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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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Brasky TM, Newton AM, Stephens JA, Strassels SA, Benzo RM, Hays JL, Stevens E, Wagener TL, Hedeker D, Krok-Schoen JL. Testing the feasibility of mobile ecological momentary assessment for symptom burden and management among metastatic cancer patients. Digit Health 2024; 10:20552076241261843. [PMID: 38854924 PMCID: PMC11162135 DOI: 10.1177/20552076241261843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024] Open
Abstract
Background Individuals who have metastatic cancer experience substantial physical and psychological distress (e.g., pain, depression, anxiety) from their disease and its treatment compared to patients with less advanced disease. As the burden of symptoms varies over time, ecological momentary assessment (EMA) may be used to better understand patients' symptom trajectories, complimenting traditional longitudinal data collection methods. However, few have used EMA in patients with metastatic disease. The current study adds to the existing literature by exploring interrelated, common cancer-related symptoms of pain, anxiety, and depression and use of cannabis-based products, opioid medications, other (nonopioid) pain medications, and medications for anxiety or depression. Methods An eight-day prospective observational feasibility study was conducted among 50 patients with metastatic cancer recruited from seven solid cancer clinics at The Ohio State University Comprehensive Cancer Center. Participants completed a week of interval-contingent mobile EMA, administered daily at 9 a.m., 3 p.m., and 8 p.m., and a comprehensive interviewer-administered questionnaire on Day 8. Participants were queried on their symptom burden and management strategies (i.e., use of medications and cannabis). We considered EMA to be feasible if a priori retention (80%) and adherence goals (75%) were met. Results Seventy-nine percent of eligible patients contacted enrolled in the study (n = 50 of 63). Among those enrolled, 92% were retained through Day 8 and 80% completed >90% of EMAs, exceeding a priori objectives. Participants' average pain, anxiety, and depressive symptoms across the week of EMA ranged from 1.7 to 1.8 (1 to 5 scale). Symptoms varied little by day or time of administration. On Day 8, significant proportions of participants reported past-week use of medications and cannabis for symptom management. Conclusions Participants exceeded a priori adherence and retention objectives, indicating that mobile EMA is feasible among metastatic cancer patients, addressing a gap in the existing literature and informing future research. Restricting eligibility to participants with a minimum cutoff of symptom burden may be warranted to increase observations of symptom variability and provide opportunities for future health interventions. Future research is needed to test the acceptability and quality of data over a longer study period in this patient population.
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Affiliation(s)
- Theodore M. Brasky
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Alison M. Newton
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Julie A. Stephens
- Center for Biostatistics, Department of Bioinformatics,
The Ohio State University College of Medicine, Columbus,
OH, USA
| | - Scott A. Strassels
- Division of Pharmacy, Atrium Health, Charlotte, NC, USA
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Roberto M. Benzo
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John L. Hays
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Erin Stevens
- Division of Palliative Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Theodore L. Wagener
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Donald Hedeker
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
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McConnell MH, Miljanovski M, Rodin G, O'Connor MF. Measuring double awareness in patients with advanced cancer: A preliminary scale development study. Palliat Support Care 2023:1-6. [PMID: 38124362 DOI: 10.1017/s1478951523001669] [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: 12/23/2023]
Abstract
BACKGROUND Individuals with advanced cancer face the challenge of living meaningfully while also preparing for end of life. The ability to sustain this duality, called "double awareness," may reflect optimal psychological adaptation, but no psychometric scale exists to measure this construct. OBJECTIVES The purpose of this study was to develop a novel scale to measure double awareness in patients living with advanced cancer. METHODS Guided by best practices for scale development, this study addresses the first three of nine steps in instrument development, including domain clarification and item generation, establishment of content validity of the items, and pre-testing of the items with patients. RESULTS Instrument development resulted in a 41-item measure with two dimensions titled "life engagement" and "death contemplation." Items retained in the measure displayed face validity and were found to be both acceptable by patients and relevant to their lived experience. SIGNIFICANCE OF RESULTS The results of this scale development study will allow for full validation of the measure and future use in clinical and research settings. This novel measure of double awareness will have clinical utility and relevance in a variety of settings where patients with advanced cancer are treated.
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Affiliation(s)
| | - Melissa Miljanovski
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, The University of Toronto, Toronto, ON, Canada
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Paterson C, Armitage L, Turner M. Current Landscape of Ecological Momentary Assessment (Real-Time Data) Methodology in Cancer Research: A Systematic Review. Semin Oncol Nurs 2023; 39:151514. [PMID: 37865555 DOI: 10.1016/j.soncn.2023.151514] [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] [Received: 08/02/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To critically synthesize and describe the use and methods of ecological momentary assessment (EMA) in cancer research. DATA SOURCES A systematic review was conducted and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guideline. Electronic databases (APA PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, and Web of Science Core Collection) were searched using a variety of keywords and subject headings by an expert systematic review librarian. All publications were double screened by two reviewers using predetermined exclusion and inclusion criteria throughout the full review process. The review used Covidence Systematic Review Software. Methodological quality assessment and data extraction were performed. A narrative synthesis was conducted to examine the aim for EMA, the characteristics of the study samples, the EMA sampling procedures, EMA completion rates, outcome measures, and any implications of findings for survivorship care. CONCLUSION A total of 42 EMA studies in cancer were included. Most studies used an electronic mobile device to capture EMA data apart from several that used paper diaries. Existing studies were found to have significant heterogeneity in methods and widely varying approaches to design and self-report measurements. While EMA in cancer research holds significant promise to advance cancer care research into the future by increasing ecological validity and reducing retrospective bias and can capture the unique idiographic within-person change over time, in real-time, further research is needed to develop standardized EMA self-report questionnaires. IMPLICATIONS FOR NURSING PRACTICE This is the first comprehensive systematic review to describe the use and methods of EMA in cancer research. There is significant heterogeneity in methods and widely varying approaches to design and self-report measurements in EMA cancer research. People affected by cancer found taking part in EMA studies reported benefit from the experience. However, researchers must engage with cancer survivors in the development and co-design of future EMA questionnaires to ensure relevant and acceptability of EMA data collection protocols.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Australia; Central Adelaide Local Health Network, Adelaide; Robert Gordon University, Aberdeen, Scotland, UK; Faculty of Health, University of Canberra, Bruce, ACT, Australia.
| | - L Armitage
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
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5
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Pralong A, Herling M, Holtick U, Scheid C, Hellmich M, Hallek M, Pauli B, Reimer A, Schepers C, Simon ST. Developing a supportive and palliative care intervention for patients with allogeneic stem cell transplantation: protocol of a multicentre mixed-methods study (allo-PaS). BMJ Open 2023; 13:e066948. [PMID: 37652589 PMCID: PMC10476131 DOI: 10.1136/bmjopen-2022-066948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Although allogeneic stem cell transplantation (allo-SCT) is a curative treatment for many haematological malignancies, it is often associated with a high morbidity and mortality. Yet, little is known about the needs for supportive and palliative care among allo-SCT recipients. Moreover, targeted interventions that reduce symptom burden and suffering are still lacking. The present study aims to inform a supportive-palliative care intervention for patients with allo-SCT and their informal carers by exploring their experience and assessing their needs, especially their existential concerns, regarding four research topics: symptom burden and quality of life; coexistence of a chance for cure and a relevant risk of dying; change in goals of care; dying phase. METHODS AND ANALYSIS This is a descriptive mixed-methods study in progress with a convergent parallel design. Data on the four research topics will be collected and analysed separately in three steps: (1) qualitative semi-structured interviews among 20 patients, 20 informal carers and 12 healthcare providers (HCPs) and focus groups among 12-24 HCPs; (2) a quantitative cross-sectional survey with validated questionnaires and self-developed questions among 100 patients, 100 informal carers and 50 HCPs; (3) a retrospective case analysis of all deceased patients who underwent an allo-SCT between 2010 and 2019, with collection of quantitative and qualitative data. The qualitative and quantitative data sets will be finally merged for comparison and interpretation. Results will serve to develop a supportive-palliative care intervention. ETHICS AND DISSEMINATION The Ethics Commission of the Faculty of Medicine of the University of Cologne approved this study (20-1370_2). The study results will be published in peer-review journals, be presented at congresses and will be translated into clinical practice through the development of the palliative-supportive care intervention. TRIAL REGISTRATION NUMBER DRKS00027290 (German Clinical Trials Register).
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Affiliation(s)
- Anne Pralong
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Centre for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Marco Herling
- Centre for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Department of Hematology, Cellular Therapy, and Hemostaseology, Faculty of Medicine, University of Leipzig, Leipzig, Sachsen, Germany
- Department of Internal Medicine I, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Udo Holtick
- Centre for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Department of Internal Medicine I, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Christoph Scheid
- Centre for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Department of Internal Medicine I, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Michael Hallek
- Centre for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Department of Internal Medicine I, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Berenike Pauli
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Centre for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Alinda Reimer
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Centre for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Carolin Schepers
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Centre for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Centre for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Centre for Health Services Research, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
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Morgan DD, Taylor RR, Ivy M, George S, Farrow C, Lee V. Contemporary occupational priorities at the end of life mapped against Model of Human Occupation constructs: A scoping review. Aust Occup Ther J 2022; 69:341-373. [PMID: 35199343 DOI: 10.1111/1440-1630.12792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/21/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION People with end-of-life care needs are seen in an increasingly diverse range of health and community settings. Opportunity for continued occupational participation is highly valued by people at the end of life. This scoping review sought to identify the priorities and preferences for participation at the end of life and to map findings using the model of human occupation. METHODS A search strategy informed by the research question was developed in collaboration with a research librarian. Data sources used were Ovid Medline(R), CINAHL, Ovid Emcare, Scopus, Web of Science and PsychInfo. Studies that focused on clinician perspectives, clinical care, grief and loss, did not clearly identify end-stage diseases, <18 years and written in languages other than English were excluded. FINDINGS Forty-four studies were included with a total of 1,070 study participants. Inductively developed themes were mapped against the model of human occupation constructs of volition (personal causation, values, interests), habituation (habits of occupational performance and routine), performance capacity and the lived body within the physical, social and occupational environment. The majority of findings sat within the construct of volition, particularly around sense of personal capacity, self-efficacy and values. At the end of life, people prioritise ongoing engagement in valued occupations even if participation is effortful. As disease progresses, opportunity to exert influence and control over this participation and engagement increases in importance. Personal causation plays an important role in the experience of occupational participation at this time. CONCLUSION This review provides important insights into the occupational priorities of people at the end of life and the importance of supporting agency and volition at this time. The model of human occupation and its client-centred focus offer a framework for a more robust examination of ways to enhance volitional capacity and enable occupational participation for people at the end of life.
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Affiliation(s)
- Deidre D Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Renée R Taylor
- Director, Model of Human Occupation Clearinghouse, Department of Occupational Therapy, University of Illinois, Chicago, Illinois, USA
| | - Mack Ivy
- Rehabilitation Services, MD Anderson Cancer Center, Manvel, Texas, USA
| | - Stacey George
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Caroline Farrow
- SA Health, Northern Adelaide Palliative Care Service, Adelaide, South Australia, Australia
| | - Vincci Lee
- Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
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Morgan DD, Marston C, Barnard E, Farrow C. Conserving dignity and facilitating adaptation to dependency with intimate hygiene for people with advanced disease: A qualitative study. Palliat Med 2021; 35:1366-1377. [PMID: 34044651 DOI: 10.1177/02692163211017388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND People at the end of life experience increased dependence with self-care as disease progresses, including care with intimate hygiene. Dependence with intimate hygiene has been identified as a factor that may compromise dignity at the end of life. However, adaption to increased dependency and subsequent impact on dignity with intimate hygiene is an under-researched area. AIM This study sought to understand how people at the end of life experience dignity with intimate hygiene when function declines and how people adapt to increased dependence with intimate hygiene needs. DESIGN A qualitative design was employed using a hermeneutic phenomenological perspective which privileges participant perspectives. Findings were mapped against occupational therapy and dignity literature. SETTING/PARTICIPANTS Participants were people with advanced disease receiving inpatient or community palliative care. RESULTS Eighteen interviews were conducted with people about their experiences and perspectives of dignity with intimate hygiene. The following themes were constructed from the data: (1) There's a way of doing and a way of asking, (2) Putting each other at ease, (3) It's just how it is, (4) Regaining and retaining control. How people adjust to dependence with intimate hygiene is individually mediated. Patterns of occupational adaptation to increased dependence with intimate hygiene and practical implications for care are discussed. CONCLUSION Adaptation to increased dependence with intimate hygiene is facilitated by enabling moments of micro-competence and agency over how care is received. Carers play a pivotal role in compromising or conserving the dignity with intimate hygiene at the end of life.
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Affiliation(s)
- Deidre D Morgan
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Research Centre for Palliative Care, Death and Dying (RePaDD), Adelaide, SA, Australia
| | - Celia Marston
- Clinical Lead, Occupational Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Research Lead, Occupational Therapy, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Elizabeth Barnard
- Department for Health and Wellbeing: SA Health, Northern Adelaide Local Health Network (NALHN), Adelaide, SA, Australia
| | - Caroline Farrow
- Department for Health and Wellbeing: SA Health, Northern Adelaide Palliative Service (NAPS), Northern Adelaide Local Health Network (NALHN), Adelaide, SA, Australia
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"When Will I Feel Normal?": Disorienting Grief Responses Among Young Adults With Advanced Cancer. Cancer Nurs 2021; 45:E355-E363. [PMID: 34183519 DOI: 10.1097/ncc.0000000000000977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnosis of an advanced cancer during young adulthood frequently entails the loss of confidence in physical function, as well as the certainty of achieving future social, vocational, and existential aspirations. These losses leave young adults with tenuous holds on facets of their life that foster hope and meaning. OBJECTIVE The aim of this study was to explore the unique physical and psychosocial-spiritual losses and patterns of grief responses among young adults living with advanced cancer. INTERVENTIONS/METHODS Theoretical sampling led to the recruitment of 13 young adults, ages 23 to 38 years, diagnosed with stage III or IV cancer. Participants completed 1 semistructured interview, a timeline of pivotal moments throughout their illness, and a sociodemographic survey. Glaser's grounded theory methods informed the study design and analysis. RESULTS Young adults displayed patterns of disorienting grief, which left them bereft of almost all familiar facets of their pretrauma lives and identities. Disorienting physical and psychosocial-spiritual losses presented in the following subcategories: disorientation to all aspects of former life, lost identity, and isolation. CONCLUSIONS Findings from this study reveal a novel framework from which to interpret grief experiences among young adults living with advanced cancer. IMPLICATIONS FOR NURSING PRACTICE The implementation of grief assessments and interventions during pivotal stages in young adults' cancer treatment and recovery may ameliorate psychological distress and normalize perceptions of life disruptions. Nursing education before treatment initiation and termination can reduce young adults' fears surrounding unfamiliar symptoms and prepare them for the physical and emotional uncertainties that often accompany remission or end-of-life.
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Philipp R, Kalender A, Härter M, Bokemeyer C, Oechsle K, Koch U, Vehling S. Existential distress in patients with advanced cancer and their caregivers: study protocol of a longitudinal cohort study. BMJ Open 2021; 11:e046351. [PMID: 33895716 PMCID: PMC8074557 DOI: 10.1136/bmjopen-2020-046351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION At the end of life, patients with advanced cancer and their informal caregivers may confront multiple existential concerns. Despite the strong potential to alleviate existential distress through psychosocial interventions, existential distress and its impact on healthcare outcomes have not yet been studied systematically. We aim to investigate the frequency, longitudinal trajectory and predictive impact of existential distress on end-of-life outcomes. We further aim to determine patients' and caregivers' specific need for and utilisation of psychosocial support for existential distress. METHODS This longitudinal cohort study will consecutively recruit 500 patients with advanced cancer and 500 caregivers from oncological outpatient and inpatient clinics. Participants will complete self-report questionnaires (sociodemographic and disease-related characteristics, existential distress, end-of-life outcomes, resources and support needs) at five points of assessment (at baseline and after 3, 6, 9 and 12 months). At baseline and 6-month follow-up, we will conduct structured diagnostic interviews to assess mental disorders. Statistical analyses will include descriptive statistics to determine the prevalence of existential distress, mental disorders and end-of-life outcomes; multiple linear and logistic regression analyses to calculate the predictive impact of existential distress on end-of-life outcomes; and growth mixture models to analyse longitudinal trajectories of existential distress. DISCUSSION This study will provide comprehensive knowledge about patients' and caregivers' existential concerns. The longitudinal empirical data will allow for conclusions concerning the frequency and course of existential distress throughout 1 year. This important extension of existing cross-sectional research will contribute to further develop targeted psychosocial interventions. Profiles of existential distress may be applied by clinicians from multiple professions and help to address existential concerns effectively. ETHICS AND DISSEMINATION The study was approved by the institutional research ethics committee (reference number LPEK-0177). Results will be presented at scientific conferences and published in peer-reviewed journals. Other forms of dissemination will include sharing results on the psychometric properties of the structured demoralisation interview with international research groups and communication with healthcare professionals providing psychosocial treatment for patients and caregivers. Following scientific standards, our progress will be regularly updated on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04600206.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Kalender
- 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
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department of Medical Psychology, 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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10
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Martin V, Sarker T, Slusarek E, McCarthy MA, Granton J, Tan A, Lo C. Conversational avoidance during existential interviews with patients with progressive illness. PSYCHOL HEALTH MED 2020; 25:1073-1082. [PMID: 31975623 DOI: 10.1080/13548506.2020.1719282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We examined patterns of avoidance when existential emotional topics were raised during conversations with patients with pulmonary arterial hypertension (PAH), an incurable life-limiting disease. 30 adult outpatients with PAH were recruited for a 20 to 60-minute interview about their illness experience. Qualitative content analysis was used to identify avoidance strategies that patients employed. Participants averaged 58 years in age (SD = 18), 77% were female, and mean length of illness was 6.3 years (SD = 5.3). We found four avoidance strategies: (1) Reversal, when individuals would begin discussing a negative concern and then backtrack to more positive sentiments; (2) Diversion for when patients would sidetrack the conversation to a different and less uncomfortable topic; (3) Diminishment for when a concern is raised and then made to seem unimportant; and (4) Obstruction, when patients refuse to discuss a concern further. Exploration of existential concerns can elicit distress but may be necessary to promote adaptation to progressive illness and to the foreseeable challenges that may affect the sense of life meaning and value. By recognizing when existential concerns may be present but not adequately discussed, clinicians may be better able to assist patients to cope and prepare for the future.
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Affiliation(s)
- Vanessa Martin
- Department of Psychology, Queen's University , Kingston, Canada.,Department of Psychology, University of Guelph-Humber , Etobicoke, Canada
| | - Tasmie Sarker
- Department of Psychology, University of Guelph-Humber , Etobicoke, Canada
| | - Emily Slusarek
- Department of Biology, Trent University , Peterborough, Canada
| | - Mary A McCarthy
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network , Toronto, Canada
| | - John Granton
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network , Toronto, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto , Toronto, Canada
| | - Adrienne Tan
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network , Toronto, Canada.,Department of Psychiatry, University of Toronto , Toronto, Canada
| | - Christopher Lo
- Department of Psychiatry, University of Toronto , Toronto, Canada.,Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
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Vehling S, Tian Y, Malfitano C, Shnall J, Watt S, Mehnert A, Rydall A, Zimmermann C, Hales S, Lo C, Rodin G. Attachment security and existential distress among patients with advanced cancer. J Psychosom Res 2019; 116:93-99. [PMID: 30655000 DOI: 10.1016/j.jpsychores.2018.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Felt security in close relationships may affect individual adaptation responses to existential threat in severe illness. We examined the contribution of attachment security to demoralization, a state of existential distress involving perceived pointlessness and meaninglessness in advanced cancer. METHOD A mixed cross-sectional sample of 382 patients with advanced cancer (mean age 59, 60% female) was recruited from outpatient oncology clinics. Participants completed self-report measures of attachment security, demoralization, depression, and physical symptom burden. We used multiple linear regression to analyze the association between attachment security and demoralization, controlling for demographic factors and symptom burden and tested whether attachment security moderated the association of symptom burden with demoralization. Separate analyses compared the contribution of the dimensions of attachment anxiety and attachment avoidance. RESULTS The prevalence of clinically relevant demoralization was 35%. Demoralization was associated with lower attachment security (β = -0.54, 95%CI: -0.62 to 0.46). This effect was empirically stronger for attachment anxiety (β = 0.52, 95%CI: 0.44 to 0.60) compared to attachment avoidance (β = 0.36, 95%CI: 0.27 to 0.45). Attachment security also significantly moderated the association of physical symptom burden with demoralization, such that with less attachment security, there was a stronger association between symptom burden and demoralization. CONCLUSION Attachment security may protect from demoralization in advanced cancer. Its relative lack, particularly on the dimension of attachment anxiety, may limit adaptive capacities to deal with illness burden and to sustain morale and purpose in life. An understanding of individual differences in attachment needs can inform existential interventions for severely ill individuals.
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Affiliation(s)
- S Vehling
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Y Tian
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - C Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - J Shnall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - S Watt
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - A Mehnert
- Department of Medical Psychology and Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - A Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - C Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - C Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Canada
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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12
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Vehling S, Kissane DW. Existential distress in cancer: Alleviating suffering from fundamental loss and change. Psychooncology 2018; 27:2525-2530. [DOI: 10.1002/pon.4872] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Sigrun Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - David W. Kissane
- University of Notre Dame; Sydney Australia
- Cunningham Centre; St Vincent's Hospital; Sydney Australia
- Szalmuk Family Psycho-Oncology Research Unit; Cabrini Health and Monash Partner's Comprehensive Cancer Centre; Melbourne Australia
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13
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Costello J. Research roundup. Int J Palliat Nurs 2018; 24:256-257. [PMID: 29792766 DOI: 10.12968/ijpn.2018.24.5.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- John Costello
- Honorary Lecturer, University of Manchester School of Nursing, Midwifery and Social Work
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