1
|
Salter EK. The new futility? The rhetoric and role of "suffering" in pediatric decision-making. Nurs Ethics 2019; 27:16-27. [PMID: 31032704 DOI: 10.1177/0969733019840745] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article argues that while the presence and influence of "futility" as a concept in medical decision-making has declined over the past decade, medicine is seeing the rise of a new concept with similar features: suffering. Like futility, suffering may appear to have a consistent meaning, but in actuality, the concept is colloquially invoked to refer to very different experiences. Like "futility," claims of patient "suffering" have been used (perhaps sometimes consciously, but most often unconsciously) to smuggle value judgments about quality of life into decision-making. And like "futility," it would behoove us to recognize the need for new, clearer terminology. This article will focus specifically on secondhand claims of patient suffering in pediatrics, but the conclusions could be similarly applied to medical decisions for adults being made by surrogate decision-makers. While I will argue that suffering, like futility, is not sufficient wholesale justification for making unilateral treatment decisions, I will also argue that claims of patient suffering cannot be ignored, and that they almost always deserve some kind of response. In the final section, I offer practical suggestions for how to respond to claims of patient suffering.
Collapse
|
2
|
Quintini D, Vitale C, Gaide M, Surdej F, Salas S. [Hypnosis to fight against pain and anxiety in palliative care]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2017; 62:11-15. [PMID: 29221549 DOI: 10.1016/j.soin.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In our society, hypnosis sometimes has a negative, distorted image. For several years now it has become more widespread in the healthcare field and its use has increased in caring for symptoms such as pain and anxiety. It can be of great help in palliative situations.
Collapse
Affiliation(s)
- Didier Quintini
- Service d'oncologie médicale et de soins palliatifs, Pôle 28 "Daccord" (digestif, anatomie pathologie, chirurgie, Cisih, oncologie, radiothérapie, dermatologie), CHU Timone, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 5, France.
| | - Claire Vitale
- Service d'oncologie médicale et de soins palliatifs, Pôle 28 "Daccord" (digestif, anatomie pathologie, chirurgie, Cisih, oncologie, radiothérapie, dermatologie), CHU Timone, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 5, France
| | - Michelle Gaide
- Service d'oncologie médicale et de soins palliatifs, Pôle 28 "Daccord" (digestif, anatomie pathologie, chirurgie, Cisih, oncologie, radiothérapie, dermatologie), CHU Timone, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 5, France
| | - Frédérique Surdej
- Service d'oncologie médicale et de soins palliatifs, Pôle 28 "Daccord" (digestif, anatomie pathologie, chirurgie, Cisih, oncologie, radiothérapie, dermatologie), CHU Timone, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 5, France
| | - Sébastien Salas
- Service d'oncologie médicale et de soins palliatifs, Pôle 28 "Daccord" (digestif, anatomie pathologie, chirurgie, Cisih, oncologie, radiothérapie, dermatologie), CHU Timone, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 5, France
| |
Collapse
|
3
|
Handel DL, Néron S. Cancer Palliation: Layered Hypnotic Approaches Mending Symptoms, Minding Hope, and Meaning. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2017; 60:33-49. [PMID: 28557678 DOI: 10.1080/00029157.2017.1299678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Advanced cancer often produces significant symptoms such as pain, anxiety, insomnia, nausea, and cachexia; many symptoms require medication adjustments in dose and route of administration, and most patients have significant symptom burdens near the end of life. Treatment strategies that integrate mind-body approaches, such as hypnosis, to improve symptoms are increasingly being studied and utilized. The current article addresses the role for adjunctive hypnotic approaches to relieve suffering from pain and other symptoms, while fostering hope, even in the midst of advancing illness, similar to Snyder's (2002) metaphorical painting of "a personal rainbow of the mind" (p. 269). We describe specific clinical indications, technical modifications, and imagistic language used in formulating hypnotic suggestions in the face of illness progression. Furthermore, we specifically describe formulation of layered hypnotic suggestions with intent to intentionally weave suggestions to modify symptoms and link to suggestions to enhance hope and alter time perception. This approach offers the opportunity to transform an experience often defined by its losses to one in which hidden opportunities for growth and change emerge within this transitional life experience.
Collapse
Affiliation(s)
| | - Sylvain Néron
- Jewish General Hospital, Segal Cancer Centre, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clin Psychol Rev 2014; 34:580-93. [DOI: 10.1016/j.cpr.2014.09.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 08/15/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022]
|
5
|
Iglesias A, Iglesias A. Hypnosis aided fixed role therapy for social phobia: a case report. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2014; 56:405-12. [PMID: 24938079 DOI: 10.1080/00029157.2013.808166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This case study details how hypnosis aided fixed role therapy (HAFRT) was employed in the successful treatment of a case of social phobia with a history of refractory outcomes to previous therapy trials. The treatment consisted of 10 office sessions, scheduled every two weeks, of HAFRT along with twice a day self-hypnotic sessions where the patient performed multiple visualization rehearsals of the vignettes that were successfully mastered in hypnosis during office visits. The results indicated that this patient was able to engage in social and professional affairs that were impossible prior to treatment. The patient retained the therapy gains at follow up 6 months later.
Collapse
|
6
|
Ciaramella A, Spiegel D. Psychiatric disorders among cancer patients. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:557-72. [PMID: 22608644 DOI: 10.1016/b978-0-444-52002-9.00033-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
7
|
Plaskota M, Lucas C, Evans R, Pizzoferro K, Saini T, Cook K. A hypnotherapy intervention for the treatment of anxiety in patients with cancer receiving palliative care. Int J Palliat Nurs 2012; 18:69-75. [PMID: 22399044 DOI: 10.12968/ijpn.2012.18.2.69] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Caroline Lucas
- Palliative Medicine, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey
| | - Rosie Evans
- Princess Alice Hospice, West End Lane, Esher, Surrey, KT10 8NA, England
| | | | - Treena Saini
- Palliative Medicine, Meadow House Hospice, Ealing Hospital, Middlesex
| | | |
Collapse
|
8
|
Boston P, Bruce A, Schreiber R. Existential suffering in the palliative care setting: an integrated literature review. J Pain Symptom Manage 2011; 41:604-18. [PMID: 21145202 DOI: 10.1016/j.jpainsymman.2010.05.010] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 05/26/2010] [Accepted: 05/28/2010] [Indexed: 11/29/2022]
Abstract
CONTEXT Existential and spiritual concerns in relation to palliative end-of-life care have received increasing attention over the past decade. OBJECTIVES To review the literature specifically related to existential suffering in palliative care in terms of the significance of existential suffering in end-of-life care, definitions, conceptual frameworks, and interventions. METHODS A systematic approach was undertaken with the aim of identifying emerging themes in the literature. Databases using CINAHL (1980-2009), MEDLINE (1970-2009), and PsychINFO (1980-2009) and the search engine of Google Scholar were searched under the key words existential suffering, existential distress, existential pain, palliative and end of life care. RESULTS The search yielded a total of 156 articles; 32% were peer-reviewed empirical research articles, 28% were peer-reviewed theoretical articles, and 14% were reviews or opinion-based articles. After manually searching bibliographies and related reference lists, 64 articles were considered relevant and are discussed in this review. Overall analysis identifies knowledge of the following: 1) emerging themes related to existential suffering, 2) critical review of those identified themes, 3) current gaps in the research literature, and 4) recommendations for future research. Findings from this comprehensive review reveal that existential suffering and deep personal anguish at the end of life are some of the most debilitating conditions that occur in patients who are dying, and yet the way such suffering is treated in the last days is not well understood. CONCLUSION Given the broad range of definitions attributed to existential suffering, palliative care clinicians may need to be mindful of their own choices and consider treatment options from a critical perspective.
Collapse
Affiliation(s)
- Patricia Boston
- Division of Palliative Care, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | |
Collapse
|
9
|
Schuman-Olivier Z, Brendel DH, Forstein M, Price BH. The use of palliative sedation for existential distress: a psychiatric perspective. Harv Rev Psychiatry 2009; 16:339-51. [PMID: 19085388 DOI: 10.1080/10673220802576917] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article introduces a structure for standardization in the ongoing debate about the application of palliative sedation for psychological and existential suffering at the end of life. We differentiate the phenomenon of existential distress from the more general one of existential suffering, defining existential distress as a special case of existential suffering that applies to persons with terminal illness. We introduce both a clinical classification system of existential distress based on proximity to expected death and a decision-making process for considering palliative sedation (represented by the mnemonic, TIRED). Neuropsychiatric clinical cases will be used to demonstrate some of the concepts and ethical arguments.
Collapse
Affiliation(s)
- Zev Schuman-Olivier
- Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA 02139, USA.
| | | | | | | |
Collapse
|
10
|
Henoch I, Danielson E. Existential concerns among patients with cancer and interventions to meet them: an integrative literature review. Psychooncology 2008; 18:225-36. [DOI: 10.1002/pon.1424] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
11
|
Huynh ME, Vandvik IH, Diseth TH. Hypnotherapy in child psychiatry: the state of the art. Clin Child Psychol Psychiatry 2008; 13:377-93. [PMID: 18783121 DOI: 10.1177/1359104508090601] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children are more easily hypnotized than adults, and hypnotherapy as a method responds to the general developmental needs of children by addressing their ability for fantasy and imagination. Hypnotherapy and self-hypnosis are tools with which to assess and develop protective factors, and enhance positive adjustment. Meta-analyses and overviews have demonstrated the effect of hypnotherapy in paediatric disorders like asthma, chronic and acute pain, and in procedure-related distress in cancer patients. We wanted to examine the use and benefits of hypnotherapy when applied to child psychiatric disorders. A review of a literature search from PubMed, PsychINFO and the Cochrane databases revealed 60 publications, mostly case reports based on 2-60 cases, addressing the use of hypnotherapy in various child psychiatric conditions. Findings indicate that hypnotherapy may be useful for a wide range of disorders and problems, and may be particularly valuable in the treatment of anxiety disorders and trauma-related conditions. In conclusion, knowledge of hypnosis is useful in clinical practice and hypnotherapy may play an important role as an adjunctive therapy in cognitive-behavioural treatment and family therapy. Additional qualitative and quantitative studies are needed to assess the place for hypnosis/hypnotherapy in child psychiatry.
Collapse
Affiliation(s)
- Melanie Ekholdt Huynh
- Section for Child and Adolescent Psychiatry, Rikshospitalet University Hospital, Oslo, Norway.
| | | | | |
Collapse
|
12
|
Abstract
A case of secondary diurnal enuresis (SDE) after a car accident was treated with hypnosis by means of the Hypnotic Trauma Narrative, an instrument created by the authors for use with children who have been exposed to traumatic events and develop either classic symptoms of posttraumatic stress disorder or manifest other psychosomatic symptoms. An ABAB time-series design with multiple replications was employed to measure the relationship of the hypnotic treatment to the dependent measure: episodes of diurnal incontinence. The findings indicated a statistically significant relationship between the degree of change from phase to phase and the treatment. Hypnosis with the Hypnotic Trauma Narrative was deemed efficacious as a method for the treatment of secondary diurnal enuresis. The patient was symptom-free at follow-up 6 months later.
Collapse
Affiliation(s)
- Alex Iglesias
- Private Practice, Palm Beach Gardens, Florida 33410, USA.
| | | |
Collapse
|
13
|
Katayama H, Gianotti LRR, Isotani T, Faber PL, Sasada K, Kinoshita T, Lehmann D. Classes of Multichannel EEG Microstates in Light and Deep Hypnotic Conditions. Brain Topogr 2007; 20:7-14. [PMID: 17587166 DOI: 10.1007/s10548-007-0024-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2007] [Indexed: 11/24/2022]
Abstract
The study assessed the brain electric mechanisms of light and deep hypnotic conditions in the framework of EEG temporal microstates. Multichannel EEG of healthy volunteers during initial resting, light hypnosis, deep hypnosis, and eventual recovery was analyzed into temporal EEG microstates of four classes. Microstates are defined by the spatial configuration of their potential distribution maps ([Symbol: see text]potential landscapes') on the head surface. Because different potential landscapes must have been generated by different active neural assemblies, it is reasonable to assume that they also incorporate different brain functions. The observed four microstate classes were very similar to the four standard microstate classes A, B, C, D [Koenig, T. et al. Neuroimage, 2002;16: 41-8] and were labeled correspondingly. We expected a progression of microstate characteristics from initial resting to light to deep hypnosis. But, all three microstate parameters (duration, occurrence/second and %time coverage) yielded values for initial resting and final recovery that were between those of the two hypnotic conditions of light and deep hypnosis. Microstates of the classes B and D showed decreased duration, occurrence/second and %time coverage in deep hypnosis compared to light hypnosis; this was contrary to microstates of classes A and C which showed increased values of all three parameters. Reviewing the available information about microstates in other conditions, the changes from resting to light hypnosis in certain respects are reminiscent of changes to meditation states, and changes to deep hypnosis of those in schizophrenic states.
Collapse
Affiliation(s)
- Hitoshi Katayama
- The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Lenggstrasse 31, CH-8032 Zurich, Switzerland
| | | | | | | | | | | | | |
Collapse
|