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Freitas MJ, Remondes-Costa S, Veiga E, Macedo G, Teixeira RJ, Leite M. Life beyond Loss: A Retrospective Analysis of the Impact of Meaning of Life Therapy on the Grieving Process of Cancer Patients' Family Caregivers. Healthcare (Basel) 2024; 12:471. [PMID: 38391846 PMCID: PMC10887668 DOI: 10.3390/healthcare12040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/18/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Oncological disease in the palliative stage is a huge challenge for patients and their family caregivers (FCs) due to the fact that it confronts them with death, as well as physical, psychological, and existential suffering. Meaning of Life Therapy (MLT) is a brief structured psycho-existential intervention aiming to help patients in a meaning-making life review process, promoting end-of-life adaptation. The Life Letter (LL) resulting from MLT is an element that facilitates communication between the patient and their caregivers. The goal of this study was to understand the impact of MLT on the grieving processes of eight FCs and to study their perceptions of the role of the LL on grief through semi-structured interviews. The results of our qualitative analysis indicate that MLT was perceived by the FCs as a positive experience despite the conspiracy of silence being identified as a drawback. The LL was interpreted as a communicational element, promoting emotional closeness with the cancer patients and serving as a valuable tool in the FCs' adaptation to loss. Our research findings show that the needs of FCs, especially after experiencing the loss of their relative, are dynamic and specific. This is why it is urgent to develop interventions that consider the idiosyncrasies of end-of-life cancer patients and their FCs in order to avoid frustrated farewells, lonely deaths, and maladaptive grieving processes. This is the direction in which MLT should evolve.
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Affiliation(s)
- Maria João Freitas
- Department of Social and Behavioural Sciences, University Institute of Health Sciences (IUCS-CESPU), 4585-116 Gandra, Portugal
| | - Sónia Remondes-Costa
- Department of Education and Psychology, University of Trás-os-Montes e Alto Douro, 5000-622 Vila Real, Portugal
| | - Elisa Veiga
- Research Centre for Human Development, Faculty of Education and Psychology, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - Gerly Macedo
- Clinical and Health Psychology Unit, Psychiatry and Mental Health Service, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Ricardo João Teixeira
- REACH-Mental Health Clinic, 4000-138 Porto, Portugal
- CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Intervention), Faculty of Psychology and Education Sciences, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Manuela Leite
- Department of Social and Behavioural Sciences, University Institute of Health Sciences (IUCS-CESPU), 4585-116 Gandra, Portugal
- iHealth4Well-Being-Innovation in Health and Well-Being-Research Unit, Instituto Politécnico de Saúde do Norte, CESPU, 4560-462 Penafiel, Portugal
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Coats H, Shive N, Bennett CR, Adrian B, Boyd AD, Doorenbos AZ, Schmiege SJ. Use of a Person-Centered Narrative Intervention in an Outpatient Palliative Care Setting: A Feasibility Study. J Patient Exp 2023; 10:23743735231202729. [PMID: 37736131 PMCID: PMC10510338 DOI: 10.1177/23743735231202729] [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] [Indexed: 09/23/2023] Open
Abstract
Person-centered narrative interventions offer potential solutions to facilitate a connection between the person receiving care and the person delivering the care, to improve quality of care, and positively impact a patient's biopsychosocial well-being. This single-arm feasibility study investigates patient-reported outcomes and barriers/facilitators to the implementation of an all-virtually delivered person-centered narrative intervention into the person's electronic health record. Overall, electronic data collection for the patient-reported outcomes was feasible. All 15 participants felt participating in the study was "easy" and "enjoyable," and "not a burden." The facilitators of implementation included: "helpful to the clinician," "appreciated looking at me as whole person," "be seen and heard," "had a connection and trust," and "felt comfortable and relaxing." The barriers to implementation included: "completing all the paperwork," "being rushed for time to complete the PCNI," and some "emotion" during collection of narrative. The use of person-centered narrative interventions is a way to deploy dedicated tools to shift dehumanized healthcare delivery to a more humanized person-centered care that treats people as experts in their own life narratives by incorporating their beliefs, values, and preferences into their plan of care.
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Affiliation(s)
- Heather Coats
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Nadia Shive
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - C Robert Bennett
- School of Medicine, University of Colorado, Anschutz Medical Campus, General Internal Medicine, Aurora, CO, USA
| | - Bonnie Adrian
- UCHealth University of Colorado Hospital, Aurora, CO, USA
| | - Andrew D Boyd
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, IL, USA
- UI Health, Chicago, IL, USA
| | - Ardith Z Doorenbos
- University of Illinois Chicago, College of Nursing, Chicago, IL, USA
- Cancer Prevention and Control Program, University of Illinois Cancer Center, Chicago, IL, USA
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Valentino TCDO, Paiva CE, de Oliveira MA, Hui D, Bruera E, Julião M, Paiva BSR. Preference and actual place-of-death in advanced cancer: prospective longitudinal study. BMJ Support Palliat Care 2023:spcare-2023-004299. [PMID: 37402541 DOI: 10.1136/spcare-2023-004299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To evaluate the preferred place-of-death (PPoD) among patients with advanced cancer over time, and the concordance between preferred and actual place-of-death. METHODS Prospective cohort study. A total of 190 patients with advanced cancer and their caregivers (n=190) were interviewed every 3 months, from study enrolment to 12 months (M0, M1, M2, M3, M4). PPoD data were obtained under four different end-of-life scenarios: (1) severe clinical deterioration without further specification; (2) clinical deterioration suffering from severe symptoms; (3) clinical deterioration receiving home-based visits; and (4) clinical deterioration receiving home-based visits and suffering from severe symptoms. RESULTS Home was the most common PPoD over time among patients in scenarios 1 (n=121, 63.7%; n=77, 68.8%; n=39, 57.4%; n=30, 62.5%; n=23, 60.5%) and 3 (n=147, 77.4%; n=87, 77.7%; n=48, 70.6%; n=36, 75.0%; n=30, 78.9%). PPoD in palliative care unit (PCU) and hospital were most frequent at baseline in scenario 2 (n=79, 41.6%; n=78, 41.1%), followed by hospital over time (n=61, 54.5%; n=45, 66.2%; n=35, 72.9%; n=28, 73.7%). During the curse of illness, 6.3% of patients change their PPoD in at least one of end-of-life scenario. About 49.7%, 30.6% and 19.7% of patients died in PCU, hospital and home, respectively. Living in rural area (OR=4.21), poor health self-perception (OR=4.49) and pain at the last days of life (OR=2.77) were associated with death in PPoD. The overall agreement between last preference and actual place-of-death was 51.0% (k=0.252). CONCLUSION Home death was not the preferred place for a large number of patients when this option was presented within a clinical context scenario. The PPoD and actual place-of-death were depending on the clinical situation.
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Affiliation(s)
| | - Carlos Eduardo Paiva
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marco Antonio de Oliveira
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - David Hui
- Palliative Care, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Lisboa, Portugal
| | - Bianca Sakamoto Ribeiro Paiva
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Coats H, Shive N, Adrian B, Boyd AD, Doorenbos AZ, Schmiege SJ. An Electronically Delivered Person-Centered Narrative Intervention for Persons Receiving Palliative Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e41787. [PMID: 36943346 PMCID: PMC10131928 DOI: 10.2196/41787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND In the health care setting, electronic health records (EHRs) are one of the primary modes of communication about patients, but most of this information is clinician centered. There is a need to consider the patient as a person and integrate their perspectives into their health record. Incorporating a patient's narrative into the EHR provides an opportunity to communicate patients' cultural values and beliefs to the health care team and has the potential to improve patient-clinician communication. This paper describes the protocol to evaluate the integration of an adapted person-centered narrative intervention (PCNI). This adaptation builds on our previous research centered on the implementation of PCNIs. The adaptation for this study includes an all-electronic delivery of a PCNI in an outpatient clinical setting. OBJECTIVE This research protocol aims to evaluate the feasibility, usability, and effects of the all-electronic delivery of a PCNI in an outpatient setting on patient-reported outcomes. The first objective of this study is to identify the barriers and facilitators of an internet-based-delivered PCNI from the perspectives of persons living with serious illness and their clinicians. The second objective is to conduct acceptability, usability, and intervention fidelity testing to determine the essential requirements for the EHR integration of an internet-based-delivered PCNI. The third objective is to test the feasibility of the PCNI in an outpatient clinic setting. METHODS Using a mixed method design, this single-arm intervention feasibility study was delivered over approximately 3 to 4 weeks. Patient participant recruitment was conducted via screening outpatient palliative care clinic schedules weekly for upcoming new palliative care patient visits and then emailing potential patient participants to notify them about the study. The PCNI was delivered via email and Zoom app. Patient-reported outcome measures were completed by patient participants at baseline, 24 to 48 hours after PCNI, and after the initial palliative care clinic visit, approximately 1 month after baseline. Inclusion criteria included having the capacity to give consent and having an upcoming initial outpatient palliative care clinic visit. RESULTS The recruitment of participants began in April 2021. A total of 189 potential patient participants were approached via email, and 20 patient participants were enrolled, with data having been collected from May 2021 to September 2022. A total of 7 clinician participants were enrolled, with a total of 3 clinician exit interviews and 1 focus group (n=5), which was conducted in October 2022. Data analysis is expected to be completed by the end of June 2023. CONCLUSIONS The findings from this study, combined with those from other PCNI studies conducted in acute care settings, have the potential to influence clinical practices and policies and provide innovative avenues to integrate more person-centered care delivery. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41787.
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Affiliation(s)
- Heather Coats
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nadia Shive
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Andrew D Boyd
- University of Illinois, Chicago, IL, United States
- UI Health, Chicago, IL, United States
| | - Ardith Z Doorenbos
- University of Illinois, Chicago, IL, United States
- University of Illinois Cancer Center, Chicago, IL, United States
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Dignity and time perspective: A pilot explorative study in cancer patients. Palliat Support Care 2023; 21:43-48. [PMID: 35393000 DOI: 10.1017/s1478951522000402] [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: 11/06/2022]
Abstract
OBJECTIVES This study investigated the possible correlation between emotional distress linked to dignity and dysfunctional temporal orientations in the oncological context. METHODS We conducted an exploratory study between December 2020 and February 2021, referring to a sample of 107 patients in active treatment for solid tumors belonging to the Oncology Department of the Fondazione Poliambulanza (Brescia, Italy). We administered two self-report questionnaires: the Patient Dignity Inventory (PDI-IT) (Italian version, Grassi L, Costantini A, Caruso R, et al. (2017) Dignity and psychosocial-related variables in advanced and nonadvanced cancer patients by using the patient dignity inventory-Italian version. Journal of Pain and Symptom Management 53(2), 279-287), as a measure of perceived level of dignity, and the Italian version of the Zimbardo Time Perspective Inventory scale (ZTPI) (Zimbardo PG and Boyd JN (2009) Il paradosso del tempo. La nuova psicologia del tempo che cambierà la tua vita. Milano: Mondadori), as a measure of the experiential dimensions of time, such as past, present, and future. RESULTS From the PDI-IT emerged that our sample reported high levels of physical and psychological distress. Furthermore, we founded higher distress in patients under 55 years (p = 0.04) and lower distress in retired patients (p = 0.01). The ZTPI showed in our patients prevailing orientations to the past-positive (39.3%) and the future (37.4%). We noticed a gender difference: men were mainly oriented to the future while women to the past-positive. Moreover, married subjects reported a prevalent orientation to past-positive and the future. Finally, data analysis found moderate positive correlation between the "Negative Past" dimension of ZTPI and high levels of physical (r = 0.203, p = 0.03) and psychological distress (r = 236, p = 0.01). SIGNIFICANCE OF RESULTS In our experience in oncology, dignity and time perspective play a central role as indicators of the quality of care. Our study shows the importance of a treatment path that integrates the constructs of Dignity and Time Perspective to favor a better psychological adaptation.
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Valentino TCDO, de Oliveira MA, Paiva CE, Paiva BSR. Where do Brazilian cancer patients prefer to die? Agreement between patients and caregivers. J Pain Symptom Manage 2022; 64:186-204. [PMID: 35398168 DOI: 10.1016/j.jpainsymman.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Preferred place-of-death (PPoD) is considered an important outcome for the development of appropriate models of care and for improving health policies in countries with underdeveloped palliative care (PC) OBJECTIVES: To determine the concordance between the PPoD of a sample of Brazilian seriously-ill cancer patients and their caregivers, and its associated factors under four different end-of-life (EOL) scenarios: 1) health deterioration in the overall context; 2) health deterioration with severe and uncomfortable symptoms; 3) health deterioration receiving home-based visits as needed; 4) health deterioration receiving home-based visits as needed, when suffering severe and uncomfortable symptoms METHODS: Cross-sectional study at a large Brazilian cancer center, between February 2019 and July 2021. 190 adult cancer patients and their caregivers (n = 190) were analyzed RESULTS: Patient and/or caregiver PPoD concordance for EOL scenario one: 64% vs. 43% for death at home, 22% vs. 30% for death in a PC unit, 14% vs. 27% for death in hospital. Higher patient and/or caregiver PPoD concordance was found for death in hospital (41%; 49%) in EOL scenario two, and for death at home for scenario three (77%; 74%). Agreement coefficient was moderate for scenario two (k = 0.430; P < 0.001), and fair for EOL scenarios one, three and four (k = 0.237, P < 0.001; k = 0.296, P < 0.001; k = 0.307, P < 0.001, respectively). Associated disagreement factors were: performance status (OR:3.03), self-perceived health (OR: 6.99), marital status (OR:2.92), and hospital and/or emergency room proximity (OR:4.11). The presence of relevant persons (42.3% vs. 44.2%), followed by spirituality (38.5% vs. 27.9%) and the place-of-death (14.0% vs. 18.4%), were the most important factors in the EOL, when comparing patients and care givers opinions, respectively CONCLUSION: Low agreement between patients and caregivers on PPoD was identified. EOL clinical factors and deterioration, and PC support seem to influence PPoD.
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Affiliation(s)
- Talita Caroline de Oliveira Valentino
- Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marco Antonio de Oliveira
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Carlos Eduardo Paiva
- Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil; Department of Clinical Oncology, Breast and Gynecology Division (C.E.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil.
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Chua KZY, Quah ELY, Lim YX, Goh CK, Lim J, Wan DWJ, Ong SM, Chong CS, Yeo KZG, Goh LSH, See RM, Lee ASI, Ong YT, Chiam M, Ong EK, Zhou JX, Lim C, Ong SYK, Krishna L. A systematic scoping review on patients' perceptions of dignity. Palliat Care 2022; 21:118. [PMID: 35787278 PMCID: PMC9251939 DOI: 10.1186/s12904-022-01004-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background A socioculturally appropriate appreciation of dignity is pivotal to the effective provision of care for dying patients. Yet concepts of dignity remain poorly defined. To address this gap in understanding and enhance dignity conserving end-of-life care, a review of current concepts of dignity is proposed. Methods To address its primary research question “How do patients conceive the concept of dignity at the end of life?”, this review appraises regnant concepts and influences of dignity, and evaluates current dignity conserving practices. To enhance accountability, transparency and reproducibility, this review employs the Ring Theory of Personhood (RToP) as its theoretical lens to guide a Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) of patient perspectives of dignity. Three independent teams of reviewers independently analysed included articles from a structured search of PubMed, Embase, PsycINFO, Scopus, CINAHL and Cochrane Databases using thematic and content analyses. The themes and categories identified were compared and combined using the Funnelling Process to create domains that guide the discussion that follows. Results Seventy-eight thousand five hundred seventy-five abstracts were identified, 645 articles were reviewed, and 127 articles were included. The three domains identified were definitions of dignity, influences upon perceptions of dignity, and dignity conserving care. Conclusions This SSR in SEBA affirms the notion that dignity is intimately entwined with self-concepts of personhood and that effective dignity conserving measures at the end of life must be guided by the patient’s concept of dignity. This SSR in SEBA posits that such personalised culturally sensitive, and timely support of patients, their family and loved ones may be possible through the early and longitudinal application of a RToP based tool. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01004-4.
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Affiliation(s)
- Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Yun Xue Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Chloe Keyi Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Jieyu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Darius Wei Jun Wan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Simone Meiqi Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Chi Sum Chong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Kennan Zhi Guang Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Laura Shih Hui Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Ray Meng See
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Min Chiam
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Jamie Xuelian Zhou
- Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.,Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore. .,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore. .,Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore. .,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore. .,Academic Palliative Care Unit, United Kingdom Cancer Research Centre, University of Liverpool, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK. .,Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore. .,The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Keisari S, Piol S, Orkibi H, Elkarif T, Mola G, Testoni I. Spirituality During the COVID-19 Pandemic: An Online Creative Arts Intervention With Photocollages for Older Adults in Italy and Israel. Front Psychol 2022; 13:897158. [PMID: 35783728 PMCID: PMC9245519 DOI: 10.3389/fpsyg.2022.897158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
The present study aimed to examine how expressions of spirituality were stimulated and reflected in an online creative arts intervention for older adults during COVID-19 lockdowns. The online process focused on the creation of digital photocollages together with narrative elements of dignity therapy. Twenty-four Israeli and Italian community-dwelling older adults aged 78–92 participated in a three-session online intervention involving the production of three photocollages. The visual and verbal data (participants’ chosen photos and photocollages, and transcripts of the sessions) were qualitatively analyzed within an abductive framework. Four themes were generated, representing the four domains of spirituality that were stimulated by and expressed in the process: (1) Connectedness with the self, (2) connectedness with others, (3) connectedness with the environment, and (4) connectedness with the transcendent. The findings show how photographs can serve as projective visual stimuli which elicit personal content through spontaneous thinking, and they reveal the multifaceted nature of spirituality, wherein each domain nourishes the others. Overall, the findings illustrate how creative arts intervention guided by the tenets of dignity therapy can contribute to the spiritual care of older adults during periods of social isolation, or to the spiritual support provided in palliative care.
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Affiliation(s)
- Shoshi Keisari
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
- The Centre for Research and Study of Aging, University of Haifa, Haifa, Israel
- The Emily Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, Padua, Italy
- *Correspondence: Shoshi Keisari,
| | - Silvia Piol
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, Padua, Italy
| | - Hod Orkibi
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
- The Emily Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
| | - Talia Elkarif
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Giada Mola
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, Padua, Italy
| | - Ines Testoni
- The Emily Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, Padua, Italy
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9
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Keisari S, Piol S, Elkarif T, Mola G, Testoni I. Crafting Life Stories in Photocollage: An Online Creative Art-Based Intervention for Older Adults. Behav Sci (Basel) 2021; 12:1. [PMID: 35049612 PMCID: PMC8773113 DOI: 10.3390/bs12010001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/03/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Creative arts therapies (CAT) provide a safe and creative environment for older adults to process life experiences and maintain personal growth while aging. There is a growing need to make creative arts therapies more accessible to the aging population, as many have limited access to these services. This need has been catalyzed by the advent of the COVID-19 pandemic. Tele-CAT offers a possible solution. This study explored the experiences of older adults who participated in an online creative process of digital photocollage based on CAT. Twenty-four Italian and Israeli community-dwelling older adults aged 78 to 92 participated in this research through Zoom teleconferencing software. Transcriptions of the sessions and the art produced through the photocollage were qualitatively analyzed through Thematic Analysis. The findings show that the projective stimuli of digital photographs supported older adults' narratives and engaged them in a more embodied emotional experience. Participant experiences involved artistic enjoyment within a positive and safe interaction with therapists. The creation of digital photocollages allowed the participants to process their life experiences and create an integrative view of their life, a vital developmental task in late life. These results point to the advantages and challenges of tele-CAT for older adults.
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Affiliation(s)
- Shoshi Keisari
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy; (S.P.); (G.M.); (I.T.)
- School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel;
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Silvia Piol
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy; (S.P.); (G.M.); (I.T.)
| | - Talia Elkarif
- School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel;
| | - Giada Mola
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy; (S.P.); (G.M.); (I.T.)
| | - Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy; (S.P.); (G.M.); (I.T.)
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
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10
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Crawford GB, Dzierżanowski T, Hauser K, Larkin P, Luque-Blanco AI, Murphy I, Puchalski CM, Ripamonti CI. Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines. ESMO Open 2021; 6:100225. [PMID: 34474810 PMCID: PMC8411064 DOI: 10.1016/j.esmoop.2021.100225] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 02/08/2023] Open
Abstract
•This ESMO Clinical Practice Guideline provides key recommendations for end-of-life care for patients with advanced cancer. •It details care that is focused on comfort, quality of life and approaching death of patients with advanced cancer. •All recommendations were compiled by a multidisciplinary group of experts. •Recommendations are based on available scientific data and the authors’ collective expert opinion.
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Affiliation(s)
- G B Crawford
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - T Dzierżanowski
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - K Hauser
- Palliative and Supportive Care Department Cabrini Health, Prahran, Victoria, Australia
| | - P Larkin
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - A I Luque-Blanco
- Palliative Care Unit, Hospital Sant Joan de Déu, Palma de Mallorca, Spain
| | - I Murphy
- Marymount University Hospital and Hospice, Curraheen, Cork, Ireland
| | - C M Puchalski
- Department of Medicine and Health Sciences, The George Washington University School of Medicine and Health Sciences, Washington, USA
| | - C I Ripamonti
- Oncology-Supportive Care in Cancer Unit, Department Onco-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Milan, Italy
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11
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Waring DR. Telling it like it was: dignity therapy and moral reckoning in palliative care. THEORETICAL MEDICINE AND BIOETHICS 2021; 42:25-40. [PMID: 34382133 DOI: 10.1007/s11017-021-09542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 06/13/2023]
Abstract
This article offers a conceptual analysis of self-respect and self-esteem that informs the ethics of psychotherapy in palliative care. It is focused on Chochinov's Dignity Therapy, an internationally recognized treatment offered to dying patients who express a need to bolster their sense of self-worth. Although Dignity Therapy aims to help such patients affirm their value through summarized life stories that are shared with their survivors, it is not grounded in a robust theory of self-respect. There is reason to be skeptical about deathbed narratives, and Dignity Therapy can unintentionally encourage distorted representations at odds with the self-respect it aims to affirm. Dignity therapy can also encourage distortions of self-esteem that are in conflict with self-respect. Although Chochinov does not address it, the distinction between self-respect and self-esteem is relevant to deathbed accounts. Dillon's feminist revisioning of self-respect can inform the practice of Dignity Therapy by encouraging honest life stories through a reckoning with one's moral complexity, especially in moral generativity cases where patients seek forgiveness, relate atonement, or present their lives as examples to be followed. Her concept of self-esteem allows for therapeutic benefits that are less demanding, but no less significant, than those derived from a moral reckoning. Appropriate affirmations of self-esteem can provide much-needed solace when self-respect is damaged beyond adequate repair. Dillon's account of self-respect and self-esteem enables a richer understanding of the kinds of personal evaluation and disclosure that Dignity Therapy accommodates. As such, their place in Dignity Therapy needs more critical evaluation than it has received.
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Affiliation(s)
- Duff R Waring
- Philosophy Department, York University, Toronto, ON, M3J 1P3, Canada.
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12
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Weru J, Gatehi M, Musibi A. Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life. BMC Palliat Care 2020; 19:114. [PMID: 32703307 PMCID: PMC7379366 DOI: 10.1186/s12904-020-00614-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 07/05/2020] [Indexed: 01/29/2023] Open
Abstract
Background Palliative care is a modality of treatment that addresses physical, psychological and spiritual symptoms. Dignity therapy, a form of psychotherapy, was developed by Professor Harvey Chochinov, MD in 2005.The aim of the study was to assess the effect of one session of dignity therapy on quality of life in advanced cancer patients. Methods This was a randomized control trial of 144 patients (72 in each arm) randomized into group 1 (intervention arm) and group 2 (control arm). Baseline ESAS scores were determined in both arms following which group 1 received Dignity therapy while Group 2 received usual care only. Data collected was presented as printed (Legacy) documents to group 1 participants. These documents were a summary of previous discussions held. Post intervention ESAS scores were obtained in both groups after 6 weeks. Analysis was based on the intention to treat principle and descriptive statistics computed. The main outcome was symptom distress scores on the ESAS (summated out of 100 and symptom specific scores out of 10). The student T-test was used to test for difference in ESAS scores at follow up and graphs were computed for common cancers and comorbidities. Results Of the 144 (72 patients in each arm) patients randomized, 70%were female while 30% were male with a mean age of 50 years. At 6 weeks, 11 patients were lost to follow up, seven died and 126 completed the study. The commonly encountered cancers were gastrointestinal cancers (43%, p = 0.29), breast cancer (27.27% p = 0.71) and gynaecologic cancers (23% p = 0.35). Majority of the patients i.e. 64.3% had no comorbidities. The primary analysis results showed higher scores for the DT group (change in mean = 1.57) compared to the UC group (change in mean = − 0.74) yielding a non-statistically significant difference in change scores of 1.44 (p = 0.670; 95% CI − 5.20 to 8.06). After adjusting for baseline scores, the mean (summated) symptom distress score was not significant (GLM p = 0.78). Dignity therapy group showed a trend towards statistical improvement in anxiety (p = 0.059). The largest effects seen were in improvement of appetite, lower anxiety and improved wellbeing (Cohen effect size 0.3, 0.5 and 0.31 respectively). Conclusion Dignity therapy showed no statistical improvement in overall quality of life. Symptom improvement was seen in anxiety and this was a trend towards statistical significance (p = 0.059). Trial registration Trial registration number PACTR201604001447244 retrospectively registered with Pan African Clinical trials on 28th January 2016.
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Affiliation(s)
- John Weru
- Palliative care, AKUHN, Nairobi, Kenya.
| | | | - Alice Musibi
- Oncology, Kenyatta National Hospital, Nairobi, Kenya
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13
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Meikle SE, Liknaitzky P, Rossell SL, Ross M, Strauss N, Thomas N, Murray G, Williams M, Castle DJ. Psilocybin-assisted therapy for depression: How do we advance the field? Aust N Z J Psychiatry 2020; 54:225-231. [PMID: 31752499 DOI: 10.1177/0004867419888575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the quest for new treatment options for depression, attention is being paid to the potential role of psychedelic drugs. Psilocybin is of particular interest given its mechanism of action, its benefits in early trials and its relatively low side effects burden. This viewpoint outlines a number of key issues that remain to be elucidated about its potential use in the clinical environment, including clarification of the profile of people most likely to benefit and those who might experience adverse effects, longer-term outcomes and the role of psychotherapeutic input alongside the drug itself. There are also opportunities to understand better, the neurobiology underpinning its effects.
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Affiliation(s)
- Sally E Meikle
- Melbourne School of Psychological Science, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Liknaitzky
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, Hawthorn, VIC, Australia
| | - Margaret Ross
- Department of Psychosocial Cancer Care and Palliative Medicine. St Vincent's Hospital Melbourne, VIC, Australia
| | - Nigel Strauss
- Honorary Research Fellow with Psychiatry, University of Melbourne, Millswyn Psychiatric Clinic, South Yarra, VIC, Australia
| | - Neil Thomas
- School of Psychology, Deakin University, Burwood, VIC, Australia.,Centre for Mental Health, Swinburne University, Hawthorn, VIC, Australia
| | - Greg Murray
- School of Psychology, Deakin University, Burwood, VIC, Australia.,Centre for Mental Health, Swinburne University, Hawthorn, VIC, Australia
| | - Martin Williams
- Medicinal Chemistry and Drug Action, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - David J Castle
- Department of Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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14
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Roikjær SG, Missel M, Bergenholtz HM, Schønau MN, Timm HU. The use of personal narratives in hospital-based palliative care interventions: An integrative literature review. Palliat Med 2019; 33:1255-1271. [PMID: 31368845 DOI: 10.1177/0269216319866651] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People living with life-threatening illness experience unmet existential needs despite the growing research and clinical field of palliative care. Narrative interventions show promise in managing these problems, but more knowledge is needed on the characteristics of narrative interventions and the feasibility of using personal narratives in a hospital. AIM To review the literature on personal narratives in hospital-based palliative care interventions and to strengthen palliative care practices. DESIGN We conducted a systematic integrative review with qualitative analysis and narrative synthesis in accordance with PRISMA where applicable (PROSPERO#:CRD42018089202). DATA SOURCES We conducted a systematic search in PubMed, Embase, Scopus, Cinahl, SocINDEX and PsychInfo for primary research articles published until June 2018. We assessed full-text articles against the eligibility criteria followed by a discussion of quality using the Critical Appraisal Skills Programme. RESULTS Of 480 articles, we found 24 eligible for this review: 8 qualitative, 14 quantitative and 2 mixed methods. The articles reported on dignity therapy, legacy building, outlook, short-term life review and life review. Data analysis resulted in five themes: core principles, theoretical framework, content of narrative, outcome and, finally, acceptability and feasibility. CONCLUSION Various types of systematic palliative care interventions use personal narratives. Common to these is a shared psychotherapeutic theoretical understanding and aim. Clinical application in a hospital setting is both feasible and acceptable but requires flexibility regarding the practices of the setting and the needs of the patient.
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Affiliation(s)
- Stine Gundtoft Roikjær
- Clinical Studies, University of Southern Denmark, Odense, Denmark.,Department of Medicine 2, Naestved, Slagelse and Ringsted Hospitals, Slagelse, Denmark.,Knowledge Centre for Rehabilitation and Palliative Care, REHPA, Nyborg, Denmark
| | - Malene Missel
- Department of Thoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Heidi Maria Bergenholtz
- Knowledge Centre for Rehabilitation and Palliative Care, REHPA, Nyborg, Denmark.,Department of Medicine and Surgery, Holbaek Hospital, Holbaek, Denmark
| | - Mai Nanna Schønau
- Department of Thoracic Surgery, Rigshospitalet, Copenhagen, Denmark.,Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Helle Ussing Timm
- Clinical Studies, University of Southern Denmark, Odense, Denmark.,Knowledge Centre for Rehabilitation and Palliative Care, REHPA, Nyborg, Denmark
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15
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Effect of Life Review on Quality of Life in Terminal Patients: A Systematic Review and Meta-Analysis. J Nurs Res 2019; 28:e83. [PMID: 31246646 DOI: 10.1097/jnr.0000000000000335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Enhancing quality of life takes precedence in the terminal stage of a disease, when a cure is considered impossible and all alternative methods to prevent disease progression have been exhausted. Life review, involving appreciating accomplishments and resolving conflicts, is widely considered to be an effective approach to bringing peace to terminal patients. PURPOSE This study was conducted to assess the effects of life review on quality of life in terminal patients. METHODS The Cochrane Library, PubMed, MEDLINE, CINAHL, CEPS, and ProQuest databases were searched for original studies published between 2007 and July 2018. Studies that used experimental designs to assess the effects of life review on quality of life in terminal patients, involved patients aged >18 years, and were published in English or Chinese were considered eligible for inclusion. Studies that measured quality of life in individuals other than patients as well as unpublished papers or data were excluded. The search terms used included "life review," "end of life," "terminal or terminally ill," "advanced cancer," "palliative," "hospice," and "quality of life." The quality of each included study was assessed using the Downs and Black checklist. RESULTS Six studies with 296 patients were included in the review. The participants in the included studies were from multiple countries. Life review was found to affect quality of life significantly (95% CI [0.147, 0.668], Z = 3.062, p < .05). The selected studies exhibited moderate heterogeneity (I = 42.407, p > .1). CONCLUSIONS Life review was found to affect quality of life significantly in the participants in the included studies. The feasibility and safety of applying life review interventions should be considered for terminal patients, and implementers of these interventions should be trained and qualified. Only a few studies in the literature have evaluated the effects of life review therapy in terminal patients. Further studies that use stricter selection criteria are necessary to evaluate the efficacy of the life review intervention before its adoption in clinical practice.
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16
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Skinner S, Bonnet K, Schlundt D, Karlekar M. Life Story Themes: A Qualitative Analysis of Recordings From Patients Approaching the End of Life. Am J Hosp Palliat Care 2019; 36:753-759. [PMID: 31117801 DOI: 10.1177/1049909119851717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify common themes and topics that patients nearing the end of life want to discuss when sharing their life stories. METHODS Twenty audio-recorded transcripts of open-ended interviews of patients cared for by a palliative care team when approaching the end of life were analyzed using a qualitative analysis. RESULTS Qualitative analysis revealed that the primary contextual factors that patients drew upon to generate his or her life story are life events (including upbringing, job, education, travel, trauma, hardships, special events, military history, and hobbies), family and support system, and values and beliefs. Participants used their current medical condition, which included mortality, morbidity, and prognosis, to frame their life story. CONCLUSION Patients facing serious illness incorporate four major themes when reflecting upon their lives to create their personal life story: life events, family and support system, values and beliefs, and current medical condition.
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Affiliation(s)
- Shannon Skinner
- 1 Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kemberlee Bonnet
- 2 Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - David Schlundt
- 2 Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Mohana Karlekar
- 1 Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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17
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Cao Y, Li WW, Xue Y. Dying and relational aftermath concerns among terminal cancer patients in China. DEATH STUDIES 2019; 44:586-595. [PMID: 31058583 DOI: 10.1080/07481187.2019.1609135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The need to make sense of one's mortality is of central concern for death studies. We aimed to explore the meaning of aftermath concerns in the process of preparing for death. Using a qualitative approach, we explored aftermath concerns among 25 participants with terminal cancer in China. Three aftermath concern themes were developed from the participants' narratives: mental concerns about parents, material concerns about children, and spiritual concerns about the self. Aftermath concerns are relational because they are not about what happens within an individual, but between individuals which are manifested within the broader cultural, social, economic, and political contexts.
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Affiliation(s)
- Yanmei Cao
- Department of Psychology, Shanxi Medical University, Taiyuan, China
| | - Wendy Wen Li
- Department of Psychology, James Cook University, Townsville, Australia
| | - Yunzhen Xue
- Department of Psychology, Shanxi Medical University, Taiyuan, China
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18
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Woodgate RL. Living in a World without Closure: Reality for Parents who have Experienced the Death of a Child. J Palliat Care 2019. [DOI: 10.1177/082585970602200203] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The death of a child has been described as being for parents one of the most traumatic of losses. Nevertheless, information about how parents experience transition through the death trajectory is lacking. This phenomenological study explored parents’ lived experienced of transitioning through the death of a child. Twenty-eight bereaved parents (17 mothers, 11 fathers) took part in retrospective, open-ended interviews. Findings showed that, regardless of the time, parents continued to live in a world without closure and, more importantly, did not want to experience closure in their transitioning. To parents, “closure” meant an end to their child in every sense of the word. Their experience of living in a world without closure was supported by four themes: “keeping the memories alive”, “being a good parent”, “being there at my child's death”, and “being there for me after my child dies”. Findings yield new insights into how parents live with the death of a child.
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Affiliation(s)
- Roberta Lynn Woodgate
- Child Health and Illness, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
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19
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Affiliation(s)
- Ruth Macklin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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20
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Warth M, Kessler J, Koehler F, Aguilar-Raab C, Bardenheuer HJ, Ditzen B. Brief psychosocial interventions improve quality of life of patients receiving palliative care: A systematic review and meta-analysis. Palliat Med 2019; 33:332-345. [PMID: 30648926 DOI: 10.1177/0269216318818011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Patients with a terminal disease report a high need for psychosocial and spiritual support. Previous literature reviews on psychosocial interventions in palliative care were restricted to certain subtypes of techniques, included a wide range of patients, conditions, and settings, or required a number of sessions unrealistic to be achieved in patients nearing the end of their lives. Aim: The aim of this study was to review and synthesize the evidence on brief psychosocial interventions (i.e. four sessions or less and less than 21 days) for patients receiving palliative treatment. Design: We performed a systematic review and meta-analysis in accordance with standard guidelines and a pre-registered protocol (PROSPERO: CRD42018082713). Data sources: Electronic databases, journals, and references were searched for controlled clinical trials. We used the Cochrane criteria to assess the risk of bias within studies. Results: In total, 15 studies met the eligibility criteria and reported the effects of 17 interventions and a total of 1248 patients. The most frequently used techniques were life review techniques and music therapy. After exclusion of outliers, psychosocial interventions showed to be superior with regard to the improvement of quality of life (effect size = 0.36, confidence interval = 0.08 to 0.64), and the reduction of emotional (effect size = −0.51, confidence interval = −0.77 to −0.26) and existential distress (effect size = −0.40, confidence interval = −0.71 to −0.07) compared to the control groups. Conclusion: Brief psychosocial interventions can improve clinically relevant health outcomes and should therefore be made available for patients receiving palliative care.
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Affiliation(s)
- Marco Warth
- 1 Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens Kessler
- 2 Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Friederike Koehler
- 1 Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Corina Aguilar-Raab
- 1 Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hubert J Bardenheuer
- 2 Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- 1 Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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21
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Franco ME, Salvetti MDG, Donato SCT, Carvalho RTD, Franck EM. PERCEPTION OF DIGNITY OF PATIENTS IN PALLIATIVE CARE. ACTA ACUST UNITED AC 2019. [DOI: 10.1590/1980-265x-tce-2018-0142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: to understand the perception of dignity of patients in palliative care and to identify factors that may increase or decrease the sense of dignity. Method: an exploratory study with a qualitative approach, carried in a Palliative Care Center in São Paulo (Brazil), with the Chochinov’s Dignity Model as theoretical framework and content analysis as methodological framework. The participants of this study were 20 patients in palliative care, assessed through semi-structured interviews based on three questions: "What is dignity for you?", "What increases your dignity?", "What decreases your dignity?" The interviews were recorded with the patients’ authorization, from September to November 2017, and transcribed for content analysis. Results: the analysis of the perception of dignity allowed the identification of three categories: Correct person, Autonomy/independence and Socio-political factors. The factors that increased the sense of dignity were the following: Care, Independence/autonomy, Leisure/positive thinking/being with friends. And those that decreased it were the following: Behaviors/attitudes, Health status and Economic situation. Conclusion: the perception of dignity of patients in palliative care was influenced by health professionals and caregivers. Being a “correct person”, maintaining autonomy, being cared for and respected has increased the sense of dignity. Urban violence and the lack of compliance with accessibility policies have reduced the sense of dignity among palliative care patients.
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22
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Johnston J, Hillier LM, Purdon M, Pears D, Robson M. Opportunities for Improving the Quality of life of Dying Persons: Use of Technology to Connect People at the end of Life. J Palliat Care 2018. [DOI: 10.1177/082585971202800309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julie Johnston
- LM Hillier (corresponding author): Specialized Geriatric Services, St. Joseph's Health Care London, and Aging, Rehabilitation and Geriatric Care Research Centre of the Lawson Health Research Institute, 801 Commissioners Road East, London, Ontario, Canada N6C 5J1
| | - Loretta M. Hillier
- J Johnston: Palliative Pain and Symptom Management Consultation Program Southwestern Ontario, London, Ontario, Canada
| | - Maura Purdon
- M Purdon: Hospice Palliative Care, Cross-Sector Education, Erie St. Clair Community Care Access Centre, Chatham, Ontario, Canada
| | - Dawn Pears
- M Purdon: Hospice Palliative Care, Cross-Sector Education, Erie St. Clair Community Care Access Centre, Chatham, Ontario, Canada
| | - Monica Robson
- D Pears: Hospice of Windsor and Essex County, Windsor, Ontario, Canada; M Robson: St. Joseph's Hospice of Sarnia Lambton, Sarnia, Ontario, Canada
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23
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Dealing with Palliative Care Patients’ Incomplete Music Therapy Legacies: Reflexive Group Supervision Research. J Palliat Care 2018. [DOI: 10.1177/082585970902500307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Legacies encompass treasured memories and items such as wills, publications, and songs, which help to validate lives. Legacy creation is encouraged by palliative care staff to help patients deal with loss and find personal meaning; the legacy works may also support the bereaved. Within the literature, however, there is no consideration of how staff deal with patients’ incomplete legacies when patients relocate, deteriorate, or die. Our research focuses on this question: What experiences did four music therapists have with palliative care patients’ incomplete tangible music therapy legacies? Data included transcripts from the therapists’ discussions about patients’ incomplete legacies in three reflexive group supervision sessions and further reflections written during transcript verification. Inductive thematic analysis yielded five themes: the nature of incomplete music therapy legacies; reasons for and feelings about these legacies; factors determining what music therapists do with them; considerations about their future “life”; and the ways therapists’ shared reflections can support their future legacy work.
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24
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Affiliation(s)
- Raymond Viola
- Division of Palliative Medicine, Department of Medicine, Queen's University, 34 Barrie Street, Kingston, Ontario, Canada K7L 3J7
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Yaakobi E. Encounters with offspring help terminally ill adult patients cope with death anxiety. DEATH STUDIES 2018; 42:89-95. [PMID: 28541814 DOI: 10.1080/07481187.2017.1334005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This overview of recent work drawing on the theories of terror management and symbolic immortality suggests practical ways of helping the terminally ill to cope with death anxiety and its potential effects. The literature review shows that parenthood can act as an anxiety buffer mechanism against the fear of death but that individual differences, including attachment avoidance, moderate this association. Encounters with adult patients' offspring may help minimize fear of death, improve coping, and increase quality of life and emotional well-being. Practical suggestions for psychologists, social workers and physicians are presented.
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Affiliation(s)
- Erez Yaakobi
- a Business Administration , Ono Academic College , Kiryat Ono , Israel
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Endrizzi C, Duglio E, Govoni RM. Body language and metaphors revealed through applications of Movement Psychotherapy in a hospice: A clinical case of refractory pruritis. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2017. [DOI: 10.1080/13642537.2017.1386222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Elena Duglio
- ASL Al, Palliative Home Care, Alessandria, Italy
| | - Rosa Maria Govoni
- Institute of Expressive Psychotherapy Integrated to Art and Dance Movement Therapy, Bologna, Italy
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Abstract
Recently, death anxiety, or dread of death, has been proposed as a key transdiagnostic process underlying the anxiety disorders, depressive disorders, somatic disorders, and trauma and stressor-related disorders. In fact, it has been argued that death anxiety underlies all psychopathology, and is more fundamental than perfectionism, a process which was previously considered the root of mental illness. However, there has been a paucity of research examining the relationship between death anxiety and the eating disorders, although these conditions have been found to be strongly related to perfectionism. The present study therefore aimed to examine whether death anxiety is related to disordered eating, and whether death anxiety is a better predictor of disordered eating than perfectionism. A sample of 164 participants (132 female), average age 33.55 years (SD= 15.45 years), completed an online survey comprising background questions (age, sex, diagnosed psychiatric disorder), the Eating Attitudes Test — 26 item version (EAT-26), the Almost Perfect Scale — Revised (APS-R), the Rosenberg Self-Esteem Scale (RSES), and the Death Anxiety Scale (DAS). The findings of a hierarchical multiple regression analysis with EAT-26 as the dependent variable, age entered at Step 1, the RSES and APS-R entered at Step 2, and the DAS entered at Step 3 showed that only death anxiety and self-esteem were independent predictors of disordered eating at Step 3. A simultaneous multiple regression analysis was subsequently run with age and the APS-R alone as predictors of EAT-26 scores. This analysis showed that perfectionism was only a predictor of disordered eating when death anxiety and self-esteem were not included in the regression model. Death anxiety and self-esteem both appear to be important transdiagnostic processes.
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Hemati Z, Ashouri E, AllahBakhshian M, Pourfarzad Z, Shirani F, Safazadeh S, Ziyaei M, Varzeshnejad M, Hashemi M, Taleghani F. Dying with dignity: a concept analysis. J Clin Nurs 2016; 25:1218-28. [DOI: 10.1111/jocn.13143] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Zeinab Hemati
- Nursing and Midwifery Care Research Center; Faculty of Nursing and Midwifery; Isfahan University of Medical Sciences; Isfahan Iran
| | - Elaheh Ashouri
- Nursing and Midwifery Care Research Center; Faculty of Nursing and Midwifery; Isfahan University of Medical Sciences; Isfahan Iran
| | - Maryam AllahBakhshian
- Nursing and Midwifery Care Research Center; Faculty of Nursing and Midwifery; Isfahan University of Medical Sciences; Isfahan Iran
| | - Zahra Pourfarzad
- Nursing and Midwifery Care Research Center; Faculty of Nursing and Midwifery; Isfahan University of Medical Sciences; Isfahan Iran
| | - Farimah Shirani
- Nursing and Midwifery Care Research Center; Faculty of Nursing and Midwifery; Isfahan University of Medical Sciences; Isfahan Iran
| | - Shima Safazadeh
- Nursing and Midwifery Care Research Center; Faculty of Nursing and Midwifery; Isfahan University of Medical Sciences; Isfahan Iran
| | - Marziyeh Ziyaei
- Department of Nursing; Faculty of Nursing and Midwifery; Isfahan (Khorasgan) Branch; Islamic Azad University; Isfahan Iran
| | - Maryam Varzeshnejad
- Nursing and Midwifery Care Research Center; Faculty of Nursing and Midwifery; Isfahan University of Medical Sciences; Isfahan Iran
| | - Maryam Hashemi
- Nursing and Midwifery Care Research Center; Faculty of Nursing and Midwifery; Isfahan University of Medical Sciences; Isfahan Iran
| | - Fariba Taleghani
- Nursing and Midwifery Care Research Center; Faculty of Nursing and Midwifery; Isfahan University of Medical Sciences; Isfahan Iran
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Endrizzi C, Ghelleri V, Palella M, D’Amico G. Movement psychotherapy in a hospice: Two case studies. BODY MOVEMENT AND DANCE IN PSYCHOTHERAPY 2016. [DOI: 10.1080/17432979.2015.1110534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Scheffold K, Philipp R, Engelmann D, Schulz-Kindermann F, Rosenberger C, Oechsle K, Härter M, Wegscheider K, Lordick F, Lo C, Hales S, Rodin G, Mehnert A. Efficacy of a brief manualized intervention Managing Cancer and Living Meaningfully (CALM) adapted to German cancer care settings: study protocol for a randomized controlled trial. BMC Cancer 2015; 15:592. [PMID: 26286128 PMCID: PMC4545321 DOI: 10.1186/s12885-015-1589-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/30/2015] [Indexed: 12/21/2022] Open
Abstract
Background Although psycho-oncological interventions have been shown to significantly reduce symptoms of anxiety and depression and enhance quality of life, a substantial number of patients with advanced cancer do not receive psycho-oncological interventions tailored to their individual situation. Given the lack of reliable data on the efficacy of psycho-oncological interventions in palliative care settings, we aim to examine the efficacy of a brief, manualized individual psychotherapy for patients with advanced cancer: Managing Cancer and Living Meaningfully (CALM). CALM aims to reduce depression and death anxiety, to strengthen communication with health care providers, and to enhance hope and meaning in life. We adapted the intervention for German cancer care settings. Methods/Design We use a single-blinded randomized-controlled trial design with two treatment conditions: intervention group (IG, CALM) and control group (CG). Patients in the CG receive a usual non-manualized supportive psycho-oncological intervention (SPI). Patients are randomized between the IG and CG and assessed at baseline (t0), after three (t1) and after 6 months (t2). We include patients with a malignant solid tumor who have tumor stages of III or IV (UICC classification). Patients who are included in the study are at least 18 years old, speak German fluently, score greater than or equal to nine on the PHQ-9 or/and greater than or equal to five on the Distress Thermometer. It is further necessary that there is no evidence of severe cognitive impairments. We measure depression, anxiety, distress, quality of life, demoralization, symptom distress, fatigue as well as spiritual well-being, posttraumatic growth and close relationship experiences using validated questionnaires. We hypothesize that patients in the IG will show a significantly lower level of depression 6 months after baseline compared to patients in the CG. We further hypothesize a significant reduction in anxiety and fatigue as well as significant improvements in psychological and spiritual well-being, meaning and post-traumatic growth in the IG compared to CG 6 months after baseline. Discussion Our study will contribute important statistical evidence on whether CALM can reduce depression and existential distress in a German sample of advanced and highly distressed cancer patients. Trial registration ClinicalTrials.gov NCT02051660
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Affiliation(s)
- Katharina Scheffold
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Rebecca Philipp
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Dorit Engelmann
- Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Philipp-Rosenthal-Strasse 55, Leipzig, 04103, Germany.
| | - Frank Schulz-Kindermann
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Christina Rosenberger
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Karin Oechsle
- Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Martin Härter
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Florian Lordick
- University Medical Center Leipzig, University Cancer Center Leipzig (UCCL), Liebigstrasse 20, Leipzig, 04103, Germany.
| | - Chris Lo
- Department of Supportive Care, 16-724, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Sarah Hales
- Department of Supportive Care, 16-724, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Gary Rodin
- Department of Supportive Care, 16-724, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Philipp-Rosenthal-Strasse 55, Leipzig, 04103, Germany.
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Fitchett G, Emanuel L, Handzo G, Boyken L, Wilkie DJ. Care of the human spirit and the role of dignity therapy: a systematic review of dignity therapy research. BMC Palliat Care 2015; 14:8. [PMID: 25844066 PMCID: PMC4384229 DOI: 10.1186/s12904-015-0007-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/04/2015] [Indexed: 12/03/2022] Open
Abstract
Background Dignity Therapy (DT), an intervention for people facing serious illness, focuses on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document for loved ones. Research on DT began more than a decade ago and has been conducted in 7 countries, but a systematic review of DT research has not been published. Methods Using a PubMed search with key terms of ‘dignity therapy’, ‘dignity psychotherapy’, ‘Chochinov’, and ‘dignity care’, we found 29 articles on DT and retained 25 after full-text review. Results Of these, 17 articles representing 12 quantitative studies establish that patients who receive DT report high satisfaction and benefits for themselves and their families, including increased sense of meaning and purpose. The effects of DT on physical or emotional symptoms, however, were inconsistent. Conclusions Conclusions point to three areas for future research on DT, to determine: (1) whether the DT intervention exerts an impact at a spiritual level and/or as a life completion task; (2) how DT should be implemented in real world settings; and (3) if DT has an effect on the illness experience within the context of not only the patient, but also the family and community. Building on this body of DT research, investigators will need to continue to be sensitive as they involve participants in DT studies and innovations to facilitate the generation and delivery of legacy documents to participants near the end of life.
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Affiliation(s)
- George Fitchett
- Rush University Medical Center, 630 S. Hermitage Ave. Suite 505, Chicago, IL 60612 USA
| | - Linda Emanuel
- Buehler Center on Health, Aging & Society Northwestern University, 750N Lake Shore Dr. Suite 601, Chicago, IL 60611 USA
| | - George Handzo
- HealthCare Chaplaincy Network, 65 Broadway, 12th Floor, New York, NY 10006 USA
| | - Lara Boyken
- Buehler Center on Health, Aging & Society Northwestern University, 750N Lake Shore Dr. Suite 601, Chicago, IL 60611 USA
| | - Diana J Wilkie
- Center of Excellence for End-of-Life Transition Research, University of Illinois at Chicago College of Nursing, 845S. Damen Ave., M/C 802, Chicago, IL 60612 USA
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Gillies JM, Neimeyer RA, Milman E. The Grief and Meaning Reconstruction Inventory (GMRI): Initial Validation of a New Measure. DEATH STUDIES 2015; 39:61-74. [PMID: 25140919 DOI: 10.1080/07481187.2014.907089] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although increasing numbers of grief theorists, researchers, and therapists have begun to focus on the quest for meaning in lives disrupted by loss, no convenient and psychometrically validated measure of meanings made specifically in bereavement has been available to guide their efforts. To construct such a measure, the authors began with a systematic content analysis of sense-making, benefit finding, and identity reconstruction themes gleaned from the narrative responses of a sample of 162 adults who were diverse in their age, ethnicity, relationship to the decedent, cause of death, and severity of their grief response. These were then formulated into a set of 65 candidate items in a Likert scale format representing the level of the respondent's endorsement of the item in the past week. Subsequent administration to a second sample of 300 bereaved respondents permitted factor analysis of this pilot version of the Grief and Meaning Reconstruction Inventory (GMRI), and reduced the items to 29, which loaded on 5 distinct factors, labeled Continuing Bonds, Personal Growth, Sense of Peace, Emptiness and Meaninglessness, and Valuing Life. Both the overall GMRI and its constituent factors showed good internal consistency and strong convergent validity in the form of negative correlations with established measures of bereavement-related negative emotions, symptoms of complicated grief, and more general psychological distress and mental health symptomatology, and positive correlations with grief related personal growth. The authors close by noting several specific research and clinical applications of the measure, which could play a useful role in testing and refining contemporary models of meaning made in the wake of loss.
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Affiliation(s)
- James M Gillies
- a New Mexico VA Healthcare System , Albuquerque , New Mexico , USA
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Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clin Psychol Rev 2014; 34:580-93. [DOI: 10.1016/j.cpr.2014.09.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 08/15/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022]
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Abstract
OBJECTIVE Hospice patients often struggle with loss of meaning, while many experience meaningful dreams. The purpose of this study was to conduct a preliminary exploration into the process and therapeutic outcomes of meaning-centered dream work with hospice patients. METHOD A meaning-centered variation of the cognitive-experiential model of dream work (Hill, 1996; 2004) was tested with participants. This variation was influenced by the tenets of meaning-centered psychotherapy (Breitbart et al., 2012). A total of 12 dream-work sessions were conducted with 7 hospice patients (5 women), and session transcripts were analyzed using the consensual qualitative research (CQR) method (Hill, 2012). Participants also completed measures of gains from dream interpretation in terms of existential well-being and quality of life. RESULTS Participants' dreams generally featured familiar settings and living family and friends. Reported images from dreams were usually connected to feelings, relationships, and the concerns of waking life. Participants typically interpreted their dreams as meaning that they needed to change their way of thinking, address legacy concerns, or complete unfinished business. Generally, participants developed and implemented action plans based on these interpretations, despite their physical limitations. Participants described dream-work sessions as meaningful, comforting, and helpful. High scores on a measure of gains from dream interpretation were reported, consistent with qualitative findings. No adverse effects were reported or indicated by assessments. SIGNIFICANCE OF RESULTS Our results provided initial support for the feasibility and helpfulness of dream work in this population. Implications for counseling with the dying and directions for future research were also explored.
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Sautier LP, Vehling S, Mehnert A. Assessment of patients' dignity in cancer care: preliminary psychometrics of the German version of the Patient Dignity Inventory (PDI-G). J Pain Symptom Manage 2014; 47:181-8. [PMID: 23830532 DOI: 10.1016/j.jpainsymman.2013.02.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 02/07/2013] [Accepted: 02/18/2013] [Indexed: 11/12/2022]
Abstract
CONTEXT The Patient Dignity Inventory (PDI) is a valid and reliable instrument designed to measure different sources of dignity-related distress in cancer patients receiving palliative care. OBJECTIVES We investigated item characteristics, factor structure, reliability, and concurrent validity of the German version of the PDI (PDI-G) among patients with cancer. METHODS PDI was translated into the German language following state-of-the-art criteria. In a sample of 112 inpatients with mixed tumor types, principal component analysis, reliability analysis (Cronbach's coefficient alpha), and correlation analysis were performed. Concurrent validity was evaluated by validated measures of distress, demoralization, anxiety, depression, hopelessness, quality of life, sense of meaning and purpose, and supportive care needs. RESULTS Cronbach's coefficient alpha for PDI-G was 0.96; factor analysis resulted in a four-factor solution, accounting for 71% of the overall variance, with factor loadings ranging from 0.49 to 0.86. Factor labels include Loss of Sense of Worth and Meaning, Anxiety and Uncertainty, Physical Symptom Distress and Body Image, and Loss of Autonomy, showing high internal consistencies ranging from Cronbach's α 0.80 to 0.95. Evidence for concurrent validity was established by significant associations between PDI-G scales and concurrent measures of distress. CONCLUSION Although we were unable to replicate the five-factor structure provided by Chochinov, this study gave strong support to an alternative four-factor solution of PDI-G, capturing all 25 items. We conclude that PDI-G is a psychometrically sound instrument assessing a broad range of dignity-related distress issues in patients with cancer.
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Affiliation(s)
- Leon P Sautier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Mehnert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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Beng TS, Chin LE, Guan NC, Yee A, Wu C, Jane LE, Meng CBC. Mindfulness-Based Supportive Therapy (MBST). Am J Hosp Palliat Care 2013; 32:144-60. [DOI: 10.1177/1049909113508640] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To develop a mindfulness-based palliative psychotherapy to address psychoexistential suffering in palliative care. Conceptualization: First, a theory of suffering was formulated by merging 2 models of suffering from 2 thematic analyses of 20 palliative care patients and 15 informal caregivers. Second, the results from a secondary thematic analysis of suffering caused by health care interactions were conceptualized into a psychotherapy framework. Third, principles of mindfulness were incorporated into the framework to form a mindfulness-based psychotherapy. Results: Mindfulness-based supportive therapy (MBST) was developed with the following 5 components of presence, listening, empathy, compassion, and boundary awareness. Conclusion: We believe that MBST is a potentially useful psychological intervention in palliative care, specifically designed to address psychoexistential suffering of terminally ill patients.
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Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Cathie Wu
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Lim Ee Jane
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
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Chochinov HM, McClement SE, Hack TF, McKeen NA, Rach AM, Gagnon P, Sinclair S, Taylor-Brown J. The Patient Dignity Inventory: applications in the oncology setting. J Palliat Med 2013; 15:998-1005. [PMID: 22946576 DOI: 10.1089/jpm.2012.0066] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Patient Dignity Inventory (PDI) is a novel 25-item psychometric instrument, designed to identify multiple sources of distress (physical, functional, psychosocial, existential, and spiritual) commonly seen in patients who are terminally ill. It was also designed to help guide psychosocial clinicians in their work with patients. While its validity and reliability have been studied within the context of palliative care, its utility in clinical settings has not as yet been examined. PURPOSE The purpose of this study was to determine how psychosocial oncology professionals would use the PDI with within their practice and what utility it might have across the broad spectrum of cancer. METHODS Between October 2008 and January 2009, psychosocial oncology clinicians from across Canada were invited to use the PDI to determine their impressions of this approach in identifying distress and informing their practice. RESULTS Ninety participants used the PDI and submitted a total of 429 feedback questionnaires detailing their experience with individual patients. In 76% of instances, the PDI revealed one or more previously unreported concerns; in 81% of instances, clinicians reported that the PDI facilitated their work. While it was used in a wide range of circumstances, clinicians were more inclined to apply the PDI to patients engaged in active treatment or palliation, rather than those in remission, having recently relapsed, or newly diagnosed. Besides its utility in identifying distress, the PDI enabled clinicians to provide more targeted therapeutic responses to areas of patient concern. CONCLUSIONS While this study suggests various clinical applications of the PDI, it also provides an ideal forerunner for research that will directly engage patients living with cancer.
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Affiliation(s)
- Harvey Max Chochinov
- Department of Psychiatry, Manitoba Palliative Care Research Unit, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
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Csikai EL, Weisenfluh S. Hospice and Palliative Social Workers’ Engagement in Life Review Interventions. Am J Hosp Palliat Care 2012; 30:257-63. [DOI: 10.1177/1049909112449067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Life review (LR) interventions are typically used with older adults and those nearing end of life to identify unresolved conflicts/issues, examine accomplishments, and leave lasting legacies. This study investigated the extent that hospice and palliative social workers engaged in LR with patients and their families. An Internet-based, quantitative survey was available via a hyperlink for 4 weeks and disseminated to several national social work professional organization list serves and Web sites. Of the 346 respondents, most had conducted LRs, however, frequency and scope varied. Barriers to implementation included high caseloads/lack of time, acuity of patients, and short lengths of stay. The opportunity for many individuals to bring closure at the end of life may be lost due to limited access to LR interventions.
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Affiliation(s)
- Ellen L. Csikai
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
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Neimeyer RA, Currier JM, Coleman R, Tomer A, Samuel E. Confronting suffering and death at the end of life: the impact of religiosity, psychosocial factors, and life regret among hospice patients. DEATH STUDIES 2011; 35:777-800. [PMID: 24501835 DOI: 10.1080/07481187.2011.583200] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although the role of spiritual, psychological, and social factors is receiving increasing attention in the end of life (EOL) context, we know far less than we need to about how these factors shape attitudes toward life and death in the face of looming loss. The present study begins to remedy these limitations by examining the relative impact of demographic characteristics, religious and psychosocial factors, and life regret on death attitudes and psychological wellbeing for a diverse group of 153 hospice patients. In addition to relying on well-validated quantitative assessments, qualitative interviews were conducted with participants to further illustrate the role of study factors in shaping various dimensions of death anxiety or acceptance and quality of life. In general, results showed that factors assessed in this investigation were significantly correlated with death attitudes and emotional health. When study factors were examined simultaneously, gender, ethnicity, intrinsic religiosity, social support, and future-related regret each were shown to have a unique impact on various aspects of EOL adjustment and distress. The article concludes by offering direction to researchers interested in integrating and extending the empirical study of the attitudes of adults facing serious illness, and underscoring the clinical implications of these findings for professionals offering psychosocial and spiritual care at the end of life.
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Affiliation(s)
- Robert A Neimeyer
- Department of Psychology, University of Memphis, Memphis, Tennessee 38152, USA.
| | - Joseph M Currier
- Department of Clinical Psychology, Fuller Theological Seminary, Pasadena, California, USA
| | - Rachel Coleman
- Department of Psychology, University of Memphis, Memphis, Tennessee 38152, USA
| | - Adrian Tomer
- Department of Psychology, Shippensburg University, Shippensburg, Pennsylvania, USA
| | - Emily Samuel
- Methodist Alliance Hospice, Memphis, Tennessee, USA
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Mehnert A, Braack K, Vehling S. Sinnorientierte Interventionen in der Psychoonkologie. PSYCHOTHERAPEUT 2011. [DOI: 10.1007/s00278-011-0857-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Baillie L, Gallagher A. Respecting dignity in care in diverse care settings: Strategies of UK nurses. Int J Nurs Pract 2011; 17:336-41. [DOI: 10.1111/j.1440-172x.2011.01944.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chochinov HM, Kristjanson LJ, Breitbart W, McClement S, Hack TF, Hassard T, Harlos M. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol 2011; 12:753-62. [PMID: 21741309 DOI: 10.1016/s1470-2045(11)70153-x] [Citation(s) in RCA: 411] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Dignity therapy is a unique, individualised, short-term psychotherapy that was developed for patients (and their families) living with life-threatening or life-limiting illness. We investigated whether dignity therapy could mitigate distress or bolster the experience in patients nearing the end of their lives. METHODS Patients (aged ≥18 years) with a terminal prognosis (life expectancy ≤6 months) who were receiving palliative care in a hospital or community setting (hospice or home) in Canada, USA, and Australia were randomly assigned to dignity therapy, client-centred care, or standard palliative care in a 1:1:1 ratio. Randomisation was by use of a computer-generated table of random numbers in blocks of 30. Allocation concealment was by use of opaque sealed envelopes. The primary outcomes--reductions in various dimensions of distress before and after completion of the study--were measured with the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale, Patient Dignity Inventory, Hospital Anxiety and Depression Scale, items from the Structured Interview for Symptoms and Concerns, Quality of Life Scale, and modified Edmonton Symptom Assessment Scale. Secondary outcomes of self-reported end-of-life experiences were assessed in a survey that was undertaken after the completion of the study. Outcomes were assessed by research staff with whom the participant had no previous contact to avoid any possible response bias or contamination. Analyses were done on all patients with available data at baseline and at the end of the study intervention. This study is registered with ClinicalTrials.gov, number NCT00133965. FINDINGS 165 of 441 patients were assigned to dignity therapy, 140 standard palliative care, and 136 client-centred care. 108, 111, and 107 patients, respectively, were analysed. No significant differences were noted in the distress levels before and after completion of the study in the three groups. For the secondary outcomes, patients reported that dignity therapy was significantly more likely than the other two interventions to have been helpful (χ(2)=35·50, df=2; p<0·0001), improve quality of life (χ(2)=14·52; p=0·001), increase sense of dignity (χ(2)=12·66; p=0·002), change how their family saw and appreciated them (χ(2)=33·81; p<0·0001), and be helpful to their family (χ(2)=33·86; p<0·0001). Dignity therapy was significantly better than client-centred care in improving spiritual wellbeing (χ(2)=10·35; p=0·006), and was significantly better than standard palliative care in terms of lessening sadness or depression (χ(2)=9·38; p=0·009); significantly more patients who had received dignity therapy reported that the study group had been satisfactory, compared with those who received standard palliative care (χ(2)=29·58; p<0·0001). INTERPRETATION Although the ability of dignity therapy to mitigate outright distress, such as depression, desire for death or suicidality, has yet to be proven, its benefits in terms of self-reported end-of-life experiences support its clinical application for patients nearing death. FUNDING National Cancer Institute, National Institutes of Health.
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Bruce A, Boston P. Relieving existential suffering through palliative sedation: discussion of an uneasy practice. J Adv Nurs 2011; 67:2732-40. [DOI: 10.1111/j.1365-2648.2011.05711.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
AbstractObjective:To deliver quality care at the end of life, understanding the impact of various changes and life transitions that occur in older age is essential. This review seeks to uncover potential sources of distress in an elder's physical, psychological, social, and spiritual well-being to shed light on the unique challenges and needs facing this age group.Methods:Papers relating to older adults (aged 65 years and older or a mean age of 65 years and older) with advanced/terminal cancer receiving palliative, hospice, or end-of-life care published after 1998 were reviewed.Results:Older adults with advanced cancer have unique needs related to changes in their physical, psychological, social, and spirituals well-being. Changes in each of these domains offer not only the risk of causing distress but also the potential for growth and development during the final stages of advanced cancer.Significance of results:Being aware of the various changes that occur with aging will help health care professionals tailor interventions to promote dignity-conserving care and greatly reduce the potential for suffering at the end of life.
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Abstract
Manualized reminiscence and life review therapies are supported as an evidence-based, effective treatment for depression among older adults, but this therapeutic approach is usually individually administered and has rarely been applied in palliative care settings. We combined mutual reminiscence and life review with engagement in meaningful activity and examined the efficacy of this family-based dyadic intervention to decrease caregiving stress and increase family communication. Seventeen individuals living with chronic, life-limiting illnesses in the community and their family caregivers received three home visits with a master's-level interventionist. During these sessions and through structured homework activities, the interventionist actively worked with the family to construct a personal Legacy Project, usually a scrapbook with photos, a cookbook, or audiotaped stories that celebrated the life of the ill individual. All participants in the intervention group initiated a Legacy Project and reported that Legacy activities improved family communication. Participation in Legacy creation also resulted in increased positive emotional experiences in patient and caregiver groups. These results are illustrated through careful examination of three case studies.
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Allen RS, Hilgeman MM, Ege MA, Shuster JL, Burgio LD. Legacy activities as interventions approaching the end of life. J Palliat Med 2008; 11:1029-38. [PMID: 18788966 DOI: 10.1089/jpm.2007.0294] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We examined the efficacy of an innovative family-based intervention designed to decrease caregiving stress and increase family communication among individuals with chronic, life-limiting illnesses and their family caregivers in a randomized, contact control group design. The intervention group received three home visits in which the interventionist actively worked with the family to construct a personal Legacy, usually a scrapbook with photographs or audiotaped stories. Control group families received three supportive telephone calls. Of the 42 families that entered the project, 31 families completed follow-up assessments within 9 to 10 weeks (14 control; 17 intervention; 72% African American) for a retention rate of 74%. Intervention caregivers showed reduced caregiving stress in comparison with control group caregivers, who showed increases in stress. Intervention patients reported decreased breathing difficulty and increased religious meaning. Caregivers and patients reported greater social interaction on the part of the patient. All participants in the intervention group initiated a Legacy activity and reported that Legacy improved family communication. Legacy interventions hold promise and are simple to implement.
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Affiliation(s)
- Rebecca S Allen
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama 35487-0315, USA.
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Baillie L. Patient dignity in an acute hospital setting: a case study. Int J Nurs Stud 2008; 46:23-36. [PMID: 18790477 DOI: 10.1016/j.ijnurstu.2008.08.003] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 07/31/2008] [Accepted: 08/04/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nurses have a professional duty to respect patients' dignity. There is a dearth of research about patients' dignity in acute hospital settings. OBJECTIVE The study investigated the meaning of patient dignity, threats to patients' dignity, and how patient dignity can be promoted, in acute hospital settings. DESIGN A qualitative, triangulated single case study design (one acute hospital), with embedded cases (one ward and its staff, and 24 patients). SETTING The study was based on a 22-bedded surgical ward in an acute hospital in England. PARTICIPANTS Twenty-four patients, aged 34-92 years were purposively selected. There were 15 men and 9 women of varied socio-economic backgrounds. They could all communicate verbally and speak English. Twelve patients, who had stayed in the ward at least 2 days, were interviewed following discharge. The other 12 patients were observed and interviewed on the ward. The ward-based staff (26 registered nurses and healthcare assistants) were observed in practice. 13 were interviewed following observation. Six senior nurses were purposively selected for interviews. METHODS The data were collected during 2005. The Local Research Ethics Committee gave approval. Unstructured interviews using topic guides were conducted with the 24 patients, 13 ward-based staff and 6 senior nurses. Twelve 4-h episodes of participant observation were conducted. The data were analysed thematically using the framework approach. FINDINGS Patient dignity comprised feelings (feeling comfortable, in control and valued), physical presentation and behaviour. The environment, staff behaviour and patient factors impacted on patient dignity. Lack of environmental privacy threatened dignity. A conducive physical environment, dignity-promoting culture and other patients' support promoted dignity. Staff being curt, authoritarian and breaching privacy threatened dignity. Staff promoted dignity by providing privacy and interactions which made patients feel comfortable, in control and valued. Patients' impaired health and older age rendered them vulnerable to a loss of dignity. Patients promoted their own dignity through their attitudes (rationalisation, use of humour, acceptance), developing relationships with staff and retaining ability and control. CONCLUSION Patients are vulnerable to loss of dignity in hospital. Staff behaviour and the hospital environment can influence whether patients' dignity is lost or upheld.
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Bartels DM, Ulvestad N, Ratner E, Wall M, Uutala MM, Song J. Dignity Matters: Advance Care Planning for People Experiencing Homelessness. THE JOURNAL OF CLINICAL ETHICS 2008. [DOI: 10.1086/jce200819303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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McClement SE, Chochinov HM. Hope in advanced cancer patients. Eur J Cancer 2008; 44:1169-74. [DOI: 10.1016/j.ejca.2008.02.031] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 02/25/2008] [Indexed: 10/22/2022]
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