, we conducted 208 semistructured qualitative interviews with 76 family members and 150 clinicians participating in the Three Wishes Project. Interviews were recorded and transcribed verbatim. Data were analyzed by three investigators using qualitative interpretive description. MEASUREMENTS AND MAIN RESULTS Participants characterize dying as a spiritual event. Spirituality is an integral part of the life narrative of the patient before, during, and after death. Experiences and expressions of spirituality for patients, families, and clinicians during end-of-life care in the ICU are supported by eliciting and implementing wishes in several ways. Eliciting wishes stimulates conversations for people of diverse spiritual orientations to respond to death in personally meaningful ways that facilitate continuity and closure, and ease emotional trauma. Soliciting wishes identifies positive aspirations, which provide comfort in the face of death. The act of soliciting wishes brings clinician humanity to the fore. Wishing makes individual spiritual preferences and practices more accessible. Wishes may be grounded in spiritual goals, such as peace, comfort, connections, and tributes; they may seek a spiritually enhanced environment or represent specific spiritual interventions. CONCLUSIONS Family members and clinicians consider spirituality an important dimension of end-of-life care. The Three Wishes Project invites and supports the expression of myriad forms of spirituality during the dying process in the ICU.
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Affiliation(s)
| | - Mita Giacomini
- 1 Department of Clinical Epidemiology and Biostatistics.,2 Centre for Health Economics and Policy Analysis, and
| | | | | | | | - Anne Boyle
- 4 Family Medicine and Palliative Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,5 Department of Medicine, and
| | - Anne Woods
- 4 Family Medicine and Palliative Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,5 Department of Medicine, and
| | - France Clarke
- 1 Department of Clinical Epidemiology and Biostatistics.,6 Department of Critical Care, St. Joseph's Healthcare, Hamilton, Ontario, Canada; and
| | | | - Robert Sheppard
- 7 Department of Emergency Medicine, North Cypress Medical Center, Cypress, Texas
| | - Deborah Cook
- 1 Department of Clinical Epidemiology and Biostatistics.,4 Family Medicine and Palliative Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,5 Department of Medicine, and.,6 Department of Critical Care, St. Joseph's Healthcare, Hamilton, Ontario, Canada; and
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Devlin AS, Andrade CC. Quality of the Hospital Experience: Impact of the Physical Environment. HANDBOOK OF ENVIRONMENTAL PSYCHOLOGY AND QUALITY OF LIFE RESEARCH 2017. [DOI: 10.1007/978-3-319-31416-7_23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
OBJECTIVE Music therapy has experienced a rising demand as an adjunct therapy for symptom management among palliative care patients. We conducted a realist review of the literature to develop a greater understanding of how music therapy might benefit palliative care patients and the contextual mechanisms that promote or inhibit its successful implementation. METHOD We searched electronic databases (CINAHL, Embase, Medline, and PsychINFO) for literature containing information on music therapy for palliative care. In keeping with the realist approach, we examined all relevant literature to develop theories that could explain how music therapy works. RESULTS A total of 51 articles were included in the review. Music therapy was found to have a therapeutic effect on the physical, psychological, emotional, and spiritual suffering of palliative care patients. We also identified program mechanisms that help explain music therapy's therapeutic effects, along with facilitating contexts for implementation. SIGNIFICANCE OF RESULTS Music therapy may be an effective nonpharmacological approach to managing distressing symptoms in palliative care patients. The findings also suggest that group music therapy may be a cost-efficient and effective way to support staff caring for palliative care patients. We encourage others to continue developing the evidence base in order to expand our understanding of how music therapy works, with the aim of informing and improving the provision of music therapy for palliative care patients.
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Francisco DP, Costa ICP, Andrade CGD, Santos KFOD, Brito FMD, Costa SFGD. Contributions of the chaplaincy service to the care of terminal patients. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-07072015003180013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study aims to identify chaplains' understanding in relation to spirituality, and to analyze the chaplaincy's contribution in the care of terminal patients. It is exploratory, qualitative research undertaken with seven hospital chaplains in two public hospitals in João Pessoa in the Brazilian state of Paraíba. The data were collected through semi-structured interviews and were subjected to content analysis. The categories which emerged were: Spirituality in the view of chaplains, and Contributions of the chaplaincy in employing spirituality in the care of the terminal patient. These categories evidenced that the chaplains value the spiritual dimension in their practice, helping the patient to cope with the end-of-life process. It is hoped that this study will provide resources for further investigations, bearing in mind that studies on the chaplaincy and spirituality in the care for the terminal patient remain incipient.
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Effects of music therapy on spirituality with patients on a medical oncology/hematology unit: A mixed-methods approach. ARTS IN PSYCHOTHERAPY 2013. [DOI: 10.1016/j.aip.2013.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McClean S, Bunt L, Daykin N. The Healing and Spiritual Properties of Music Therapy at a Cancer Care Center. J Altern Complement Med 2012; 18:402-7. [PMID: 22384974 DOI: 10.1089/acm.2010.0715] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stuart McClean
- Department of Health and Applied Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Leslie Bunt
- Department of Allied Health Professions, Faculty of Health and Life Sciences, University of the West of England, Bristol, United Kingdom
| | - Norma Daykin
- Department of Health and Applied Social Sciences, University of the West of England, Bristol, United Kingdom
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Knapp C, Madden V, Wang H, Curtis C, Sloyer P, Shenkman E. Music therapy in an integrated pediatric palliative care program. Am J Hosp Palliat Care 2009; 26:449-55. [PMID: 19666889 DOI: 10.1177/1049909109341870] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
National experts have recommended that children with life-limiting illnesses receive integrated palliative and medical care. These programs offer a variety of services, including music therapy. Using survey data from parents whose were enrolled in Florida's Partners in Care: Together for Kids (PIC:TFK) program, this study investigates parents' experiences with music therapy. About 44% of children with life-limiting illnesses and 17% of their siblings used music therapy. For children who used music therapy, multivariate results suggest that their parents were 23 times as likely to report satisfaction with the overall PIC:TFK program (P < .05) versus parents whose children did not use music therapy. Pediatric palliative care programs should include music therapy, although recruiting licensed music therapists may be challenging.
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Affiliation(s)
- Caprice Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL, USA.
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Renz M, Koeberle D, Cerny T, Strasser F. Between Utter Despair and Essential Hope. J Clin Oncol 2009; 27:146-9. [PMID: 19047303 DOI: 10.1200/jco.2008.19.2203] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Monika Renz
- From the Sections of Psychooncology and Musictherapy, Oncological Palliative Medicine; and the Division of Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland
| | - Dieter Koeberle
- From the Sections of Psychooncology and Musictherapy, Oncological Palliative Medicine; and the Division of Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland
| | - Thomas Cerny
- From the Sections of Psychooncology and Musictherapy, Oncological Palliative Medicine; and the Division of Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland
| | - Florian Strasser
- From the Sections of Psychooncology and Musictherapy, Oncological Palliative Medicine; and the Division of Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland
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Cooper L, Foster I. The use of music to aid patients' relaxation in a radiotherapy waiting room. Radiography (Lond) 2008. [DOI: 10.1016/j.radi.2007.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mystakidou K, Tsilika E, Parpa E, Pathiaki M, Patiraki E, Galanos A, Vlahos L. Exploring the relationships between depression, hopelessness, cognitive status, pain, and spirituality in patients with advanced cancer. Arch Psychiatr Nurs 2007; 21:150-61. [PMID: 17556108 DOI: 10.1016/j.apnu.2007.02.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 01/28/2007] [Accepted: 02/03/2007] [Indexed: 10/23/2022]
Abstract
The growing interest in the psychological morbidity of patients with cancer has been the major reason for conducting this study. The measurements used were the Beck Depression Inventory, the Beck Hopelessness Scale, the Mini Mental State Examination, the Greek Brief Pain Inventory, and the Spiritual Involvement and Beliefs Scale. The analysis was conducted in 82 patients with advanced cancer. Significant associations were found between pain interference in "mood" and in "enjoyment of life" and hopelessness, as well as between worse pain and pain interference items with depression and cognitive status. Significant correlations were found between hopelessness, depression, and cognitive condition. These findings demonstrate the physical, psychological, and cognitive aspects of patients with cancer.
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Affiliation(s)
- Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Athens, Greece.
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Rydé K, Friedrichsen M, Strang P. Crying: A force to balance emotions among cancer patients in palliative home care. Palliat Support Care 2007; 5:51-9. [PMID: 17461371 DOI: 10.1017/s1478951507070071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Crying is a common but seldom studied phenomenon in palliative care. The aim of this study was to explore the significance of patients crying in a palliative care context.Methods: Tape-recorded interviews with 14 cancer patients in palliative home care were carried out. To gain deeper understanding, a hermeneutic analysis and interpretation was used.Results: Crying was described in different dimensions: (1) intense and despondent crying as a way of ventilating urgent needs, (2) gentle, sorrowful crying as a conscious release of emotions, and (3) quiet, tearless crying as a protection strategy. Crying seems to be an expression for an inner emotional force, provoked by different factors, which cause changes in the present balance. To cry openly but also to cry on the inside meant being able to achieve or maintain balance. Crying may be something useful, which could create release and help reduce tension, but it may also have a negative impact as it consumes energy and creates feelings of shame.Significance of results: Professionals need to understand the different levels of crying. In such situations sometimes comforting the patient may not be the best solution, as some may need privacy.
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Affiliation(s)
- Kerstin Rydé
- Department of Social and Welfare Studies, Faculty of Health Sciences, Campus Norrköping, Linköping University, Norrköping, Sweden.
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Methodological issues in music interventions in oncology settings: A systematic literature review. ARTS IN PSYCHOTHERAPY 2006. [DOI: 10.1016/j.aip.2006.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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