1
|
Garcia JT, Dos Santos MA, Arantes de Oliveira-Cardoso É. Pre-death grief in patients requiring hematopoietic stem cell transplantation. DEATH STUDIES 2022:1-12. [PMID: 36437595 DOI: 10.1080/07481187.2022.2150723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This study aimed to understand the pre-death grief experienced by patients requiring Hematopoietic Stem Cell Transplantation. The sample consisted of nine adult patients. A semi-structured interview was applied individually, and audio was recorded and analyzed qualitatively using thematic analysis. The results were organized into two categories, namely: Pre-death grief: Receiving the diagnosis, and Pre-death adjustment: Adaptation to the new condition. It was observed that there was a shock and a need to deal with the losses stemming from a serious illness, but then there was openness to reflection, and from this a new way of being and living emerged.
Collapse
Affiliation(s)
- Juliana Tomé Garcia
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Avenida Bandeirantes, Ribeirão Preto, Brazil
| | - Manoel Antônio Dos Santos
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Avenida Bandeirantes, Ribeirão Preto, Brazil
| | - Érika Arantes de Oliveira-Cardoso
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Avenida Bandeirantes, Ribeirão Preto, Brazil
| |
Collapse
|
2
|
Siafaka V, Mavridis D, Tsonis O, Tzamakou E, Christogiannis C, Tefa L, Arnaoutoglou E, Tzimas P, Pentheroudakis G. The WHOQOL-BREF instrument: Psychometric evaluation of the Greek version in patients with advanced cancer and pain and associations with psychological distress. Palliat Support Care 2022:1-11. [PMID: 35983635 DOI: 10.1017/s1478951522001055] [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
OBJECTIVES Assessment of the psychometric characteristics of the Greek version of the brief World Health Organization Quality of Life Instrument (WHOQOL-BREF) in patients with advanced cancer and pain, and exploration of the association between psychological distress and quality of life (QoL). METHOD The sample consisted of 145 patients with advanced cancer and pain who completed the WHOQOL-BREF, the Symptom Checklist-90 (SCL-90), and the Pain Visual Analogue Scale (VAS). In analysis, the following methods were used: Cronbach's alpha, Item Response Theory (IRT), polychoric, Pearson and polyserial correlation, t-test, and Linear regression. RESULTS The internal consistency was high for all domains of the WHOQOL-BREF (Cronbach's α ≥ 0.731). Similarly, with the exception of three items, the WHOQOL-BREF items has large discrimination parameters suggesting that they have a high ability in differentiating subjects. On SCL-90, the three dimensions with the highest scores were Depression, Somatization, and Anxiety. The overall score for psychological distress, the Global Severity Index (GSI), showed significant negative association with all the WHOQOL-BREF factor scores (Physical Health: B = -1.488, p < 0.001, Psychological Health: B = -1.688, p < 0.001, Social Relationships: B = -0.910, p < 0.001, Environment: B = -1.064, p < 0.001). Male gender was associated with lower scores for Social Relationships (B = -0.358, p = 0.007) and Environment (B = -0.293, p = 0.026). SIGNIFICANCE OF RESULTS The Greek version of the WHOQOL-BREF showed good psychometric properties in patients with advanced cancer and can be used as a reliable instrument in clinical practice. The level of psychological distress can be considered a determinant of QoL in patients with advanced cancer and pain, independently of pain intensity or other clinical characteristics. In cancer, the disease process can activate multiple physiological and psychological mechanisms that lead to a wide range of symptoms of psychological distress. To improve their QoL, psychological intervention focused on the identification and alleviation of psychological distress in patients with advanced cancer, and help in finding meaning in their experience, should be provided.
Collapse
Affiliation(s)
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Orestis Tsonis
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | | | | | - Louiza Tefa
- Department of Anesthesiology, University Hospital of Ioannina, Ioannina, Greece
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Petros Tzimas
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - George Pentheroudakis
- Department of Oncology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| |
Collapse
|
3
|
Qama E, Diviani N, Grignoli N, Rubinelli S. Health professionals' view on the role of hope and communication challenges with patients in palliative care: A systematic narrative review. PATIENT EDUCATION AND COUNSELING 2022; 105:1470-1487. [PMID: 34593262 DOI: 10.1016/j.pec.2021.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify health professionals' (HPs) perspectives on the role of hope and the main challenges faced when communicating with patients in palliative care (PC). METHODS Search on PubMed, Scopus, SocIndex, Cochrane, and Web of Science using: palliat*, palliative care, palliative medicine, hospice care, terminal care, long term care, supportive care, end of life (EOL) care and hope*, followed by a thematic narrative analysis. RESULTS Thirty-five studies were included. HPs' views were grouped in: Bringing out hope and Taking down hope. HPs believe that hope is elicited through a personal patient-provider bond and exhibited through medical treatment delivery. HPs face difficulties when delivering prognosis, referring to hospice, and providing palliation. CONCLUSION Hope is conveyed through verbal and non-verbal communication. HPs struggle to account for hope's shifting character, challenging the engagement in EOL discussions. PRACTICAL IMPLICATIONS Findings show a patient-provider clash of perspectives, suggesting a gap in acknowledging the shifting nature of hope. An important question emerges: Are the existing theories of hope that are solely explained from a patient experience relevant for HPs' own interpretation? Investigating the HPs' attitudes gathered in collective experiences in PC, might contribute to answering the question in the context of building more constructive communication approaches.
Collapse
Affiliation(s)
- Enxhi Qama
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Grignoli
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, 6850 Mendrisio, Switzerland.
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| |
Collapse
|
4
|
"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.
Collapse
|
5
|
Latuga NM, Luczkiewicz DL, Grant PC, Levy K, Hansen E, Kerr CW. Single Subcutaneous Ketamine Dose Followed by Oral Ketamine for Depression Symptoms in Hospice Patients: A Case Series. J Pain Palliat Care Pharmacother 2021; 35:106-112. [PMID: 33847212 DOI: 10.1080/15360288.2021.1883182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Management of depression symptoms in hospice patients is complicated by the fact that an appropriate trial of antidepressant therapy requires 4-6 weeks and most hospice patients receive hospice services for less than 8 weeks. Intravenously administered ketamine has been shown to produce rapid improvement in depression symptoms but is not an ideal route for hospice patients and oral ketamine appears to have a slower onset of antidepressant activity. We present a case series that illustrates the use of a single subcutaneous dose of ketamine (0.5 mg/kg) followed by daily oral ketamine (0.5 mg/kg daily) therapy to manage depression symptoms in three hospice patients. Clinical improvement of depression symptoms occurred quickly for all patients as measured by the PHQ-4, numeric ratings, and subjective reporting. A single subcutaneous dose of ketamine followed by oral therapy presents itself as an option to quickly reduce depression symptoms in hospice patients that do not also require additional pain management. Combining the use of the subcutaneous and oral routes takes advantage of the possibly faster onset, home administration, and milder side effects than intravenous dosing. Prospective studies are needed to determine which dosing strategy would be the most beneficial for hospice patients.
Collapse
Affiliation(s)
- Natalie M Latuga
- Natalie M. Latuga, PharmD, BCPS, Debra L. Luczkiewicz, MD, Christopher W. Kerr, MD, PhD, are with Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA
| | - Debra L Luczkiewicz
- Natalie M. Latuga, PharmD, BCPS, Debra L. Luczkiewicz, MD, Christopher W. Kerr, MD, PhD, are with Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA
| | - Pei C Grant
- Pei C. Grant, PhD, is with the Research Department, Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA
| | - Kathryn Levy
- Pei C. Grant, PhD, is with the Research Department, Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,Kathryn Levy, MSW, is with AdvStat, Research Department, Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA; Department of Planning and Research, Trocaire College, Buffalo, NY, USA
| | - Eric Hansen
- Eric Hansen, MD, is with the Department of Supportive and Palliative Care, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Division of Geriatrics and Palliative Medicine, State University at Buffalo Jacobs School of Medicine and Biomedical Science, Buffalo, NY, USA
| | - Christopher W Kerr
- Natalie M. Latuga, PharmD, BCPS, Debra L. Luczkiewicz, MD, Christopher W. Kerr, MD, PhD, are with Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA
| |
Collapse
|
6
|
Caruso R, Nanni MG, Rodin G, Hales S, Malfitano C, De Padova S, Bertelli T, Murri MB, Bovero A, Miniotti M, Leombruni P, Zerbinati L, Sabato S, Grassi L. Effectiveness of a brief manualized intervention, Managing Cancer and Living Meaningfully (CALM), adapted to the Italian cancer care setting: Study protocol for a single-blinded randomized controlled trial. Contemp Clin Trials Commun 2020; 20:100661. [PMID: 33089003 PMCID: PMC7566943 DOI: 10.1016/j.conctc.2020.100661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/29/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022] Open
Abstract
Patients with advanced cancer suffer from psychosocial distress that may impair quality of life and that may be ameliorated by psychotherapeutic treatment. We describe here the methodology of a randomized controlled trial (RCT) to assess the effectiveness of a novel, brief, semi-structured psychotherapeutic intervention to reduce distress and increase well-being in patients with advanced or metastatic cancer. The intervention, called Managing Cancer and Living Meaningfully (CALM), was originally developed in Canada and we are now testing its Italian adaptation (CALM-IT). The study is a single-blinded phase III RCT with assessment at baseline, 3 and 6 months with two conditions: CALM-IT versus a nonspecific supportive intervention (SPI). Eligibility criteria include: ≥ 18 years of age; fluency in the Italian language; no cognitive deficit, and diagnosis of advanced or metastatic cancer with an expected survival of 12–18 months. CALM-IT includes up to 12 sessions, delivered over 6 months and covers 4 domains: i) Symptom Management and Communication with Health Care Providers; ii) Changes in Self and Relations with Close Others; iii) Sense of Meaning and Purpose; and iv) the Future and Mortality. The primary outcome is difference in severity of depressive symptoms between treatment arm and the primary endpoint is 6 months. The secondary endpoint is 3 months and secondary outcomes are: generalized anxiety, distress about dying and death, demoralization, spiritual well-being, attachment security, posttraumatic growth, communication with partners, quality of life, and satisfaction with clinical care. If shown to be effective, CALM-IT can be implemented nationally to relieve distress and to promote psychological well-being in patients with advanced cancer.
Collapse
Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Trust and University S. Anna Hospital, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Trust and University S. Anna Hospital, Ferrara, Italy
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON M5G 2M9, Canada.,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON M5G 2M9, Canada.,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON M5G 2M9, Canada.,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Silvia De Padova
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Tatiana Bertelli
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Trust and University S. Anna Hospital, Ferrara, Italy
| | - Andrea Bovero
- Clinical Psychology Unit, Department of Neuroscience, University of Turin, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
| | - Marco Miniotti
- Clinical Psychology Unit, Department of Neuroscience, University of Turin, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
| | - Paolo Leombruni
- Clinical Psychology Unit, Department of Neuroscience, University of Turin, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Silvana Sabato
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Trust and University S. Anna Hospital, Ferrara, Italy
| | | |
Collapse
|
7
|
Contingent hope theory: The developmental exploration of hope and identity reconciliation among young adults with advanced cancers. Palliat Support Care 2020; 19:437-446. [PMID: 32729458 PMCID: PMC7856215 DOI: 10.1017/s1478951520000656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The diagnosis of an advanced cancer in young adulthood can bring one's life to an abrupt halt, calling attention to the present moment and creating anguish about an uncertain future. There is seldom time or physical stamina to focus on forward-thinking, social roles, relationships, or dreams. As a result, young adults (YAs) with advanced cancer frequently encounter existential distress, despair, and question the purpose of their life. We sought to investigate the meaning and function of hope throughout YAs' disease trajectory; to discern the psychosocial processes YAs employ to engage hope; and to develop a substantive theory of hope of YAs diagnosed with advanced cancer. METHOD Thirteen YAs (ages 23-38) diagnosed with a stage III or IV cancer were recruited throughout the eastern and southeastern United States. Participants completed one semi-structured interview in-person, by phone, or Skype, that incorporated an original timeline instrument assessing fluctuations in hope and an online socio-demographic survey. Glaser's grounded theory methodology informed constant comparative methods of data collection, analysis, and interpretation. RESULTS Findings from this study informed the development of the novel contingent hope theoretical framework, which describes the pattern of psychosocial behaviors YAs with advanced cancer employ to reconcile identities and strive for a life of meaning. The ability to cultivate the necessary agency and pathways to reconcile identities became contingent on the YAs' participation in each of the psychosocial processes of the contingent hope theoretical framework: navigating uncertainty, feeling broken, disorienting grief, finding bearings, and identity reconciliation. SIGNIFICANCE OF RESULTS Study findings portray the influential role of hope in motivating YAs with advanced cancer through disorienting grief toward an integrated sense of self that marries cherished aspects of multiple identities. The contingent hope theoretical framework details psychosocial behaviors to inform assessments and interventions fostering hope and identity reconciliation.
Collapse
|
8
|
Kanser Hastalarında Umutsuzluk ve Manevi Bakım Algısının Değerlendirilmesi. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.649645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
9
|
Garciandía Imaz JA, Rozo Reyes CM. Chronic Pain and Grief. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2019; 48:182-191. [PMID: 31426921 DOI: 10.1016/j.rcp.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 03/06/2017] [Accepted: 05/06/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this article was to conduct a systematic review in order to find information that enables a connection between chronic pain and the grieving process to be established, beyond the intuitive relationships that connects them. METHODS The medical literature was reviewed in search of articles that provide some evidence of the connection between chronic pain and grief. RESULTS The available information on both topics by themselves is profuse but there are very few publications that deal with both issues simultaneously. CONCLUSIONS The connection between chronic pain and grief has been mentioned intuitively as a condition taken for granted. However, little evidence of this relationship has been published, which suggests that this topic has not been widely researched.
Collapse
Affiliation(s)
- José Antonio Garciandía Imaz
- Departamento de Medicina Preventiva y Social, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Claudia Marcela Rozo Reyes
- Programa de Terapia Ocupacional, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
10
|
Communicating terminal prognosis: The provider's role in reframing hope. Palliat Support Care 2018; 16:803-805. [DOI: 10.1017/s1478951518000329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
11
|
Davis EL, Deane FP, Lyons GCB, Barclay GD. Is Higher Acceptance Associated With Less Anticipatory Grief Among Patients in Palliative Care? J Pain Symptom Manage 2017; 54:120-125. [PMID: 28479414 DOI: 10.1016/j.jpainsymman.2017.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/28/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Patients in palliative care can experience substantial psychological suffering. Acceptance-based interventions from approaches such as Acceptance and Commitment Therapy have demonstrated effectiveness in helping people cope with a range of life challenges. However, there is a dearth of research examining mechanisms of therapeutic change for patients in palliative care. OBJECTIVES To assess the relationships between acceptance, anticipatory grief, anxiety, and depression among patients in palliative care. METHODS A cross-sectional survey was verbally administered to inpatients (N = 73) receiving palliative care. RESULTS Correlations revealed that acceptance had a strong relationship with anticipatory grief, anxiety, and depression. A hierarchical regression analysis on anticipatory grief showed that acceptance was the largest predictor and accounted for an additional 13% of variance in anticipatory grief over and above anxiety and depression. CONCLUSION The present study provides preliminary data suggesting that interventions that target acceptance may be indicated in patients in palliative care.
Collapse
Affiliation(s)
- Esther L Davis
- School of Psychology and Illawarra Institute for Mental Health, University of Wollongong, Wollongong NSW, Australia.
| | - Frank P Deane
- School of Psychology and Illawarra Institute for Mental Health, University of Wollongong, Wollongong NSW, Australia
| | - Geoffrey C B Lyons
- School of Psychological Sciences, Australian College of Applied Psychology, Sydney NSW, Australia
| | - Gregory D Barclay
- Graduate School of Medicine, University of Wollongong, Wollongong NSW, Australia; Palliative Care Services, Illawarra Shoalhaven Local Health District, Port Kembla NSW, Australia
| |
Collapse
|
12
|
Gökler-Danışman I, Yalçınay-İnan M, Yiğit İ. Experience of grief by patients with cancer in relation to perceptions of illness: The mediating roles of identity centrality, stigma-induced discrimination, and hopefulness. J Psychosoc Oncol 2017; 35:776-796. [DOI: 10.1080/07347332.2017.1340389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - İbrahim Yiğit
- Department of Psychology, Ankara University, Ankara, Turkey
| |
Collapse
|
13
|
Johnson J, Lodhi MK, Cheema U, Stifter J, Dunn-Lopez K, Yao Y, Johnson A, Keenan GM, Ansari R, Khokhar A, Wilkie DJ. Outcomes for End-of-Life Patients with Anticipatory Grieving: Insights from Practice with Standardized Nursing Terminologies within an Interoperable Internet-based Electronic Health Record. J Hosp Palliat Nurs 2017; 19:223-231. [PMID: 28943805 DOI: 10.1097/njh.0000000000000333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Julie Johnson
- Dept. of Biobehavioral Health Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Muhammad Kamran Lodhi
- Dept. of Computer Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Umer Cheema
- Dept. of Electrical and Computer Engineering, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Janet Stifter
- Dept. of Biobehavioral Health Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Karen Dunn-Lopez
- Dept. of Health System Science, College of Nursing, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Yingwei Yao
- Dept. of Biobehavioral Health Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Andrew Johnson
- Dept. of Computer Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Gail M Keenan
- College of Nursing, University of Florida, Gainesville, FL
| | - Rashid Ansari
- Dept. of Electrical and Computer Engineering, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Ashfaq Khokhar
- Dept. of Electrical and Computer Engineering, Iowa State University, Ames, IA
| | - Diana J Wilkie
- Dept. of Biobehavioral Health Science, College of Engineering, University of Illinois at Chicago, Chicago, IL.,Dept. of Electrical and Computer Engineering, College of Engineering, University of Illinois at Chicago, Chicago, IL.,College of Nursing, University of Florida, Gainesville, FL
| |
Collapse
|
14
|
Vergo MT, Whyman J, Li Z, Kestel J, James SL, Rector C, Salsman JM. Assessing Preparatory Grief in Advanced Cancer Patients as an Independent Predictor of Distress in an American Population. J Palliat Med 2017; 20:48-52. [PMID: 27585066 PMCID: PMC6436024 DOI: 10.1089/jpm.2016.0136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Grief is a universal experience for patients living with a terminal illness, but it is not routinely measured. The Preparatory Grief in Advanced Cancer (PGAC) instrument has been used in Greece, but this is its first use in an American population with advanced cancer. OBJECTIVE Our aim was to use the PGAC instrument in an American population of advanced cancer patients to explore demographic, clinical, and psychological factors that may predict higher preparatory grief. DESIGN Subjects completed a single cross-sectional time point evaluation. SETTING/SUBJECTS Fifty-three adult outpatients and inpatients with incurable solid malignancies from Chicago, IL. MEASUREMENTS Demographic and clinical information, the PGAC instrument, the Hospital Anxiety and Depression Scale (HADS), the distress thermometer (DT), the Edmonton Symptom Assessment Scale (ESAS), and a quality-of-life (QOL) 2-question scale. RESULTS The mean PGAC score was 26.9 (range 0-70) and was only correlated with DT in multivariate analysis. CONCLUSIONS Preparatory grief was a common experience, and one-fourth of our sample participants had significant grief. Distress was the only independent factor (including psychological, physical, clinical, or demographic factors) correlated with higher preparatory grief scores.
Collapse
Affiliation(s)
- Maxwell T. Vergo
- Section of Palliative Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jeremy Whyman
- Department of Geriatrics and Palliative Medicine, Mount Sinai Hospital and Medical School, New York, New York
| | - Zhigang Li
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jeanne Kestel
- Illinois Crisis Prevention Network, Chicago, Illinois
| | - Spencer L. James
- Section of Palliative Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Christopher Rector
- Department of Clinical Psychology, Illinois School of Professional Psychology at Argosy University, Chicago, Illinois
| | - John M. Salsman
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
15
|
Burke LA, Clark KA, Ali KS, Gibson BW, Smigelsky MA, Neimeyer RA. Risk Factors for Anticipatory Grief in Family Members of Terminally Ill Veterans Receiving Palliative Care Services. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2015; 11:244-266. [PMID: 26654060 DOI: 10.1080/15524256.2015.1110071] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Anticipatory grief is the process associated with grieving the loss of loved ones in advance of their inevitable death. Because anticipatory grief has been associated with a variety of outcomes, risk factors for this condition deserve closer consideration. Fifty-seven family members of terminally ill, hospice-eligible veterans receiving palliative care services completed measures assessing psychosocial factors and conditions. Elevated anticipatory grief was found in families characterized by relational dependency, lower education, and poor grief-specific support, who also experienced discomfort with closeness and intimacy, neuroticism, spiritual crisis, and an inability to make sense of the loss. Thus, in this sample, anticipatory grief appears to be part of a cluster of factors and associated distress that call for early monitoring and possible intervention.
Collapse
Affiliation(s)
- Laurie A Burke
- a Memphis Veterans Affairs Medical Center and Department of Psychology , University of Memphis , Memphis , Tennessee , USA
| | - Karen A Clark
- b Memphis Veterans Affairs Medical Center , Memphis , Tennessee , USA
| | - Khatidja S Ali
- b Memphis Veterans Affairs Medical Center , Memphis , Tennessee , USA
| | - Benjamin W Gibson
- c Department of Psychology , University of Memphis , Memphis , Tennessee , USA
| | - Melissa A Smigelsky
- a Memphis Veterans Affairs Medical Center and Department of Psychology , University of Memphis , Memphis , Tennessee , USA
| | - Robert A Neimeyer
- c Department of Psychology , University of Memphis , Memphis , Tennessee , USA
| |
Collapse
|
16
|
Janberidze E, Hjermstad MJ, Haugen DF, Sigurdardottir KR, Løhre ET, Lie HC, Loge JH, Kaasa S, Knudsen AK. How are patient populations characterized in studies investigating depression in advanced cancer? Results from a systematic literature review. J Pain Symptom Manage 2014; 48:678-98. [PMID: 24681108 DOI: 10.1016/j.jpainsymman.2013.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/22/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Prevalence rates of depression in patients with advanced cancer vary considerably. This may be because of heterogeneous samples and use of different assessment methods. Adequate sample descriptions and consistent use of measures are needed to be able to generalize research findings and apply them to clinical practice. OBJECTIVES Our objective was twofold: First, to investigate which clinically important variables were used to describe the samples in studies of depression in patients with advanced cancer; and second, to examine the methods used for assessing and classifying depression in these studies. METHODS PubMed, PsycINFO, Embase, and CINAHL were searched combining search term groups representing "depression," "palliative care," and "advanced cancer" covering 2007-2011. Titles and abstracts were screened, and relevant full-text articles were evaluated independently by two authors. Information on 32 predefined variables on cancer disease, treatment, sociodemographics, depression-related factors, and assessment methods was extracted from the articles. RESULTS After removing duplicates, 916 citations were screened of which 59 articles were retained. Age, gender, and stage of the cancer disease were the most frequently reported variables. Depression-related variables were rarely reported, for example, antidepressant use (17%) and previous depressive episodes (12%). Only 25% of the studies assessed and classified depression according to a validated diagnostic system. CONCLUSION Current practice for describing sample characteristics and assessing depression varies greatly between studies. A more standardized practice is recommended to enhance the generalizability and utility of findings. Stakeholders are encouraged to work toward a common standard for sample descriptions.
Collapse
Affiliation(s)
- Elene Janberidze
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Katrin Ruth Sigurdardottir
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway; Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Erik Torbjørn Løhre
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon Håvard Loge
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | |
Collapse
|
17
|
Abstract
BACKGROUND Hopelessness negatively affects ovarian cancer patients' quality of life (QOL). Research validating the effects of complementary and alternative medicine (CAM) use on QOL and hope is scarce, even though QOL and hope are reasons that patients cite for using CAM therapy. Clinicians need effective, evidence-based interventions to improve QOL and reduce hopelessness. OBJECTIVE The objectives of this study were to examine factors influencing hopelessness in patients with newly diagnosed disease, long-term survivors, and patients experiencing ovarian cancer recurrence and to examine the effects of CAM on hopelessness in the same population. METHODS Surveys of ovarian cancer patients (N = 219) undergoing treatment at a comprehensive cancer center in the United States were analyzed. Descriptive, correlation, and multivariate analyses described variables and demonstrated the effects of sociodemographics, disease state, psychological distress, QOL, CAM use, and faith on hopelessness. RESULTS Patients ages 65 years or older (-0.95, P = .03), with strong faith (-0.28, P = .00), and good QOL (0.11, P = .00) directly reduced hopelessness scores (mean, 3.37). Massage therapy substantially reduced hopelessness scores (-1.07, P = .02); holding age constant, employed patients were twice as likely to use massage (odds ratio, 2.09; P = .04). Patients who had newly diagnosed and recurrent ovarian cancer were more hopeless because of greater distress from symptoms and adverse effects of treatment. CONCLUSION Patients who used massage therapy were significantly less hopeless, as were those with strong faith and well-controlled disease symptoms and treatment for adverse effects. IMPLICATIONS FOR PRACTICE Support of spiritual needs and symptom management are important interventions to prevent and/or reduce hopelessness, especially for patients with newly diagnosed and recurrent ovarian cancer. Further research testing the positive effect of massage interventions on hopelessness is needed.
Collapse
|
18
|
Affiliation(s)
- Mike Brady
- College of Human and Health Science, Swansea University, an associate lecturer with the Open University, and a paramedic with South Western Ambulance Service NHS Foundation Trust
| |
Collapse
|
19
|
Fasse L, Sultan S, Flahault C, MacKinnon CJ, Dolbeault S, Brédart A. How do researchers conceive of spousal grief after cancer? A systematic review of models used by researchers to study spousal grief in the cancer context. Psychooncology 2013; 23:131-42. [DOI: 10.1002/pon.3412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Léonor Fasse
- Institut Curie; Paris F-75006 France
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| | - Serge Sultan
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| | - Cécile Flahault
- Institut Curie; Paris F-75006 France
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| | - Christopher J. MacKinnon
- Department of Educational and Counseling Psychology; McGill University; Montréal Québec Canada
- Palliative Care Research; SMBD Jewish General Hospital; Montréal Québec Canada
- Psychosocial Oncology Program; Montreal General Hospital; Montréal Québec Canada
| | - Sylvie Dolbeault
- Institut Curie; Paris F-75006 France
- Inserm, U 669; Paris France
- Université Paris-Sud and Université Paris Descartes; UMR-S0669; Paris France
| | - Anne Brédart
- Institut Curie; Paris F-75006 France
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| |
Collapse
|
20
|
O'Grady E, Dempsey L, Fabby C. Anger: a common form of psychological distress among patients at the end of life. Int J Palliat Nurs 2013; 18:592-6. [PMID: 23560316 DOI: 10.12968/ijpn.2012.18.12.592] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Psychological distress is common in palliative care patients and their families, and anger is a complex component of distress experienced by many patients at the end of life. Anger can be a form of tension release, as well as a coping mechanism for the patient and a way to disguise fear and anxiety. The interdisciplinary team are responsible for recognising psychological distress in patients, assessing their needs, and providing adequate psychological support. Although a certain level of psychological distress such as anger is expected in terminally ill patients owing to their situation, such responses may also be dysfunctional. This paper aims to highlight the challenges and complexities of adequately assessing and supporting palliative care patients who are presenting with psychological distress in the form of anger, in order to relieve their suffering and assist them in resolving their issues and improving their quality of life. Anger can be difficult to treat, and for some patients can be more distressing than some physical symptoms. Hence this paper also aims to offer anger management guidance to palliative care practitioners.
Collapse
|
21
|
Warmenhoven F, van Rijswijk E, van Hoogstraten E, van Spaendonck K, Lucassen P, Prins J, Vissers K, van Weel C. How family physicians address diagnosis and management of depression in palliative care patients. Ann Fam Med 2012; 10:330-6. [PMID: 22778121 PMCID: PMC3392292 DOI: 10.1370/afm.1373] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/29/2011] [Accepted: 10/17/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in family physicians' opinions regarding the recognition, diagnosis, and management of depression in palliative care patients. METHODS We conducted a focus group study in a sample of family physicians with varied practice locations and varying expertise in palliative care. Transcripts were analyzed independently by 2 researchers using constant comparative analysis in ATLAS.ti. RESULTS In 4 focus group discussions with 22 family physicians, the physicians described the diagnostic and therapeutic process for depression in palliative care patients as a continuous and overlapping process. Differentiating between normal and abnormal sadness was viewed as challenging. The physicians did not strictly apply criteria of depressive disorder but rather relied on their clinical judgment and strongly considered patients' context and background factors. They indicated that managing depression in palliative care patients is mainly supportive and nonspecific. Antidepressant drugs were seldom prescribed. The physicians described difficulties in diagnosing and treating depression in palliative care, and gave suggestions to improve management of depression in palliative care patients in primary care. CONCLUSIONS Family physicians perceive the diagnosis and management of depression in palliative care patients as challenging. They rely on open communication and a long-standing physician-patient relationship in which the patient's context is of great importance. This approach fits with the patient-centered care that is promoted in primary care.
Collapse
Affiliation(s)
- Franca Warmenhoven
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Vollmer TC, Wittmann M, Schweiger C, Hiddemann W. Preoccupation with death as predictor of psychological distress in patients with haematologic malignancies. Eur J Cancer Care (Engl) 2011; 20:403-11. [PMID: 20597956 DOI: 10.1111/j.1365-2354.2010.01203.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of the present study was to identify preoccupation with death in relation to levels of psychological distress in patients with haematologic malignancies. One hundred and two inpatients with haematologic malignancies, treated with curative intent, and thirty-three control inpatients with benign dysfunction participated in the present study. Psychological distress was measured with the Hospital Anxiety and Depression Scale and the Freiburg Questionnaire of Coping with Illness. Preoccupation with death was assessed with the Subjective Estimation of Sickness and Death Scale. Patients with haematologic malignancies had significantly more preoccupation with death than the control group. In patients with haematologic malignancies preoccupation with death was related to depressive coping style as well as symptoms of depression and anxiety; regression analyses reveal that the diagnosis of haematologic malignancy leads to stronger subjective feelings of being close to death, which in turn leads to more psychological distress. To the best of our knowledge this is the first study that quantitatively shows the existence of preoccupation with death in patients with haematologic malignancies and its association with psychological distress. Our findings indicate that patients who are treated with a curative regime need psychological intervention focusing on death-related fear in order to prevent severe emotional distress.
Collapse
Affiliation(s)
- T C Vollmer
- Institute of Applied Psychology in Architecture and Health, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|
23
|
Gender, age and surgery as a treatment modality leads to higher distress in patients with cancer. Support Care Cancer 2010; 19:239-50. [DOI: 10.1007/s00520-009-0810-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
|
24
|
Yildirim Y, Sertoz OO, Uyar M, Fadiloglu C, Uslu R. Hopelessness in Turkish cancer inpatients: The relation of hopelessness with psychological and disease-related outcomes. Eur J Oncol Nurs 2009; 13:81-6. [DOI: 10.1016/j.ejon.2009.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 01/06/2009] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
|
25
|
Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|