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Quah ELY, Chua KZY, Lin CKR, Vijayan AV, Abdul Hamid NAB, Owyong JLJ, Satku N, Woong N, Lim C, Phua GLG, Ong EK, Fong W, Krishna LKR. The role of patients' stories in medicine: a systematic scoping review. BMC Palliat Care 2023; 22:199. [PMID: 38087237 PMCID: PMC10714554 DOI: 10.1186/s12904-023-01319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patients' stories provide Palliative Care physicians with a glimpse into the former's lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients' stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this 'care influencing' practice in medicine. METHODS This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach's concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion. RESULTS Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns. CONCLUSION Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this 'care influencing' practice.
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Affiliation(s)
- Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Casper Keegan Ronggui Lin
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
- Division of Outpatient Pharmacy, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Andrew Vimal Vijayan
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Nur Amira Binte Abdul Hamid
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Neeta Satku
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
| | - Natalie Woong
- Department of Internal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Road, Singapore, 574627, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC C/O Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
- Health Data Science, University of Liverpool, Whelan Building The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK.
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Nikoloudi M, Tsilika E, Parpa E, Kostopoulou S, Tentolouris A, Psarros C, Alexandra M, Mystakidou K. Herth Hope Index: A Psychometric Evaluation Study within a Sample of Greek Patients with Cancer. Indian J Palliat Care 2021; 27:367-374. [PMID: 34898931 PMCID: PMC8655662 DOI: 10.25259/ijpc_364_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/22/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: This study aims to develop the Greek version of the Herth Hope Index (HHI) and assess its psychometric properties to a palliative care patient sample, using a cross-sectional design. Materials and Methods: The HHI was translated into Greek (HHI-Gr) using the ‘forward-backward’ procedure. It was administered to 130 eligible cancer patients, while for the stability of patients’ responses, 40 of these patients completed the HHI-Gr 3 days later. Along with the HHI-Gr, patients also completed the Hospital Anxiety and Depression Scale (HADS) and the Beck Hopelessness Scale (BHS). The HHI-Gr internal consistency reliability (Cronbach’s a), stability (intraclass correlation coefficient [ICC]), factor structure (factor analysis) and convergent validity (correlation with the HADS and the BHS questionnaires) were examined using the Eastern Cooperative Oncology Group (ECOG) performance status. Results: The HHI-Gr yielded a one-factor model and a Cronbach alpha (0.860) with excellent internal consistency reliability and stability ICC (>0.90). Satisfactory convergent validity was supported by the correlation analysis between the HHI-Gr and BHS (r = 0.718, P < 0.001). Overall test-retest reliability was satisfactory with a range between 0.77 and 0.96 (P < 0.001). Conclusion: These results demonstrate that the HHI-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the measurement of the levels of hope among Greek oncology patients.
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Affiliation(s)
- Maria Nikoloudi
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
| | - Eleni Tsilika
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
| | - Efi Parpa
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
| | - Sotiria Kostopoulou
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine, Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Aigaleo, Greece
| | - Constantin Psarros
- Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Aigaleo, Greece
| | | | - Kyriaki Mystakidou
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
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Development of a Patient-Centered Framework for Oncology Clinicians to Address Uncertainty in Cancer Care During the COVID-19 Pandemic. Curr Treat Options Oncol 2020; 21:99. [PMID: 33119833 PMCID: PMC7594962 DOI: 10.1007/s11864-020-00795-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/26/2023]
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Laskow T, Small L, Wu DS. Narrative Interventions in the Palliative Care Setting: A Scoping Review. J Pain Symptom Manage 2019; 58:696-706. [PMID: 31216430 DOI: 10.1016/j.jpainsymman.2019.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT This scoping review maps the existing literature on narrative interventions within a palliative care and end-of-life context. OBJECTIVES A scoping review was performed to address the following research question: What observational or randomized controlled trials have been performed to evaluate narrative interventions in the palliative care setting? METHODS A search across multiple electronic databases was performed. The search results were screened. Relevant articles were reviewed for the identification of common themes and challenges. RESULTS After reviewing 495 citations from electronic searches, and 44 articles from author archives or from manual review of article reference lists, we identified 34 articles for inclusion. Narrative interventions have focused on reflection or communication, and have been studied among providers, students, patients, and caregivers. Only patient/caregiver studies used randomized controlled design. Most studies were small and at the level of evaluating feasibility. Challenges include a high degree of heterogeneity among interventions and heterogeneity among parameters for evaluating those interventions. CONCLUSION Narrative interventions are actively being evaluated with the intention of improving communication and well-being among all parties within the palliative care and end-of-life experience. The field would benefit from selecting a subset of outcomes that are comparable across studies, and a common framework for describing narrative interventions. Scant literature exists regarding narrative interventions to assist providers in communication.
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Affiliation(s)
- Thomas Laskow
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren Small
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David S Wu
- Palliative Care Program, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Mai SS, Gerlach C, Schmidtmann I, Vogt AR, Zeller V, Renner KH, Weber M. Are Repeated Self-Reports of Psychological Variables Feasible for Patients Near the End of Life at a Palliative Care Unit? J Palliat Med 2018; 21:1005-1010. [PMID: 29437545 DOI: 10.1089/jpm.2017.0537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measurement is crucial to assess the benefit of psychotherapeutic interventions. Is repeated assessment of psychometric self-report data possible, as inpatient palliative care patients suffer from physical and psychological symptoms? What is the self-perceived strain caused by the assessment? Objective The main objective of this study was to investigate the feasibility of a repeated comprehensive psychometric self-assessment of inpatient palliative care patients. Secondary objectives were the PROs of the psychometric assessment. DESIGN We conducted a prospective cohort study. Patients admitted to our palliative care unit (PCU) were reviewed for eligibility within 72 hours. They were asked for weekly self-reports regarding hope (HHI-D), well-being (FACIT-Sp), anxiety and depression (STADI), and quality of life (QoL; EORTC-QLQ-C-30 single item). The strain caused by the assessment was assessed by a numeric rating scale (0-10) and free comments. RESULTS Within 11 months, 219 patients were admitted to the PCU. In total, 92 patients were eligible. The most frequent exclusion criterion was "life expectancy <1 week." A total of 60 patients participated at the first point of measurement. The mean of self-perceived strain (Likert scale 0-10) due to the assessment was 1.44 (SD 1.99) at T1. Twenty-four patients participated twice. Here we found increased scores for physical well-being and QoL. CONCLUSION Repeated assessment of psychological conditions is feasible for 27.4% of inpatients at a German PCU. The most limiting factor is life expectancy of only days at admission to the PCU. However, the self-perceived strain is low.
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Affiliation(s)
- Sandra Stephanie Mai
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
| | - Christina Gerlach
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
| | - Irene Schmidtmann
- 2 Institute for Medical Biostatistics, Epidemiology and Informatics, Department of Biometry and Bioinformatics, University Medical Centre of the Johannes Gutenberg University , Mainz, Germany
| | - Annika Renate Vogt
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
| | - Viola Zeller
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
| | - Karl-Heinz Renner
- 3 Department of Psychology, Bundeswehr University Munich , Neubiberg, Germany
| | - Martin Weber
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
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Wise M, Marchand LR, Roberts LJ, Chih MY. Suffering in Advanced Cancer: A Randomized Control Trial of a Narrative Intervention. J Palliat Med 2017; 21:200-207. [PMID: 29135330 DOI: 10.1089/jpm.2017.0007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advanced cancer can erode patients' wellbeing. Narrative interventions have improved patients' wellbeing, but might not be feasible for widespread implementation. OBJECTIVES (1) Test the effects of miLivingStory, a telephone-based life review and illness narrative intervention with online resources and social networking, on community-dwelling advanced cancer patients' wellbeing. (2) Explore intervention use and satisfaction. PATIENTS AND SETTING Stage III or IV cancer patients having completed initial therapy were randomized to miLivingStory or to an active control group, miOwnResources. Data and Analysis: Primary outcomes measured at baseline, two and four months included subscales for the FACIT-Sp peace and meaning and the POMS-SF depressed, anxious, and angry mood, scored on 0-4-point Likert scales. Linear mixed modeling, controlling for baseline primary outcome scores, tested for group comparisons of repeated outcome measures. Pairwise comparisons tested for within- and between-group differences. Intervention use and satisfaction data were collected automatically and by survey. RESULTS Eighty-six primarily white, female patients with high baseline wellbeing completed the study. There were no between-group differences at baseline or at two months. At four months, miLivingStory had a direct and positive effect for peace (2.86 vs. 2.57, p = 0.029), a trend effect for lower depressed mood (0.55 vs. 0.77, p = 0.097), and appeared to protect against the control group's declining wellbeing between two and four months. miLivingStory use was low and assessed as helpful to quite helpful. CONCLUSIONS Telephone-based narrative interventions hold promise in improving advanced cancer patients' wellbeing. Further testing of delivery and implementation strategies is warranted.
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Affiliation(s)
- Meg Wise
- 1 Sonderegger Research Center, University of Wisconsin-Madison , Madison, Wisconsin
| | - Lucille R Marchand
- 2 Department of Family Medicine, University of Washington-Seattle , Seattle, Washington
| | - Linda J Roberts
- 3 Department of Human Development and Family Studies, University of Wisconsin-Madison , Madison, Wisconsin
| | - Ming-Yuan Chih
- 4 Department of Clinical Sciences, University of Kentucky , Lexington, Kentucky
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Searching for wisdom in oncology care: A scoping review. Palliat Support Care 2016; 15:384-400. [PMID: 27666083 DOI: 10.1017/s1478951516000675] [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: 11/07/2022]
Abstract
OBJECTIVE The concept of "wisdom" is beginning to emerge in the oncology literature, raising questions concerning: (1) how the concept of wisdom is used in oncology literature; (2) the ways in which wisdom has been a focus of inquiry within oncology care; and (3) how wisdom is characterized when the term is used. METHOD A scoping review, using Arksey and O'Malley's five-step framework, was undertaken to address these questions. In consultation with oncology reference librarians, "wisdom"- and "oncology"-related search terms were identified, and four electronic databases were searched: CINAHL, SocINDEX, PubMed, and PsychINFO. After removal of duplicates and application of inclusion and exclusion criteria, 58 records were identified and included for analysis. RESULTS The concept of wisdom was employed with a breadth of meanings, and 58 records were schematized into 7 genres, including: (1) empirical research with wisdom foregrounded as a study focus (n = 2); (2) empirical research articles where "wisdom" appears in the findings (n = 16); (3) a quality-improvement project where wisdom is an embedded concept (n = 1); (4) essays where wisdom is an aspect of the discussion (n = 5); (5) commentary/opinion pieces where wisdom is an aspect of its focus (n = 6); (6) personal stories describing wisdom as something gleaned from lived experience with cancer (n = 2); and (7) everyday/taken-for-granted uses of wisdom (n = 26). SIGNIFICANCE OF RESULTS The notion of wisdom has a taken-for-granted presence in the published oncology literature and holds promise for future research into patient and clinician wisdom in oncology care. Nonetheless, the terminology is varied and unclear. A scholarly focus on wisdom has not been brought to bear in cancer care to the degree it has in other fields, and research is in the early stages. Various characterizations of wisdom are present. If such a resource as "wisdom" exists, dwelling in human experiences and practices, there may be benefit in recognizing wisdom as informing the epistemologies of practice in oncology care.
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Ng CG, Lai KT, Tan SB, Sulaiman AH, Zainal NZ. The Effect of 5 Minutes of Mindful Breathing to the Perception of Distress and Physiological Responses in Palliative Care Cancer Patients: A Randomized Controlled Study. J Palliat Med 2016; 19:917-24. [DOI: 10.1089/jpm.2016.0046] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Kiah Tian Lai
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Seng Beng Tan
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Nor Zuraida Zainal
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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Solano JPC, da Silva AG, Soares IA, Ashmawi HA, Vieira JE. Resilience and hope during advanced disease: a pilot study with metastatic colorectal cancer patients. BMC Palliat Care 2016; 15:70. [PMID: 27484092 PMCID: PMC4971726 DOI: 10.1186/s12904-016-0139-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/25/2016] [Indexed: 11/12/2022] Open
Abstract
Background The balance between hope-hopelessness plays an important role in the way terminally ill patients report quality of life, and personal resilience may be related to hope at the end of life. The objective of this study was to explore associations between personal resilience, hope, and other possible predictors of hope in advanced cancer patients. Methods A cross-sectional pilot study was carried out with metastatic colorectal cancer patients in a tertiary hospital. The patients answered the Connor-Davidson Resilience Scale, Herth Hope Index, Barthel Index, an instrument addressing family and social support, visual-numeric scales for pain and suffering, a two-item screening for depression, socio-demographic and socio-economic information about the family. Results Forty-four patients were interviewed (mean age 56 years; range 29-86). A strong correlation was noted between resilience and hope (0.63; p < 0.05). No correlation was found between hope and independence for activities of daily living, support from family and community, and pain and suffering levels. Of the 44 patients, 20 presented with depressive symptoms. These depressive patients had lower resilience (p = 0.005) and hope (p = 0.003), and higher scores of suffering (p < 0.001). The association between resilience and hope kept stable after adjusting for age, gender, and presence of depression (p < 0.001). Conclusion Given that resilience is a dynamic, changeable path that can improve hope, resilience-fostering interventions should be most valued in palliative care settings and should be commenced as soon as possible with cancer patients. Patients with advanced stages of non-malignant conditions would also probably benefit from such interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0139-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joao Paulo Consentino Solano
- Hospital das Clínicas of Universidade de São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 (INCOR), 2° andar, bloco I, Zipcode: 05403-900, São Paulo, Brazil.
| | | | | | - Hazem Adel Ashmawi
- Hospital das Clínicas of Universidade de São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 (INCOR), 2° andar, bloco I, Zipcode: 05403-900, São Paulo, Brazil
| | - Joaquim Edson Vieira
- Department of Anesthesiology, Universidade de São Paulo Medical School, São Paulo, Brazil
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Assari S, Lankarani MM. Depressive Symptoms Are Associated with More Hopelessness among White than Black Older Adults. Front Public Health 2016; 4:82. [PMID: 27200335 PMCID: PMC4854870 DOI: 10.3389/fpubh.2016.00082] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/15/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hopelessness is a core component of depression. Our information is, however, very limited on ethnic variations in the magnitude of the link between depression and hopelessness. Using a national sample of older adults in United States, we compared Blacks and Whites for the magnitude of the association between depressive symptoms and hopelessness. METHODS With a cross-sectional design, we used baseline data of the Religion, Aging, and Health Survey, 2001. Linear regression models were used for data analysis. Depressive symptoms (CES-D) and hopelessness were conceptualized as independent and dependent variables in different models, respectively. Demographic factors (age and gender), socioeconomic status (education and marital status), and health (self-rated health) were covariates. Ethnicity was the moderator. RESULTS In the pooled sample, higher depressive symptoms were predictive of hopelessness, above and beyond all covariates. We also found significant interactions suggesting that the association between depressive symptoms and hopelessness is weaker among Blacks compared to Whites. In ethnic-specific models, there were significant associations between depressive symptoms and hopelessness among Whites but not Blacks. CONCLUSION Depressive symptoms accompany more hopelessness among Whites than Blacks. This finding may explain why Blacks with depression have a lower tendency to commit suicide. Future research should test whether or not Whites with depression better respond to psychotherapies and cognitive behavioral therapies that focus on hope enhancement. This finding may explain differential correlates of depression based on race and ethnicity.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Center for Research on Ethnicity, Culture and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Wong JSH, Gottwald M. Advance Care Planning Discussions in Chronic Obstructive Pulmonary Disease: A critical review. J Palliat Care 2016; 31:258-64. [PMID: 26856127 DOI: 10.1177/082585971503100408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Best M, Aldridge L, Butow P, Olver I, Webster F. Conceptual analysis of suffering in cancer: a systematic review. Psychooncology 2015; 24:977-86. [PMID: 25754062 DOI: 10.1002/pon.3795] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patient suffering is a neglected area of care, partly because of poor definitions. The aim of this study was to distill what is currently known about suffering in the health literature in order to generate a conceptual basis for further research. METHODS A systematic review focusing on suffering across all cancers was undertaken. The search included peer-reviewed English articles published between 1992 and 2012 in MEDLINE, Embase, PsycINFO and the Cochrane Library databases focusing on conceptualisation of suffering in adult cancer patients. Seminal theoretical articles conceptualising suffering more generally were also eligible. To ensure identification of a sufficiently broad range of conceptualisations of suffering in cancer, the search strategy was drafted iteratively. Study findings were subjected to conceptual analysis using the evolutionary method. RESULTS One hundred twenty-eight studies were identified, which discussed definitions or conceptualisations of suffering. In terms of its attributes, suffering is defined as 'an all-encompassing, dynamic, individual phenomenon characterized by the experience of alienation, helplessness, hopelessness and meaninglessness in the sufferer which is difficult for them to articulate. It is multi-dimensional and usually incorporates an undesirable, negative quality.' Surrogate terms, antecedents and consequences of suffering are described. CONCLUSIONS The systematic review revealed that suffering includes holistic suffering, which is multidimensional, oscillating, individual and difficult for individuals to express. Opportunities should be provided for patients to express their suffering. The potential for suffering to be transcended needs to be recognized and facilitated by healthcare staff.
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Affiliation(s)
- Megan Best
- Psycho-Oncology Co-operative Research Group, University of Sydney, Level 6 North, Lifehouse C39Z, New South Wales, 2006, Australia
| | - Lynley Aldridge
- Psycho-Oncology Co-operative Research Group, University of Sydney, Level 6 North, Lifehouse C39Z, New South Wales, 2006, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, University of Sydney, Level 6 North, Lifehouse C39Z, New South Wales, 2006, Australia
| | - Ian Olver
- Cancer Council Australia, GPO Box 4708, Sydney, New South Wales, 2001, Australia
| | - Fleur Webster
- Cancer Australia, Locked Bag 3, Strawberry Hills, New South Wales, 2012, Australia
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Ruijs CD, van der Wal G, Kerkhof AJ, Onwuteaka-Philipsen BD. Unbearable suffering and requests for euthanasia prospectively studied in end-of-life cancer patients in primary care. BMC Palliat Care 2014; 13:62. [PMID: 25587240 PMCID: PMC4292985 DOI: 10.1186/1472-684x-13-62] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background An international discussion about whether or not to legally permit euthanasia and (or) physician assisted suicide (EAS) is ongoing. Unbearable suffering in patients may result in a request for EAS. In the Netherlands EAS is legally permitted, and unbearable suffering is one of the central compulsory criteria. The majority of EAS is performed in cancer patients in the primary care practice. In around one in every seven end-of-life cancer patients dying in the primary care setting EAS is performed. The prevalence of unbearable symptoms and overall unbearable suffering in relationship to explicit requests for EAS was studied in a cohort of end-of-life cancer patients in primary care. Methods A prospective study in primary care cancer patients estimated to die within six months was performed. Every two months suffering was assessed with the State-of-Suffering V (SOS-V). The SOS-V is a comprehensive instrument for quantitative and qualitative assessment of unbearable suffering related to 69 physical, psychological and social symptoms in five domains. Results Out of 148 patients who were asked to participate 76 (51%) entered the study. The studied population were 64 patients who were followed up until death; 27% explicitly requested EAS, which was performed in 8% of the patients. The final interview per patient was analyzed; in four patients the SOS-V was missing. Unbearable symptoms were present in 94% of patients with an explicit request for EAS and in 87% of patients without an explicit request. No differences were found in the prevalence of unbearable suffering for physical, psychological, social and existential symptoms, nor for overall unbearable suffering, between patients who did or who did not explicitly request EAS. Conclusions In a population of end-of-life cancer patients cared for in primary care no differences in unbearable suffering were found between patients with and without explicit requests for EAS. The study raises the question whether unbearable suffering is the dominant motive to request for EAS. Most patients suffered from unbearable symptoms, indicating that the compulsory criterion of unbearable suffering may be met a priori in most end-of-life cancer patients dying at home, whether they request EAS or not.
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Affiliation(s)
- Cees Dm Ruijs
- Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute, Expertise Center for Palliative Care, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands ; Primary Care Center De Greev, Grevelingenstraat 10, 3522 PR Utrecht, The Netherlands
| | - Gerrit van der Wal
- Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute, Expertise Center for Palliative Care, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Ad Jfm Kerkhof
- Department of Clinical Psychology, VU University, EMGO+ Institute, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute, Expertise Center for Palliative Care, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Hunsaker AE, Terhorst L, Gentry A, Lingler JH. Measuring hope among families impacted by cognitive impairment. DEMENTIA 2014; 15:596-608. [PMID: 24784938 DOI: 10.1177/1471301214531590] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current exploratory investigation aims to establish the reliability and validity of a hope measure, the Herth Hope Index, among families impacted by early cognitive impairment (N = 96). Exploratory factor analysis was used to examine the dimensionality of the measure. Bivariate analyses were used to examine construct validity. The sample had moderately high hope scores. A two-factor structure emerged from the factor analysis, explaining 51.44% of the variance. Both factors exhibited strong internal consistency (Cronbach's alphas ranged from .83 to .86). Satisfaction with social support was positively associated with hope, supporting convergent validity. Neurocognitive status, illness insight, and depression were not associated with hope, indicating discriminant validity. Families impacted by cognitive impairment may maintain hope in the face of a potentially progressive illness, regardless of cognitive status. The Herth Hope Index can be utilized as a reliable and valid measure of hope by practitioners providing support to families impacted by cognitive impairment.
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Affiliation(s)
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh
| | - Amanda Gentry
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh
| | - Jennifer H Lingler
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh
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15
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Gamper EM, Groenvold M, Petersen MA, Young T, Costantini A, Aaronson N, Giesinger JM, Meraner V, Kemmler G, Holzner B. The EORTC emotional functioning computerized adaptive test: phases I-III of a cross-cultural item bank development. Psychooncology 2013; 23:397-403. [PMID: 24217943 PMCID: PMC3974657 DOI: 10.1002/pon.3427] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/27/2013] [Accepted: 09/12/2013] [Indexed: 11/29/2022]
Abstract
Background The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group is currently developing computerized adaptive testing measures for the Quality of Life Questionnaire Core-30 (QLQ-C30) scales. The work presented here describes the development of an EORTC item bank for emotional functioning (EF), which is one of the core domains of the QLQ-C30. Methods According to the EORTC guidelines on module development, the development of the EF item bank comprised four phases, of which the phases I–III are reported in the present paper. Phase I involved defining the theoretical framework for the EF item bank and a literature search. Phase II included pre-defined item selection steps and a multi-stage expert review process. In phase III, feedback from cancer patients from different countries was obtained. Results On the basis of literature search in phase I, a list of 1750 items was generated. These were reviewed and further developed in phase II with a focus on relevance, redundancy, clarity, and difficulty. The development and selection steps led to a preliminary list of 41 items. In phase III, patient interviews (N = 41; Austria, Denmark, Italy, and the UK) were conducted with the preliminary item list, resulting in some minor changes to item wording. The final list comprised 38 items. Discussion The phases I–III of the developmental process have resulted in an EF item list that was well accepted by patients in several countries. The items will be subjected to larger-scale field testing in order to establish their psychometric characteristics and their fit to an item response theory model.
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Affiliation(s)
- Eva-Maria Gamper
- Department for Psychiatry and Psychotherapy, University Clinic for Biological Psychiatry, Anichstraße 35, Innsbruck, Austria
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Philip J, Gold M, Brand C, Douglass J, Miller B, Sundararajan V. Negotiating hope with chronic obstructive pulmonary disease patients: a qualitative study of patients and healthcare professionals. Intern Med J 2013; 42:816-22. [PMID: 22152049 DOI: 10.1111/j.1445-5994.2011.02641.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The information needs of patients with chronic obstructive pulmonary disease (COPD) towards the end of life are poorly understood. AIM This study explored the views of patients with COPD and healthcare professionals, focusing upon information needs and treatment preferences. METHOD In-depth, semi-structured interviews were held with patients with COPD following admission to hospital with respiratory failure, and focus groups held with healthcare professionals from hospital and community settings. RESULTS Ten patients were interviewed, who had a median 4 previous hospital admissions, and had smoked for median 47 years. Five focus groups were held with 31 healthcare professionals (18 nurses, 7 doctors, 6 allied health). The theme underpinning all discussions was of tension between maintaining hope and negotiating the reality of the illness and its consequences. Within this theme, patients tended to be optimistic, viewed acute exacerbations as separate from their underlying chronic illness, and were keen for intensive treatments, including intubation if acutely unwell. They had little understanding of the complexities of decision-making around treatment escalation. Both patients and health workers believed that information around end of life should be offered routinely, but delivered in a manner that recognises and maintains a form of hope. CONCLUSION Patients and healthcare professionals believe information around illness course, future goals and treatment is important to care. An expanded view of hope may assist when providing such information, including when discussing goals of care in the setting of advanced illness.
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Affiliation(s)
- J Philip
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Victoria, Australia.
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Cavers D, Hacking B, Erridge SE, Kendall M, Morris PG, Murray SA. Social, psychological and existential well-being in patients with glioma and their caregivers: a qualitative study. CMAJ 2012; 184:E373-82. [PMID: 22431898 PMCID: PMC3328542 DOI: 10.1503/cmaj.111622] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cerebral glioma has a devastating impact on cognitive, physical, social, psychological and spiritual well-being. We sought to understand the multidimensional experience of patients with this form of cancer as they progressed from receiving a diagnosis to the terminal phase of the disease. METHODS We recruited patients with a suspected brain tumour from a tertiary referral centre in the United Kingdom. We interviewed patients and their caregivers at key stages of the illness: before receiving a formal diagnosis, at the start of initial treatment, after initial treatment was completed and at six months' follow-up; caregivers were also interviewed postbereavement. We interviewed the patients' general practitioners once, after treatment had been completed. We transcribed the interviews and analyzed them thematically using the constant comparative method of a grounded theory approach. RESULTS We conducted in-depth interviews with 26 patients, 23 of their relatives and 19 general practitioners. We saw evidence of physical, social, psychological and existential distress even before a diagnosis was confirmed. Social decline followed a similar trajectory to that of physical decline, whereas psychological and existential distress were typically acute around diagnosis and again after initial treatment. Each patient's individual course varied according to other factors including the availability of support and individual and family resources (e.g., personal resilience and emotional support). INTERPRETATION There are practical ways that clinicians can care for patients with glioma and their caregivers, starting from before a diagnosis is confirmed. Understanding the trajectories of physical, social, psychological and existential well-being for these patients allows health care professionals to predict their patients' likely needs so they can provide appropriate support and sensitive and effective communication.
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Affiliation(s)
- Debbie Cavers
- From the Primary Palliative Care Research Group (Cavers, Kendall, Morris, Murray), Centre for Population Health Sciences, General Practice Section, The University of Edinburgh Medical School; and the Edinburgh Cancer Centre (Hacking, Erridge), Western General Hospital, Edinburgh, UK
| | - Belinda Hacking
- From the Primary Palliative Care Research Group (Cavers, Kendall, Morris, Murray), Centre for Population Health Sciences, General Practice Section, The University of Edinburgh Medical School; and the Edinburgh Cancer Centre (Hacking, Erridge), Western General Hospital, Edinburgh, UK
| | - Sara E. Erridge
- From the Primary Palliative Care Research Group (Cavers, Kendall, Morris, Murray), Centre for Population Health Sciences, General Practice Section, The University of Edinburgh Medical School; and the Edinburgh Cancer Centre (Hacking, Erridge), Western General Hospital, Edinburgh, UK
| | - Marilyn Kendall
- From the Primary Palliative Care Research Group (Cavers, Kendall, Morris, Murray), Centre for Population Health Sciences, General Practice Section, The University of Edinburgh Medical School; and the Edinburgh Cancer Centre (Hacking, Erridge), Western General Hospital, Edinburgh, UK
| | - Paul G. Morris
- From the Primary Palliative Care Research Group (Cavers, Kendall, Morris, Murray), Centre for Population Health Sciences, General Practice Section, The University of Edinburgh Medical School; and the Edinburgh Cancer Centre (Hacking, Erridge), Western General Hospital, Edinburgh, UK
| | - Scott A. Murray
- From the Primary Palliative Care Research Group (Cavers, Kendall, Morris, Murray), Centre for Population Health Sciences, General Practice Section, The University of Edinburgh Medical School; and the Edinburgh Cancer Centre (Hacking, Erridge), Western General Hospital, Edinburgh, UK
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Desai AK, Grossberg GT. Palliative and end-of-life care in psychogeriatric patients. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A rapidly growing number of elderly persons and their families are burdened by one or more terminal illnesses in the later years of their life. How best to support their quality of life is a major challenge for healthcare teams. Palliative and end-of-life (PEOL) care is well positioned to respond to this challenge. While the evidence of PEOL is just beginning, much of the suffering can be relieved by what is already known. PEOL care for the elderly needs to go beyond the focus on the patient and should rest on a broad understanding of the nature of suffering that includes family and professional caregivers in that experience of suffering. The dissemination of PEOL care principles should be a public health priority. This article aims to improve understanding of appropriate PEOL care in the elderly and discuss future perspectives.
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Affiliation(s)
- Abhilash K Desai
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, 1438 S. Grand Blvd, St Louis, MO 63104, USA
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Fegg MJ, Kögler M, Brandstätter M, Jox R, Anneser J, Haarmann-Doetkotte S, Wasner M, Borasio GD. Meaning in life in patients with amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2010; 11:469-74. [DOI: 10.3109/17482961003692604] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sand L, Olsson M, Strang P. Coping strategies in the presence of one's own impending death from cancer. J Pain Symptom Manage 2009; 37:13-22. [PMID: 18676119 DOI: 10.1016/j.jpainsymman.2008.01.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 01/14/2008] [Accepted: 01/25/2008] [Indexed: 11/29/2022]
Abstract
An incurable cancer is a threat to life itself. This study focused on how native-born Swedes, who define themselves as nonreligious, actually reflect and act when they try to create helpful strategies in the presence of their own impending deaths and how the strategies serve their purposes. Twenty patients were interviewed in depth. The patients were enrolled in an advanced hospital-based home care team. The interviews were taped, transcribed and analyzed with a qualitative, hermeneutic interpretative method. The informants' efforts to develop useful strategies to restrain death could be symbolized as a cognitive and emotional pendulum, swinging between the extremes of life and death. During the swings of the pendulum, the informants used every means available: their own resources, other people, animals, nature, a transcendent power, hope, imagination and magical thinking. They strove to find factors that fitted their conceptual system and supported their inner balance and structure, all to keep death at a discreet distance and preserve their links to life. These links were togetherness, involvement, hope and continuance, and they served as a shield against hurtful feelings connected to their impending death. The new knowledge about how strategies in the presence of one's own impending death can develop and be used is perhaps the most novel and clinically relevant contribution of this study.
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Affiliation(s)
- Lisa Sand
- Unit for Palliative Medicine and Advanced Medical Home Care, ASIH Långbro Park, Stockholm, Sweden.
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22
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Sanatani M, Schreier G, Stitt L. Level and direction of hope in cancer patients: an exploratory longitudinal study. Support Care Cancer 2007; 16:493-9. [PMID: 17891421 DOI: 10.1007/s00520-007-0336-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
Abstract
GOALS Hope is an important factor to consider when caring for cancer patients as a key component of coping with adversity. The aim of our study was to address the following questions: Is there a difference in level of hope between those patients being curatively and those palliatively treated, and how does this change over time? What are patients' most important hopes? Better understanding of patients' hopes may promote more effective patient-centered care. MATERIALS AND METHODS Outpatients referred to medical oncology or pain and symptom clinics at the London Regional Cancer Program were surveyed before consultation. The Herth Hope Index (HHI) questionnaire was administered to assess level of hope, and the patients were asked to indicate their highest priority hopes. Qualitative thematic analysis was performed on the responses, and comparison was made between patients treated with curative vs those treated with palliative intent. This survey was repeated 4 months after initial assessment. RESULTS Fifty patients were surveyed (29 curative-intent; 21 palliative). Highest priority initial hopes were categorized as follows: cure, other positive health outcomes, emotional well-being, life achievements/return to normalcy, interpersonal goals, other. There was no association noted between treatment intent and choice of highest-priority hope. Follow-up assessments after 4 months revealed no significant differences in the distribution pattern of hopes. There was a statistically significant increase in the HHI over time in curatively treated patients, but none in the combined analysis. DISCUSSION AND CONCLUSION Our study indicates that patients receiving palliative therapy have a HHI score not significantly different from patients being treated for cure. The hope deemed most important is also similar between groups. Over time, overall hope was maintained or increased even in the presence of a trend towards fewer patients hoping for a cure. These results remind oncologists to explore the experience of hope with all patients to ensure that the subjective needs and goals of the patients are met by the proposed therapies.
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Affiliation(s)
- Michael Sanatani
- London Health Sciences Centre, 790 Commissioners Road East, London, ON, N6A 4L6, Canada.
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Abstract
Research investigating the psychological distress of palliative care patients has contributed to our understanding of the needs and experiences of individuals approaching death. This paper aims to provide a brief review of such measurement of psychological distress in palliative care, focusing on established psychiatric and psychological research tools, and quantitative research methods. This includes clinical screening and diagnostic assessment instruments used to identify key distress-related symptoms and the presence of common clinical syndromes, such as depression, anxiety, delirium, as well as the broader psychological dimensions of suffering, such as existential concerns, spirituality, hope and demoralisation. There are important considerations in undertaking psychological research in palliative care, such as maintaining a balance between the methods and measurements that will address key research questions, and sensitivity to the range of physical and emotional demands facing individuals at the point of receiving palliative care. The clinical application of psychological and psychiatric research tools and methods can aid the detection of psychological distress, aid the thorough assessment of the psychological dimension of the patients' illness and care, aid the identification of individuals who would benefit from specific psychotherapeutic or pharmacologic interventions, and the evaluation of response to treatments.
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Affiliation(s)
- Brian Kelly
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW, Australia.
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Abstract
Caring for elderly patients and their families at the end of life gives physicians the opportunity to have a meaningful impact on the lives of others. By expanding our clinical expertise beyond the arena of cure and the preservation of life, we can discover new ways to encounter our patients as full human beings and to share a profound life passage that many of us might otherwise ignore. The skills that are needed to enter this new arena are well within the grasp of the office-based clinician, and physicians who employ them are rewarded with the fulfillment of knowing they have provided an invaluable service at a time of greatest need.
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Affiliation(s)
- Karen S Ogle
- Department of Family Practice, College of Human Medicine, Michigan State University, B110 Clinical Center, East Lansing, MI 48824, USA.
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