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Philipp R, Walbaum C, Vehling S. Psychodynamic psychotherapy in serious physical illness: A systematic literature review of approaches and techniques for the treatment of existential distress and mental disorders. DEATH STUDIES 2024:1-22. [PMID: 38865193 DOI: 10.1080/07481187.2024.2353362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Individuals with life-limiting physical illness experience lower mental health due to existential distress (e.g., demoralization, death anxiety) and mental disorders (e.g., depression, anxiety). Psychodynamic psychotherapy may be helpful in alleviating such distress by focusing patients' unconscious emotional and relational motivations. There is yet limited knowledge on the application of psychodynamic psychotherapies in this population. We systematically searched electronic databases and analyzed results using meta-ethnography. Of 15,112 identified records, we included 31 qualitative studies applying psychodynamic psychotherapies (n = 69, mean age: 49.3 [SD = 16.9)], 56% female). Psychodynamic treatment in this population can be beneficial when considering modification of the treatment setting to the illness reality, balancing needs for autonomy and separation in light of helplessness and death anxiety, and careful integration of supportive interventions and conflict-oriented interventions (e.g., exploring relational issues that interfere with mourning illness-related loss). We discuss future directions for the development and evaluation of treatments specific to serious physical illness.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Walbaum
- 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
| | - 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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Feldstain A. Psychosocial intervention in palliative care: What do psychologists need to know. J Health Psychol 2024; 29:707-720. [PMID: 38282369 PMCID: PMC11141107 DOI: 10.1177/13591053231222848] [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] [Indexed: 01/30/2024] Open
Abstract
Emotional and existential suffering is prevalent in advanced diseases and psychologists have valuable skills to support people in this time of life. Yet, psychologists are rarely integrated in palliative care and relevant training is sparse. Being integrated in other areas of health, it is likely that we will be supporting these patients, whether integrated in a specialized team or not. This article is meant to serve psychologists, already skilled in the art and science of psychosocial intervention, who may find themselves supporting patients with advanced disease. Relevant history of palliative care is provided to elucidate palliative philosophy and approach. Evidence-based existential interventions will be reviewed. Integration of psychological models and both palliative theory and practice is provided to support palliative-appropriate case conceptualizations. Finally, case examples are provided throughout to help readers reconcile their existing practice in this domain of care.
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Schultz M, Baziliansky S, Mitnik I, Ulitzur N, Campisi-Pinto S, Givoli S, Bar-Sela G, Zalman D. Some differences between social work, spiritual care, and psychology: Content variance in end-of-life conversations. Palliat Support Care 2024; 22:306-313. [PMID: 37605972 DOI: 10.1017/s1478951523000652] [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: 08/23/2023]
Abstract
OBJECTIVES Within the multidisciplinary team, there can sometimes be lack of clarity as to the specific different contributions of each of the psycho-social-spiritual professionals: social workers, psychologist, and spiritual caregivers. This study examined the content of their end-of-life conversations with patients. METHODS A total of 180 patients with terminal cancer received standard multidisciplinary care, including conversations with a social worker, psychologist, and spiritual caregiver. After each patient's death, these professionals reported using a structured tool which content areas had arisen in their conversations with that patient. RESULTS Across all content areas, there were significant differences between social work and spiritual care. The difference between social work and psychology was slightly smaller but still quite large. Psychology and spiritual care were the most similar, though they still significantly differed in half the content areas. The differences persisted even among patients who spoke with more than 1 kind of professional. The 6 content areas examined proved to subdivide into 2 linked groups, where patients speaking about 1 were more likely to speak about the others. One group, "reflective" topics (inner and transpersonal resources, interpersonal relationships, one's past, and end of life), included all those topics which arose more often with spiritual caregivers or psychologists. The second group, "decision-making" topics (medical coping and life changes), was comprised of those topics which arose most commonly with social workers, bridging between the medical and personal aspects of care and helping patients navigate their new physical, psychological, and social worlds. SIGNIFICANCE OF RESULTS These findings help shed light on the differences, in practice, between patients' conversations with social workers, psychologists, and spiritual caregivers and the roles these professionals are playing; can aid in formulating individualized care plans; and strengthen the working assumption that all 3 professions contribute in unique, complementary ways to improving patients' and families' well-being.
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Affiliation(s)
- Michael Schultz
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | | | - Inbal Mitnik
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Nirit Ulitzur
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | | | - Simon Givoli
- Statistical Department, Midot Ltd., Tel Aviv, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniela Zalman
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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De Vincenzo F, Lombardo L, Iani L, Maruelli A, Durante S, Ragghianti M, Park CL, Innamorati M, Quinto RM. Spiritual well-being, dignity-related distress and demoralisation at the end of life-effects of dignity therapy: a randomised controlled trial. BMJ Support Palliat Care 2024; 13:e1238-e1248. [PMID: 36702519 DOI: 10.1136/spcare-2022-003696] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This single-centre prospective randomised controlled study aimed to investigate the effectiveness of dignity therapy on spiritual well-being, demoralisation and dignity-related distress compared with standard palliative care. METHODS A total of 111 terminally ill hospice patients were randomly allocated to one of two groups: dignity therapy plus standard palliative care (intervention group) or standard palliative care alone (control group). The main outcomes were meaning, peace, faith, loss of meaning and purpose, distress and coping ability, existential distress, psychological distress and physical distress. Assessments were conducted at baseline, 7-10 and 15-20 days. RESULTS Following randomisation, 11 dropped out before baseline assessment and 33 after post-treatment assessment. A total of 67 patients completed the study, 35 in the experimental group and 32 in the control group. Repeated measures general linear model showed significant differences between groups on peace and psychological distress over time, but not on existential distress, physical distress, meaning and purpose, distress and coping ability, meaning and faith. Specifically, patients in the dignity therapy intervention maintained similar levels of peace from baseline to follow-up, whereas patients in the control group significantly declined in peace during the same time period. Moreover, psychological distress significantly decreased from pretreatment to post-treatment in the intervention group and increased in the control group. CONCLUSIONS Dignity therapy may be an effective intervention in maintaining sense of peace for terminally ill patients. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of this psychological intervention.
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Affiliation(s)
| | - Luigi Lombardo
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Luca Iani
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Alice Maruelli
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | - Sieva Durante
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Matilde Ragghianti
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | - Crystal L Park
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
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Moglia C, Palumbo F, Veronese S, Calvo A. Withdrawal of mechanical ventilation in amyotrophic lateral sclerosis patients: a multicenter Italian survey. Neurol Sci 2023; 44:4349-4357. [PMID: 37418099 PMCID: PMC10641048 DOI: 10.1007/s10072-023-06905-7] [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: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Law 219/2017 was approved in Italy in December 2017, after a years-long debate on the autonomy of healthcare choices. This Law, for the first time in Italian legislation, guarantees the patient's right to request for withdrawal of life-sustaining treatments, including mechanical ventilation (MV). OBJECTIVE To investigate the current status of MV withdrawal in amyotrophic lateral sclerosis (ALS) patients in Italy and to assess the impact of Law 219/2017 on this practice. METHODS We conducted a Web-based survey, addressed to Italian neurologists with expertise in ALS care, and members of the Motor Neuron Disease Study Group of the Italian Society of Neurology. RESULTS Out of 40 ALS Italian centers, 34 (85.0%) responded to the survey. Law 219/2017 was followed by an increasing trend in MV withdrawals, and a significant increase of neurologists involved in this procedure (p 0.004). However, variations across Italian ALS centers were observed, regarding the inconsistent involvement of community health services and palliative care (PC) services, and the intervention and composition of the multidisciplinary team. CONCLUSIONS Law 219/2017 has had a positive impact on the practice of MV withdrawal in ALS patients in Italy. The recent growing public attention on end-of-life care choices, along with the cultural and social changes in Italy, requires further regulatory frameworks that strengthen tools for self-determination, increased investment of resources in community and PC health services, and practical recommendations and guidelines for health workers involved.
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Affiliation(s)
- Cristina Moglia
- "Rita Levi Montalcini", Department of Neuroscience, ALS Centre, University of Turin, Turin, Italy.
- Azienda Ospedaliero-Universitaria Città Della Salute e Della Scienza Di Torino, Turin, Italy.
| | - Francesca Palumbo
- "Rita Levi Montalcini", Department of Neuroscience, ALS Centre, University of Turin, Turin, Italy
| | | | - Andrea Calvo
- "Rita Levi Montalcini", Department of Neuroscience, ALS Centre, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città Della Salute e Della Scienza Di Torino, Turin, Italy
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Marina S, Wainwright T, Ricou M. Views of Psychologists About Their Role in Hastened Death. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:200-215. [PMID: 34494472 DOI: 10.1177/00302228211045166] [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: 11/16/2022]
Abstract
Hastened death practices are legal in several countries. Psychologists are increasingly taking a more active role in end-of-life issues, but the role of psychologists in requests to hasten death is not established. This study aims to contribute guidance for psychological practice in the context of requests to hasten death. We conducted a cross-sectional and cross-cultural study with Psychologists from Portugal and Luxembourg who answer closed and open questions to provide views about their role in hastened death. Psychological assessment, psychological support to patient and family, the exploration of patient decision-making and reorientation of patients were viewed as roles for psychologists. However, these roles may differ depending whether the patient has a terminal or non-terminal illness.
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Affiliation(s)
- Sílvia Marina
- Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Tony Wainwright
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Miguel Ricou
- Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
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Cardoso AR, Remondes-Costa S, Veiga E, Almeida V, Rocha J, Teixeira RJ, Macedo G, Leite M. Meaning of Life Therapy: A Pilot Study of a Novel Psycho-Existential Intervention for Palliative Care in Cancer. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231209654. [PMID: 37884277 DOI: 10.1177/00302228231209654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Intervention in Palliative Care aims to provide physical, psychosocial, and spiritual relief for patients and family members. Brief interventions with a psycho-existential approach have shown positive responses; however, cultural adaptations are needed. This pilot study aimed to develop the Meaning of Life Therapy (MLT), a novel psycho-existential intervention, rooted in the Dignity Therapy, Life Review, and Meaning-Centered Psychotherapy. MLT was culturally adapted to the Portuguese context to include questions about forgiveness, apology, reconciliation, farewell, and a legacy document, i.e., the Life Letter. Nine PC cancer patients answered a 14-question MLT protocol, intended to help patients find purpose and meaning in life. Eight themes emerged: Family, Preservation of Identity, Life Retrospective, Clinical Situation, Achievements, Socio-Professional Valorization, Forgiveness/Apology/Reconciliation, and Saying Goodbye. MLT has proved its ability to respond to the psycho-existential needs of PC patients. Further studies should be conducted to gain extensive knowledge of the effectiveness of culturally responsive interventions.
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Affiliation(s)
- Ana Rita Cardoso
- Casa de Saúde do Telhal, Instituto São João de Deus, Lisboa, Portugal
| | - Sónia Remondes-Costa
- Department of Education and Psychology, School of Human and Social Sciences, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Elisa Veiga
- Faculty of Education and Psychology, Universidade Católica Portuguesa, Research Centre for Human Development, Porto, Portugal
| | - Vera Almeida
- Department of Social and Behavioural Sciences, University Institute of Health Sciences(IUCS), CESPU, Gandra, Portugal
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences(IUCS), CESPU, Gandra, Portugal
| | - José Rocha
- Department of Social and Behavioural Sciences, University Institute of Health Sciences(IUCS), CESPU, Gandra, Portugal
| | - Ricardo João Teixeira
- CINEICC- Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
- REACH - Mental Health Clinic, Porto, Portugal
| | - Gerly Macedo
- Clinical and Health Psychology Unit, Psychiatry and Mental Health Service, Hospital da Senhora de Oliveira de Guimarães, Guimarães, Portugal
| | - Manuela Leite
- Department of Social and Behavioural Sciences, University Institute of Health Sciences(IUCS), CESPU, Gandra, Portugal
- iHealth4Well-being - Innovation in Health and Well-Being, Research Unit, Instituto Politécnico de Saúde do Norte, CESPU, Penafiel, Portugal
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8
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Chow AYM, Fordjour GA, Lui JNM, Chan IKN, Zhang AY, Chan CLW. The Physical and Psychosocial Outcomes of a Psychosocial Home-Based end-of-Life Care Intervention in Hong Kong. J Palliat Care 2023; 38:481-489. [PMID: 36793228 DOI: 10.1177/08258597231157346] [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: 02/17/2023]
Abstract
OBJECTIVE Living the final days of life being cared for at home is a preference expressed by many. The data on the effectiveness of home-based end-of-life care (EoLC) intervention to improve the holistic conditions of terminally ill patients are scanty. This study sought to evaluate a psychosocial home-based EoLC intervention for terminally ill patients in Hong Kong. METHODS A prospective cohort study was conducted, applying the Integrated Palliative Care Outcome Scale (IPOS) at 3 timepoints (service intake, 1-month, and 3-months after enrollment). A total of 485 eligible, consenting terminally ill people (mean age = 75.48, SD = 11.39) were enrolled, with 40.21% (n = 195) providing data at all 3 timepoints for this study. RESULTS Decreasing symptom severity scores were observed for all IPOS psychosocial symptoms, and most physical symptoms, over the 3 timepoints. Improvements in depression and practical concerns had the highest omnibus time effects (F > 31.92, P < .01) and T0 to T2 paired comparison effects (Cohen's d > 0.54, P < .01). Physical symptoms of weakness/lack of energy, poor mobility, and poor appetite also showed significant improvements at T1 and T2 (Cohen's d: 0.22-0.46, P < .05). Bivariate regression analyses showed that improvements in anxiety, depression, and family anxiety were associated with improvements in physical symptoms of pain, shortness of breath, weakness/lack of energy, nausea, poor appetite, and poor mobility. Patients' demographic and clinical characteristics were not associated with changes in symptoms. CONCLUSIONS The psychosocial home-based EoLC intervention effectively improved the psychosocial and physical status of terminally ill patients, irrespective of their clinical characteristics or demographics.
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Affiliation(s)
- Amy Y M Chow
- The University of Hong Kong, Hong Kong
- Jockey Club End-of-Life Community Care Project, The University of Hong Kong, Hong Kong
| | - Genevieve A Fordjour
- Jockey Club End-of-Life Community Care Project, The University of Hong Kong, Hong Kong
| | - Juliana N M Lui
- Jockey Club End-of-Life Community Care Project, The University of Hong Kong, Hong Kong
| | - Iris K N Chan
- Jockey Club End-of-Life Community Care Project, The University of Hong Kong, Hong Kong
| | - Anna Y Zhang
- Jockey Club End-of-Life Community Care Project, The University of Hong Kong, Hong Kong
| | - Cecilia L W Chan
- The University of Hong Kong, Hong Kong
- Jockey Club End-of-Life Community Care Project, The University of Hong Kong, Hong Kong
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Bovero A, Pesce S, Botto R, Tesio V, Ghiggia A. Self-Transcendence: Association with Spirituality in an Italian Sample of Terminal Cancer Patients. Behav Sci (Basel) 2023; 13:559. [PMID: 37504006 PMCID: PMC10376349 DOI: 10.3390/bs13070559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023] Open
Abstract
Terminally ill cancer patients often experience demoralization and loss of dignity, which undermines their spiritual wellbeing, which could, however, be supported by the presence of other factors such as self-transcendence and religious coping strategies. To assess self-transcendence and religious coping strategies and how they influence spirituality, we studied 141 end-stage cancer patients (64.3% male; mean age 68.6 ± 14.6) with a Karnofsky Performance Status ≤ 50 and a life expectancy ≤ 4 months using the Self-Transcendence Scale, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-Sp-12), the Brief Religious COPE, and the Patient Dignity Inventory. To understand the effects of these variables on spirituality, hierarchical multiple regression was performed on FACIT-Sp-12. The final model predicted 67% of the variance in spiritual wellbeing. Demoralization was the strongest influencing factor (β = -0.727, p < 0.001), followed by self-transcendence (β = 0.256, p < 0.001), and positive religious coping (β = 0.148, p < 0.05). This study suggests that self-transcendence and positive religious coping may be protective factors for spirituality in terminal cancer patients. These factors should be considered in treatment to promote spiritual wellbeing and improve patients' quality of life at the end of life.
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Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, AOU Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy
| | - Sara Pesce
- Clinical Psychology Unit, AOU Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy
| | - Rossana Botto
- Clinical Psychology Unit, AOU Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy
- Department of Neuroscience, University of Turin, AOU Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy
| | - Valentina Tesio
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Ada Ghiggia
- Department of Life Sciences, University of Trieste, Via Edoardo Weiss 21, 34128 Trieste, Italy
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Edwards J, Stone M, Bartlett H, Wallace M, Ventura A. Grief in School-Aged Youth. NASN Sch Nurse 2023; 38:171-175. [PMID: 36942564 DOI: 10.1177/1942602x231161332] [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: 03/23/2023]
Abstract
Grief is an expected response to an internalized sense of loss, regardless of age. This response occurs after experiencing the death of a loved one or a drastic life change that creates a sense of loss. Children and adolescents move through the grief process according to their age and stage of development. Proper support is essential to promote healthy coping and acceptance in youth experiencing grief. The interprofessional school team can support students experiencing grief to enhance student learning outcomes and overall health and well-being.
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Affiliation(s)
| | - Misty Stone
- Fayetteville State University, Fayetteville, NC
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Di Risio M, Thompson A. Current practices in managing end-of-life existential suffering. Curr Opin Support Palliat Care 2023; 17:119-124. [PMID: 37039587 DOI: 10.1097/spc.0000000000000646] [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: 04/12/2023]
Abstract
PURPOSE OF REVIEW Within the context of palliative care, existential suffering (ES) can be an exclusive source of suffering or intertwined with physical pain and/or psychological and spiritual suffering. With newly emerging modalities for addressing this phenomenon and its increasing salience given that many patients cite ES as a significant contributing factor to requests for hastened death, a review of recent interventions for addressing ES at the end of life is timely. RECENT FINDINGS This review of newer approaches to dealing with ES in the palliative context suggests some promising new modalities and pharmacological interventions, such as brain stimulation and the use of psychedelics. The use of other pharmacological interventions, such as palliative sedation and lethal injections, solely for the alleviation of existential distress remains ethically controversial and difficult to disentangle from other forms of suffering, not least because a clear clinical definition of ES has yet to emerge in the literature. SUMMARY The evaluation of end-of-life (EOL) ES mitigating tools should also consider how broader contexts, such as institutional arrangements and barriers, and cultural factors may influence the optimal management of dying persons' ES in the palliative care setting.
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Affiliation(s)
- Michelle Di Risio
- Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Rom-Arjona B, Atanacio E, Crisologo D, Narvaez RA. Impact of Environment and Milieu Therapy in Palliative Care. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231180235. [PMID: 37258425 DOI: 10.1177/00302228231180235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The collaborative approach offered by palliative care benefits both patients and their caregivers. They provide a system of support that enables patients to lead as active a life as possible. This integrative review aimed to find out whether milieu and environment therapy has a significant impact on palliative care patients. Analyses and summaries of seventeen (17) papers were completed. There were three themes identified: environmental factors for quality of life, milieu therapy in forms of arts and music, and milieu therapy is safe, structured, and psychotherapeutic. This review demonstrates that milieu and environment therapy may also help to reduce physical symptoms, such as pain, and enhance quality of life. The study suggests that even if there are many interventions for palliative patients, more research is needed to generate a more thorough evaluation of the efficacy of various environmental control components and milieu therapies for palliative care patients.
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Lippe MP, Eyer JC, Roberts KE, Ritter ER, DiMauro PK, McKinney RE, Williamson CL, Rosa WE. Affirmative Palliative Care for Transgender and Gender Nonconforming Individuals. Am J Nurs 2023; 123:48-53. [PMID: 36951345 PMCID: PMC10262213 DOI: 10.1097/01.naj.0000925508.62666.99] [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] [Indexed: 03/24/2023]
Abstract
ABSTRACT Nurses have a professional and ethical responsibility to provide inclusive, affirmative palliative care to transgender and gender nonconforming (TGNC) individuals experiencing life-limiting illness or injury. In accordance with standards for professional nursing and health organizations, nurses must continue to take tangible steps to achieve a level of care that is affirming, holistic, nonprejudicial, and collaborative. Providing quality care for TGNC individuals requires informed, competent integration of palliative nursing care, gender-affirmative care, and trans-person-centered health care within nursing practice. An interdisciplinary national team of experts collaborated to identify ways nurses could better uphold their professional responsibilities to TGNC individuals with serious illness. The purposes of this article are to: 1) describe elements of TGNC-inclusive palliative nursing care; and 2) present eight concrete recommendations to achieve affirmative clinical practice for TGNC patients living with life-limiting illness and their family of origin and/or family of choice. These recommendations address professional development, communication, medication reconciliation, mental health, dignity and meaning, social support and caregivers, spiritual beliefs and religion, and bereavement care.
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Affiliation(s)
- Megan Pfitzinger Lippe
- Megan Pfitzinger Lippe is an associate professor at the University of Texas Health Science Center at San Antonio. Joshua C. Eyer is director of the Southern Regional Drug Data Research Center in the Institute of Data and Analytics, Culverhouse College of Business, University of Alabama in Tuscaloosa. Kailey E. Roberts is an assistant professor in the Clinical Psychology PsyD Program at Yeshiva University in the Bronx, NY, where Emma R. Ritter is a doctoral student. Pierce K. DiMauro is a DNP candidate at the Columbia University School of Nursing in New York City. Robert E. McKinney Jr. is an associate professor of behavioral medicine in the College of Community Health Sciences at the University of Alabama in Tuscaloosa. Cassandra L. Williamson is executive director of the Transgender American Veterans Association and a former research assistant at the University of Alabama in Tuscaloosa. William E. Rosa is a postdoctoral research fellow at the Memorial Sloan Kettering Cancer Center in New York City. Contact author: Megan Pfitzinger Lippe, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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The Critical Need for a Meaning-Centered Team-Level Intervention to Address Healthcare Provider Distress Now. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137801. [PMID: 35805459 PMCID: PMC9265276 DOI: 10.3390/ijerph19137801] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 12/29/2022]
Abstract
COVID-19 has unveiled and amplified the burnout, grief, and other forms of distress among healthcare providers (HCPs) that long preceded the pandemic. The suffering of the healthcare workforce cannot be simply and sufficiently addressed with a single psychotherapeutic intervention. Nevertheless, the National Academies of Sciences, Engineering, and Medicine Studies recommended prioritizing interventions that generate an increased sense of meaning in life and in work to reduce burnout and cultivate clinician wellbeing. Despite their guidance, there is a dearth of interventions for HCPs specifically targeting meaning and purpose as an avenue to reduce HCP distress. In a time when such an intervention has never been more essential, Meaning-Centered Pyschotherapy (MCP), a brief, evidence-based intervention designed for patients with advanced cancer may be key. This piece describes the principles underlying MCP and how it might be adapted and applied to ameliorate burnout among HCPs while providing a rationale to support future empirical studies in this area. Importantly, the systemic factors that contribute to the emotional and mental health burdens of HCPs are discussed, emphasizing the need for systems-level changes that are needed to leverage the potential outcomes of MCP for HCPs.
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Harris DA. Interpreting end-of-life experiences of the person with motor neurone disease. Palliat Support Care 2022; 20:300-301. [PMID: 34167614 DOI: 10.1017/s1478951521000699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Denise Andrea Harris
- Faculty of Health, Psychology & Social Care/Nursing, Manchester Metropolitan University, Manchester, UK
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Abstract
Purpose of Review To present new findings in order to aid in the provision of high-quality symptom management and psychosocial care for adolescents and young adults with advanced cancer at the end of life. Recent Findings Behavioral health providers support patients by teaching them symptom control skills, building legacies, and making meaning of their lives. Integration of cultural values is essential for comprehensive assessment and decision-making. Effective management of physiological symptoms and psychological distress begins with accurate communication about prognosis and goals of care that focus on patient preferences and priorities. Oncology teams promote quality of life and the successful management of fatigue, pain, decreased mobility, poor appetite, and dyspnea with the early inclusion of palliative care. Summary While provision of end-of-life care in a young person with cancer presents challenges, multidisciplinary teams can effectively accompany patients in this journey by prioritizing patient and family preferences to promote quality of life.
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17
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Julião M, Chochinov HM, Samorinha C, da Silva Soares D, Antunes B. Prevalence and Factors Associated With Will-to-Live in Patients With Advanced Disease: Results From a Portuguese Retrospective Study. J Pain Symptom Manage 2021; 62:820-827. [PMID: 33631327 DOI: 10.1016/j.jpainsymman.2021.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 01/30/2023]
Abstract
CONTEXT Will-to-live (WtL) is a complex and multifactorial dimension of end-of-life experience. Health care decisions on assisted suicide and euthanasia are rarely based on WtL evidence-based discussions. OBJECTIVES To inform the debate, we aimed to evaluate the prevalence of WtL and its associations within a tertiary home-based palliative care unit. METHODS Retrospective analysis of all WtL entries registered in our anonymized clinical registry, from October 2018 to September 2020. RESULTS One-hundred and twelve patients were included: 53% were male, average age was 66 years old; 88% had malignancies, with a mean performance status of 55%. Mean for WtL of was 3.26 (SD = 3.87) with a prevalence of 60.7% strong, 8.9% moderate and 30.4% weak WtL. Weaker WtL was observed among patients who were not well adapted to their disease (P = .001), felt a burden to others (P< .001), were depressed (P = .001), anxious (P< .001) and endorsed a desire for death (P< .001). Weaker WtL was associated with pain (P = .002) and lower well-being (P = .001). Results from the logistic regression model found that the adaptation to disease emerged as a significant predictor of WtL (P = .025), and burden to others remained marginally significant (P = .087). CONCLUSION The factors associated with lower WtL scores are consistent with previous studies, indicating that these patients experience a myriad of physical, psychological and existential symptoms requiring an interdisciplinary palliative care approach. These factors pertaining to WtL should be made known, as Portugal considers how to navigate death-hastening legislation.
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Affiliation(s)
- Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Sintra, Portugal.
| | - Harvey Max Chochinov
- Department of Psychiatry, Research Institute of Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Manitoba, Canada
| | - Catarina Samorinha
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Duarte da Silva Soares
- Departamento de Cuidados Paliativos da Unidade Local de Saúde do Nordeste, Bragança, Portugal
| | - Bárbara Antunes
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Centro de Estudos e Investigação em Saúde da Universidade de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Department of Midwifery and Palliative Care, Florence Nightingale School of Nursing, King's College London, London, UK
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18
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Reflecting on meaning in an existential-reorientation group psychotherapy approach for cancer patients: A qualitative thematic analysis. Palliat Support Care 2021; 20:313-320. [PMID: 34275498 DOI: 10.1017/s1478951521000936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objectives of this study were to evaluate, in the Italian cultural context, breast cancer patients' main meaning themes related to the experience of the disease, on the one side, and to be part of an existentially oriented group intervention, on the other. METHOD A short reorientation-existential (RET) group intervention, structured by using some tools and background from cognitive analytic therapy (CAT) and based on the meaning-centered psychotherapy (MCP) existential framework, was delivered to 29 breast cancer patients. The sessions were audio-recorded and transcribed verbatim, with the narratives from reflective exercises (meaning of the journey cancer, meaning of the journey of intervention) uploaded to computer software NVivo 11. Analysis of the transcripts emerged from reflective exercises on the personal meaning of cancer and the letters of meaning (goodbye letter) written by the patients to express the meaning of their experience in the group was conducted through the interpretative phenomenological analysis (IPA) framework. RESULTS Four superordinate themes were identified in the exercise meaning of the experience of cancer, namely "sense of stigma and loneliness (the foreigner)," "guilt (unjust guilt and anticipatory guilt)," "reconsidering one's own life and nostalgia," and "rebirth (a new life, life after life)." Three superordinate themes were found in the meaning of the group experience in the letters, namely "togetherness and gratitude," "legacy," and "acceptance." SIGNIFICANCE OF RESULTS The study confirmed that a short group intervention, based on the existentially oriented framework and delivered in a public clinical healthcare setting, was enriched by focusing on the personal meaning of cancer. Some themes, such as loneliness, nostalgia, and rebirth, emerged during reflection giving, in written letters to participants, the sense of the group therapeutic experience.
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19
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Sokol LL, Lum HD, Creutzfeldt CJ, Cella D, Forlizzi J, Cerf M, Hauser JM, Kluger BM. Meaning and Dignity Therapies for Psychoneurology in Neuropalliative Care: A Vision for the Future. J Palliat Med 2021; 23:1155-1156. [PMID: 32877285 DOI: 10.1089/jpm.2020.0129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Leonard L Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hillary D Lum
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eastern Colorado VA Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | | | - David Cella
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jodi Forlizzi
- Human-Computer Interaction Institute, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Moran Cerf
- Kellogg School of Management, Northwestern University, Evanston, Illinois, USA
| | - Joshua M Hauser
- Center for Bioethics and Medical Humanities, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Section of Palliative Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Palliative Care Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Sokol LL, Jordan SR, Applebaum AJ, Hauser JM, Forlizzi J, Cerf M, Lum HD. Social Media Perceptions of Legacy-Making: A Qualitative Analysis. Palliat Med Rep 2020; 1:326-330. [PMID: 34223493 PMCID: PMC8241363 DOI: 10.1089/pmr.2020.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Individuals with life-limiting illnesses experience psychotherapeutic benefits of transmitting their life's history to loved ones; however, the scope and depth of what warrants preservation and who ought to undertake such activity remains less clear. Furthermore, individuals with conditions that afflict the brain face barriers regarding the timing and structure of such interventions. We analyzed data from an online social media forum to understand perceptions of legacy-making. Methods: This is a qualitative descriptive study of Slashdot, a social media website with a focus on science, technology, and politics. In August 2010, a Slashdot user inquired about a loved one with a life-limiting illness and asked for opinions on how to preserve the individual's memories. We conducted a content analysis of the individual comments related to digital legacy-making to identify common themes. Results: Slashdot users contributed 527 replies to the initial inquiry. Users often included bereaved individuals who offered input on the need to preserve information about a loved one, the modalities in which to preserve, and what type of content to preserve. Three key themes emerged related to legacy-making: (1) capture the individual's essence and avoid the minutia, (2) live for now to avoid prolonged suffering, and (3) recognize the equal benefits to all who memorialize. Conclusions: Users in a social media forum articulated the value of capturing their loved ones' essence for posterity, which many believed would help them to avoid prolonged grief. These findings have implications for the development and timing of personalized psychosocial interventions as well as informing application development of evidence-based digital legacy systems.
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Affiliation(s)
- Leonard L Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah R Jordan
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joshua M Hauser
- Center for Bioethics and Medical Humanities, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Section of Palliative Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Palliative Care Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Jodi Forlizzi
- Human-Computer Interaction Institute, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Moran Cerf
- Kellogg School of Management, Northwestern University, Evanston, Illinois, USA
| | - Hillary D Lum
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eastern Colorado VA Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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21
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Ounalli H, Mamo D, Testoni I, Belvederi Murri M, Caruso R, Grassi L. Improving Dignity of Care in Community-Dwelling Elderly Patients with Cognitive Decline and Their Caregivers. The Role of Dignity Therapy. Behav Sci (Basel) 2020; 10:bs10120178. [PMID: 33255402 PMCID: PMC7759823 DOI: 10.3390/bs10120178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
Demographic changes have placed age-related mental health disorders at the forefront of public health challenges over the next three decades worldwide. Within the context of cognitive impairment and neurocognitive disorders among elderly people, the fragmentation of the self is associated with existential suffering, loss of meaning and dignity for the patient, as well as with a significant burden for the caregiver. Psychosocial interventions are part of a person-centered approach to cognitive impairment (including early stage dementia and dementia). Dignity therapy (DT) is a therapeutic intervention that has been shown to be effective in reducing existential distress, mood, and anxiety symptoms and improving dignity in persons with cancer and other terminal conditions in palliative care settings. The aims of this paper were: (i) To briefly summarize key issues and challenges related to care in gerontology considering specifically frail elderly/elderly with cognitive decline and their caregivers; and (ii) to provide a narrative review of the recent knowledge and evidence on DT in the elderly population with cognitive impairment. We searched the electronic data base (CINAHL, SCOPUS, PSycInfo, and PubMed studies) for studies regarding the application of DT in the elderly. Additionally, given the caregiver’s role as a custodian of diachronic unity of the cared-for and the need to help caregivers to cope with their own existential distress and anticipatory grief, we also propose a DT-dyadic approach addressing the needs of the family as a whole.
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Affiliation(s)
- Heifa Ounalli
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
| | - David Mamo
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
- Department of Psychiatry, University of Malta, 2080 Msida, Malta
| | - Ines Testoni
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy;
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation (formerly Department Biomedical and Specialty Surgical Sciences), University of Ferrara, 44121 Ferrara, Italy; (H.O.); (D.M.); (M.B.M.); (R.C.)
- Correspondence: ; Tel.: +39-0532-455813; Fax: +39-0532-212240
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22
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Cheung G, Martinez-Ruiz A, Knell R, O'Callaghan A, Guthrie DM. Factors Associated With Terminally Ill People Who Want to Die. J Pain Symptom Manage 2020; 60:539-548.e1. [PMID: 32305576 DOI: 10.1016/j.jpainsymman.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022]
Abstract
CONTEXT The decision to request and proceed with euthanasia or physician-assisted dying is complex, and predictors of such decisions are heterogeneous with regard to physical health, psychological, and social factors. Local research is therefore needed. OBJECTIVES To examine the interplay of demographic, clinical, and psychosocial factors routinely collected by a standardized clinical instrument, the interRAI Resident Assessment Instrument for Palliative Care (interRAI-PC), in people with a prognosis of less than 12 months who wanted to die. METHODS All New Zealanders who had an interRAI-PC in 2018 were included. The outcome variable was the single item Wants to die now. Independent variables included biopsychosocial factors and health index scales generated by interRAI-PC. A binary logistic regression was used to determine the predictive factors of Wants to die now (yes vs. no). RESULTS There were 771 individuals included (mean age 76.0 years; SD 11.6; female 50.1%); 9.3% of whom reported yes to Wants to die now, 59.8% no, and for 30.9%, the assessor was unable to determine. The factors with the largest odds ratios (ORs) were awareness of terminal prognosis (OR 4.8; 95% CI 2.2-10.3), high level of depression (OR 4.6; 95% CI 1.7-12.6), not finding meaning in day-to-day life (OR 3.8; 95% CI 1.8-8.1), and pain (less than severe: OR 3.7; 95% CI 1.3-10.4 and severe to excruciating: OR 3.5; 95% CI 1.1-10.7). CONCLUSION Addressing the significant factors we identified should form part of a multidisciplinary assessment when terminally ill patients express a wish to die, to ensure their physical, psychological, and existential needs are adequately met.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.
| | - Adrian Martinez-Ruiz
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand; National Institute of Geriatrics, Mexico City, Mexico
| | - Rebecca Knell
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Anne O'Callaghan
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada; Department of Health Science, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Beyond striae cutis: A case report on how physical skin complaints unveiled end-of-life total experience. Palliat Support Care 2020; 19:119-121. [PMID: 32856581 DOI: 10.1017/s1478951520000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND End-of-life is a unique and multidimensional experience, and physical complaints can reveal other areas of distress. METHOD A case report of a woman with terminal cancer with painful and deforming skin striae cared by a multidisciplinary team. RESULTS After initially treating her physical pain, other end-of-life psychosocial, spiritual, and existential aspects could be addressed. SIGNIFICANCE OF RESULTS Physical distress can unveil other essential areas of end-of-life experience when multidisciplinary teams caring for the terminally ill patients use holistic approaches.
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24
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Iani L, De Vincenzo F, Maruelli A, Chochinov HM, Ragghianti M, Durante S, Lombardo L. Dignity Therapy Helps Terminally Ill Patients Maintain a Sense of Peace: Early Results of a Randomized Controlled Trial. Front Psychol 2020; 11:1468. [PMID: 32670169 PMCID: PMC7330164 DOI: 10.3389/fpsyg.2020.01468] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction: Dignity Therapy (DT) is a brief, individualized, narrative psychotherapy developed to reduce psychosocial and existential distress, and promote dignity, meaning, and hope in end of life patients. Previous studies have shown that DT was effective in reducing anxiety and depression, and improving dignity-related distress. However, less is known about its efficacy on spiritual well-being. The aim of this study is to contribute to the existing literature by investigating the effects of DT on specific dimensions of spiritual well-being, demoralization and dignity-related distress in a sample of terminally ill patients. Methods: A randomized, controlled trial was conducted with 64 terminally ill patients who were randomly assigned to the intervention group (DT + standard palliative care) or the control group (standard palliative care alone). The primary outcome measures were Meaning, Peace, and Faith whereas the secondary outcome measures were (loss of) Meaning and purpose, Distress and coping ability, Existential distress, Psychological distress, and Physical distress. All measures were assessed at baseline (before the intervention), 7-10 and 15-20 days after the baseline assessment. The trial was registered with ClinicalTrials.gov (Protocol Record NCT04256239). Results: The MANOVA yielded a significant effect for the Group X Time interaction. ANOVA with repeated measures showed a significant effect of time on peace and a significant Group X Time interaction effect on peace. Post hoc comparisons revealed that, while there was a decrease in peace from pre-treatment to follow-up and from post-treatment to follow-up in the control group, there was no such trend in the intervention group. Discussion: This study provides initial evidence that patients in the DT intervention maintained similar levels of peace from pre-test to follow-up, whereas patients in the control group showed a decrease in peace during the same time period. We did not find significant longitudinal changes in measures of meaning, faith, loss of meaning and purpose, distress and coping ability, existential, psychological and physical distress. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of DT, since they offer evidence for the importance of this intervention in maintaining peace of mind for terminally ill patients.
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Affiliation(s)
- Luca Iani
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | - Alice Maruelli
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | | | - Matilde Ragghianti
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | - Sieva Durante
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Luigi Lombardo
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
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25
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“Truly holistic?” Differences in documenting physical and psychosocial needs and hope in Portuguese palliative patients. Palliat Support Care 2020; 19:69-74. [DOI: 10.1017/s1478951520000413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivePalliative care (PC) aims to improve patients' and families' quality of life through an approach that relieves physical, psychosocial, and spiritual suffering, although the latter continues to be under-assessed and under-treated. This study aimed to describe the prevalence of physical, psychosocial, and hope assessments documented by a PC team in the first PC consultation.MethodThe retrospective descriptive analysis of all first PC consultations registered in our anonymized database (December 2018–January 2020), searching for written documentation regarding (1) Edmonton Symptom Assessment Scale (ESAS) physical subscale (pain, tiredness, nausea, drowsiness, appetite, shortness of breath, constipation, insomnia, and well-being), (2) the single question “Are you depressed?” (SQD), (3) the question “Do you feel anxious?” (SQA), (4) feeling a burden, (5) hope-related concerns, (6) the dignity question (DQ), and (7) will to live (WtL).ResultsOf the 174 total of patients anonymously registered in our database, 141 PC home patients were considered for analysis; 63% were male, average age was 70 years, the majority had malignancies (82%), with a mean performance status of 52%. Evidence of written documentation was (1) ESAS pain (96%), tiredness (89%), nausea (89%), drowsiness (79%), appetite (89%), shortness of breath (82%), constipation (74%), insomnia (72%), and well-being (52%); (2) the SQD (39%); (3) the SQA (11%); (4) burden (26%); (5) hope (11%); (6) the DQ (33%); and (7) WtL (33%).Significant differences were found between the frequencies of all documented items of the ESAS physical subscale (29%), and all documented psychosocial items (SQD + SQA + burden + DQ) (1%), hope (11%), and WtL (33%) (p = 0.0000; p = 0.0005; p = 0.0181, respectively).Significance of resultsThere were differences between documentation of psychosocial, hope, and physical assessments after the first PC consultation, with the latter being much more frequent. Further research using multicenter data is now required to help identify barriers in assessing and documenting non-physical domains of end-of-life experience.
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26
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Kremeike K, Frerich G, Romotzky V, Boström K, Dojan T, Galushko M, Shah-Hosseini K, Jünger S, Rodin G, Pfaff H, Perrar KM, Voltz R. The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach. BMC Palliat Care 2020; 19:49. [PMID: 32299415 PMCID: PMC7164236 DOI: 10.1186/s12904-020-00548-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress. METHODS Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria. RESULTS 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was "proactively addressing desire to die". CONCLUSIONS We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically - based on evidence, patients' views and consensus among professional experts. TRIAL REGISTRATION The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).
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Affiliation(s)
- Kerstin Kremeike
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Gerrit Frerich
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Vanessa Romotzky
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kathleen Boström
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maren Galushko
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Medical Faculty, Cologne, Germany
| | - Klaus Maria Perrar
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS), University of Cologne, Cologne, Germany
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27
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Fraguell-Hernando C, Limonero JT, Gil F. Psychological intervention in patients with advanced cancer at home through Individual Meaning-Centered Psychotherapy-Palliative Care: a pilot study. Support Care Cancer 2020; 28:4803-4811. [PMID: 31974770 DOI: 10.1007/s00520-020-05322-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare Individual Meaning-Centered Psychotherapy-Palliative Care (IMCP-PC) to counselling-based psychotherapy in patients receiving home palliative care (PC). METHODS Fifty-one patients with advanced-stage cancer receiving home PC were recruited for this. Two-arm (individual meaning-centered psychotherapy-palliative-IMCP-PC-care vs. counselling) randomized feasibility trial. Anxiety, depression, demoralization, and emotional distress were evaluated before and after three psychotherapy sessions. Patient perceptions of the treatment were assessed after completion of therapy. RESULTS Thirty-two patients (16 in each group) completed all three sessions as well as the pre- and post-therapy questionnaires and were therefore included in the final analysis. All patients in the IMCP-PC group showed a significant decrease in levels of demoralization (despair), anxiety, depression, and emotional distress. By contrast, the only variable that significantly improved in the counselling group was demoralization. The post-treatment questionnaire revealed no significant between-group differences regarding patient perception of the structure, focus, or length of treatment. However, the IMCP-PC group rated the treatment more highly with regard to its value in helping them to find meaning in life. CONCLUSIONS IMCP-PC is a specific psychotherapy tailored to the needs of patients with advanced cancer. The results of the present study indicate that this treatment is suitable for patients at end of life that are not able to attend outpatient sessions. Although more research is needed, the findings of this feasibility trial suggest that the IMCP-PC merits consideration for patients receiving home palliative care (PC).
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Affiliation(s)
- Clara Fraguell-Hernando
- EAPS Mutuam Barcelona, Barcelona, Spain.,Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Joaquín T Limonero
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| | - Francisco Gil
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.,Psycho-Oncology Unit, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), Spain
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Reischer HN, Beverley J. Diverse Approaches to Meaning-Making at the End of Life. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:68-70. [PMID: 31746713 DOI: 10.1080/15265161.2019.1674419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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