Effectiveness of Psychosocial Interventions in Complex Palliative Care Patients: A Quasi-Experimental, Prospective, Multicenter Study

Family caregiver emotional distress in advanced cancer: the DME-C scale psychometric properties

BACKGROUND

Family caregivers of patients with advanced illness at end of life often report high levels of emotional distress. To address this emotional distress is necessary to have adequate and reliable screening tools.

AIM

This study analyses the psychometric properties and clinical utility of the Family Caregiver Emotional Detection Scale for caregivers of patients with end-stage cancer (DME-C, Spanish acronym) who are receiving palliative care (PC).

DESIGN

Multicentre, cross-sectional study.

SETTINGS/PARTICIPANTS

Family caregivers of patients with advanced cancer at end of life receiving palliative treatment were interviewed to explore their emotional distress through the DME-C scale and other instruments measuring anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), distress thermometer (DT) and overload (B), as well as a clinical psychological assessment (CPA).

RESULTS

138 family caregivers, 85 (61.6%) female and 53 (38.4%) male, with an average age of 59.69±13.3 participated in the study. The reliability of the scale, as measured by Cronbach's alpha, was 0.76, and its stability over time was 0.734. Positive, significant correlations were found between the DME-C and the scores for anxiety and depression registered on the HADS scale, as well as with the total result of this latter scale and the results for B, the DT and the CPA. A statistical analysis of the receiver-operating characteristic curves showed that the scale has a sensitivity and specificity of 75%, and that the cut-off point for the detection of emotional distress was a score ≥11. Fifty-four per cent of the caregivers displayed emotional distress according to this scale.

CONCLUSIONS

The DME-C displays good psychometric properties. It is simple, short, reliable and easy to administer. We believe that the instrument is useful for the detection of emotional distress in the family caregivers of hospitalised patients suffering from end-stage illnesses and receiving PC.

Patients' expectations of and experiences with psychosocial care needs in perioperative nursing: a descriptive study

BACKGROUND

Meeting inpatients' psychosocial care needs is essential for their wellbeing, recovery, and positive experiences. This study aimed to describe and compare surgical inpatients' subjective perceptions of the importance of fundamental psychosocial and overall care received.

METHODS

A descriptive study with a convenient sample was conducted from September 2019 to April 2020. A total of 194 surgical inpatients from Norway and Denmark answered a perioperative user participation questionnaire on the day of discharge. The questionnaire was previously face- and content validated. The questionnaire assessed patients' sociodemographic characteristics and four dimensions of fundamental care domains: Psychosocial, Relational, Physical, and System level. This study reports the results from the psychosocial domain. Descriptive statistics including frequencies, percentages, means, and standard deviations were used to analyze background information variables. The congruency between participants' expectations of and experiences with psychosocial care is presented.

RESULTS

The inpatients expected (and experienced) the healthcare personnel to treat them with respect and dignity, and to be involved and informed throughout their perioperative care. The average ratings regarding these aspects of psychosocial care needs were 72.1-93.8%. There was congruency between patients' perceptions of the subjective importance (SI) of psychosocial fundamental care and their perceived reality (PR) of care. Congruency between high SI and high PR ranged from 59.1 to 92.2%, and congruency between low SI and low PR ranged from 0 to 6.6%. Incongruency between SI and PR varied between 5.9 and 39.6% and was mainly related to higher PR than SI. We found no association between education level, sex, length of stay, age, and patient expectations of or experiences with psychosocial care needs.

CONCLUSIONS

Surgical inpatients in Norway and Denmark experience respectful and dignified treatment, and they feel involved and informed in their perioperative care. It is important to include patient perspectives in further research to avoid missed care and disconnection between what patients prefer and what healthcare personnel plan to do. Understanding patient preferences might also lead to less stress and workload for healthcare personnel.

What are the digitally enabled psychosocial interventions delivered by trained practitioners being offered to adults with life-shortening illnesses and palliative care needs and their informal and professional caregivers? A scoping review

OBJECTIVES

Computer-mediated and telephone communication connecting professionals and patients (eHealth) is well established. Yet there is little information about psychosocial interventions delivered by trained practitioners for a palliative care population. The aim is to describe digitally enabled psychosocial interventions offered to adults with life-shortening or terminal illnesses and carers/families receiving palliative care, and how these are delivered and evaluated.

METHODS

Using Joanna Briggs Institute scoping review methodology, 4 databases (MEDLINE, CINAHL, PsycINFO, and Academic Search Ultimate) were searched (January 2011-April 2021). Inclusion criteria: (a) any design reporting and (b) psychosocial interventions delivered digitally by palliative care health and social care practitioners to (c) adults with life-shortening illnesses.

RESULTS

Included papers (n=16) were from Europe ((n=8), Asia (n=2), and the USA (n=6). Research designs encompassed pre- and post-studies, randomized control trials, feasibility, and pilot studies. Tools evaluated psychological, somatic, functional, and psychosocial outcomes. Underpinning approaches included cognitive behavioral therapy, Erikson's life review, coping skills training, psychoeducation, problem-solving therapy, counseling, emotional support and advice, and art therapy. Delivery tools used were telephones, text messages and emails, websites, videos, workbooks, and compact discs. Practitioners included counselors, psychotherapists, psychologists, art therapists, social workers, registered nurses, and trainees. Patients had Alzheimer's disease and related dementias, advanced cancers, chronic obstructive pulmonary disease, and heart failure.

SIGNIFICANCE OF RESULTS

COVID-19 has accelerated the usages of digitally enabled psychosocial interventions. Evidence indicates a growing interest in hybrid, novel, synchronous, and asynchronous digital psychosocial interventions for adults with life-shortening illnesses and their caregivers receiving palliative care.

Holistic nursing clinical practice experiences of nursing students in medical-surgical clinics: A qualitative study

PURPOSE

This study was conducted to examine the experiences of nursing students in holistic nursing clinical practice.

DESIGN

Twenty senior nursing students participated in this study. Data were collected through focus group interviews with a qualitative approach followed by thematic data analysis.

FINDINGS

Four themes were obtained holistic care, barriers to holistic care, the contributions of holistic nursing internship, and students' expectations.

PRACTICE IMPLICATIONS

The participants stated that they believe that physical care is sufficient enough in the care they provide to patients and their families in clinical practice and that they only provide physical care. However, they stated that they became aware of the importance of holistic care with this practice and gained better insights into their professional requirements.

Need for additional professional psychosocial and spiritual support in patients with advanced diseases in the course of specialist palliative care - a longitudinal observational study

BACKGROUND

We investigated the need for additional professional support and associated factors in patients (pts) at initiation and in the course of in- and outpatient specialist palliative care (I-SPC/O-SPC).

METHODS

Pts entering an urban SPC network consecutively completed questionnaires on psychosocial/spiritual problems and support needs within 72 h (T0) as well as within the first 6 weeks (T1) of SPC. Hierarchical linear regression analysis was used to investigate the impact of sociodemographic / disease-related variables, psychological / physical burden, social support, and SPC setting on the extent of support needs.

RESULTS

Four hundred twenty-five pts (70 years, 48% female, 91% cancer, 67% O-SPC) answered at T0, and 167 at T1. At T0, main problems related to transportation, usual activities, and dependency (83-89%). At T1, most prevalent problems also related to transportation and usual activities and additionally to light housework (82-86%). At T0, support needs were highest for transportation, light housework, and usual activities (35-41%). Cross-sectional comparisons of SPC settings revealed higher problem scores in O-SPC compared to I-SPC at T0 (p = .039), but not at T1. Support need scores were higher in O-SPC at T0 (p < .001), but lower at T1 (p = .039). Longitudinal analyses showed a decrease of support need scores over time, independent from the SPC setting. At T0, higher distress (p = .047), anxiety/depression (p < .001), physical symptom burden (p < .001) and I-SPC (p < .001) were associated with higher support need scores (at T1: only higher distress, p = .037).

CONCLUSION

Need for additional professional psychosocial/spiritual support was identified in up to 40% of pts. with higher need at the beginning of O-SPC than of I-SPC. During SPC, this need decreased in both settings, but got lower in O-SPC than in I-SPC over time. Support need scores were not only associated with psychological, but also physical burden.

Physician-assisted suicide and physician-assisted euthanasia: evidence from abroad and implications for UK neurologists

In this article, we consider the arguments for and against physician-assisted suicide (AS) and physician-assisted euthanasia (Eu). We assess the evidence around law and practice in three jurisdictions where one or both are legal, with emphasis on data from Oregon. We compare the eligibility criteria in these different regions and review the range of approved disorders. Cancer is the most common cause for which requests are granted, with neurodegenerative diseases, mostly motor neurone disease, ranking second. We review the issues that may drive requests for a physician-assisted death, such as concerns around loss of autonomy and the possible role of depression. We also review the effectiveness and tolerability of some of the life-ending medications used. We highlight significant variation in regulatory oversight across the different models. A large amount of data are missing or unavailable. We explore physician-AS and physician-assisted Eu within the wider context of end-of-life practice.

Psychological intervention in patients with advanced cancer at home through Individual Meaning-Centered Psychotherapy-Palliative Care: a pilot study

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).

Caregiver emotional distress: external open-behaviour signs

OBJECTIVES

To determine whether specific external signs of emotional distress (ESED) can be an indirect measure of emotional distress in caregivers.

METHODS

A cross-sectional multicentre design was used. 148 primary caregivers of advanced cancer patients attended in four Spanish palliative care units participated in this study. The emotional distress of caregivers was measured using both the Emotional Distress of Caregivers Scale and a psychological interview. Health professionals collected data using a standard clinical interview process after a brief training period.

RESULTS

More than half the caregivers (60%) presented with emotional distress. A positive correlation (r=0.566) was found between the intensity of ESED and emotional distress per se. Caregivers who presented emotional distress showed more ESED than those that did not (p<0.01). The study found significant differences for the categories 'visible signs of sadness, fear, crying, feeling overwhelmed' (p<0.001), 'difficulty in separating from the patient: family refuses to let the patient make decisions and insists on care' (p<0.001) and 'visible signs of anger, irritability or frequent disagreement with therapeutic measures' (p<0.001). No significant differences were found with respect to gender. The set of items to measure these external signs presented an adequate reliability assessed using Cronbach's alpha (α=0.773).

CONCLUSIONS

The assessment of ESED in caregivers could serve as a useful method to assess their emotional distress. Incorporating the systematic assessment of these external signs as part of the assessment of the emotional distress of primary caregivers could improve the overall assessment and treatment provided to these caregivers.

Chair ICO/UVIC-UCC of palliative care at the University of Vic - Central University of Catalonia: an innovative multidisciplinary model of education, research and knowledge transfer

OBJECTIVES

Generation and dissemination of knowledge is a relevant challenge of palliative care (PC). The Chair Catalan Institute of Oncology (ICO)/University of Vic (UVIC) of Palliative Care (CPC) was founded in 2012, as a joint project of the ICO and the University of Vic/Central of Catalonia to promote the development of PC with public health and community-oriented vision and academic perspectives. The initiative brought together professionals from a wide range of disciplines (PC, geriatrics, oncology, primary care and policy) and became the first chair of PC in Spain. We describe the experience of the CPC at its fifth year of implementation.

METHODS

Data collection from annual reports, publications, training and research activities.

RESULTS

Results for period 2012-2017 are classified into three main blocks: (1) Programme: (a) The advanced chronic care model (Palliative needs (NECPAL)); (b) the psychosocial and spiritual domains of care (Psychosocial needs (PSICPAL)); (c) advance care planning and shared decision making (Advance care planning (PDAPAL)); and (d) the compassive communities projects (Society involvement (SOCPAL)). (2) Education and training activities: (a) The master of PC, 13 editions and 550 professionals trained; (b) postgraduate course on psychosocial care, 4 editions and 140 professionals trained; and (c) workshops on specific topics, pregraduate training and online activities with a remarkable impact on the Spanish-speaking community. (3) Knowledge-transfer activities and research projects: (a) Development of 20 PhDs projects; and (b) 59 articles and 6 books published.

CONCLUSION

Being the first initiative of chair in PC in Spain, the CPC has provided a framework of multidisciplinary areas that have generated innovative experiences and projects in PC.

Development of a tool to identify and assess psychosocial and spiritual needs in end-of-life patients: The ENP-E scale

Objective

The goal of this study is to describe the development of a new tool, the Psychosocial and Spiritual Needs Evaluation scale Instrumento de Evaluación de Necesidades Psicosociales y Espirituales del Enfermo al Final de Vida (ENP-E), designed to assess the psychosocial needs of end-of-life (EOL) patients. And, secondarily, to describe the face validity and psychometric properties of this instrument in the Spanish-speaking context.

Method

The scale was developed through a seven-stage process: (1) literature review; (2) expert panel establishment; (3) discussion and agreement on the most relevant dimensions of psychosocial care; (4) description of key indicators and consensus-based questions to evaluate such dimensions; (5) assessment of the scale by external palliative care (PC) professionals; (6) evaluation by patients; and (7) analysis of scale's psychometrics properties. To assess content validity, 30 PC professionals and 20 patients evaluated the questionnaire. To determine psychometric properties, 150 participants completed these scales: the ENP-E; the Hospital Anxiety and Depression Scale; item 15 from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative; and the Distress Thermometer.

Result

All respondents evaluated the tool as “excellent.” In terms of construct validity, the internal consistency (Cronbach's alpha = 0.74) and temporal stability (test-retest r = 0.74, p &lt; 0.1) were both adequate. On the factorial analysis, four factors (emotional-wellbeing, social support, spiritual, and information) explained 58.4% of the variance. This scale has a sensitivity of 76.3%, specificity of 78.9%, and the cutoff is 28.

Significance of results

To provide quality PC to EOL patients, it is essential to determine the psychosocial factors that influence well-being. This requires the use of reliable and specific instruments. The ENP-E is a novel tool that provides a systematic, holistic assessment of the psychosocial needs of EOL patients. Its routine use would allow clinicians to monitor such needs over time. This would, in turn, permit comprehensive, highly individualized interventions to improve effective PC approach.