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Tan SB, Chee CH, Ngai CF, Hii SL, Tan YW, Ng CG, Capelle DP, Zainuddin SI, Loh EC, Lam CL, Chai CS, Ng DLC. Mindfulness-based supportive therapy on reducing suffering in patients with advanced cancer: randomised controlled trial. BMJ Support Palliat Care 2024; 13:e1117-e1125. [PMID: 35459688 DOI: 10.1136/bmjspcare-2021-003349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Suffering is common among patients with advanced cancer. The practice of mindfulness during patient care can potentially reduce suffering. We aimed to examine the efficacy of mindfulness-based supportive therapy (MBST) on reducing suffering in patients with advanced cancer. METHODS We conducted a parallel-group, single-blinded, randomised controlled trial at the University of Malaya Medical Centre, Malaysia. Seventy-three patients with advanced cancer with an overall suffering score ≥4/10 based on the Suffering Pictogram were recruited and randomly assigned into either the MBST group (n=34) or the control group (n=39). RESULTS There was a statistically significant reduction in the overall suffering score in the MBST group compared with the control group (U=432.5, median1=-2.0, median2=-1.0, z=-2.645, p=0.008). There was also significant improvement in the total Hospital Anxiety and Depression Scale score (U=483.5, median1=-4.0, median2=-3.0, z=-1.994, p=0.046), and the total Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being score (U=252.0, median1=+14.5, median2=+5.0, z=-4.549, p=0.000) in the MBST group compared with the control group. CONCLUSIONS The results provided evidence that the practice of MBST during patient care could promote positive psychosocial outcomes.
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Affiliation(s)
- Seng Beng Tan
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chin Fei Ngai
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siew Lin Hii
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi Wen Tan
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Guan Ng
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Ee Chin Loh
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chee Shee Chai
- Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
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Riss T. A case report of posttraumatic stress disorder at the end of life. Wien Med Wochenschr 2021; 172:184-188. [PMID: 34727275 DOI: 10.1007/s10354-021-00892-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
A case of posttraumatic stress disorder (PTSD) in the last days of life is presented. It shows insufficient pharmacological therapy and PTSD that was not recognized early enough. We discuss the dilemma caused by the necessity of a long-term psychotherapy and the challenge of little time being left at the end of life. Additionally, a language barrier can be a main reason for misinterpreting symptoms of PTSD.
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Affiliation(s)
- Tabea Riss
- PBZ Berndorf/NÖ, Leobersdorferstraße 8, 2560, Berndorf, Austria.
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3
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Abstract
Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners. Results: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes). Conclusions: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited. Clinical Implications: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.
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Affiliation(s)
- Anica Pless Kaiser
- National Center for PTSD at VA Boston Healthcare System, Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Joan M. Cook
- Department of Psychiatry, Yale School of Medicine and National Center for PTSD, West Haven, CT, USA
| | | | - Jennifer Moye
- New England Geriatric Research Education and Clinical Center and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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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: 37] [Impact Index Per Article: 7.4] [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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Glick DM, Cook JM, Moye J, Kaiser AP. Assessment and Treatment Considerations for Post Traumatic Stress Disorder at End of Life. Am J Hosp Palliat Care 2018; 35:1133-1139. [PMID: 29463090 PMCID: PMC6546161 DOI: 10.1177/1049909118756656] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Post traumatic stress disorder (PTSD) may first emerge, reemerge, or worsen as individuals approach end of life and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at end of life can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma-focused treatments may not be feasible or advisable with this group as many patients at end of life often lack the physical and mental stamina to participate in traditional psychotherapy. This article reviews the clinical and empirical literature on PTSD at end of life, as well as discusses assessment and psychotherapy treatment issues with this neglected population. In addition, it expands on the current reviews of this literature1-3 by extrapolating results from nontraditional treatment approaches with other patient populations. Elements of these approaches with patients sharing similar characteristics and/or comorbidities with patients with PTSD at end of life may provide additional benefits for the latter population. Clinical implications and suggestions for interdisciplinary care providers are provided.
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Affiliation(s)
- Debra M. Glick
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Joan M. Cook
- National Center for PTSD, VA Connecticut Healthcare System and Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer Moye
- VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
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Beng TS, Ann YH, Guan NC, Chin LE, Loong LC, Ying NT, Teck TY, Li HL, Meng CBC. The Suffering Pictogram: Measuring Suffering in Palliative Care. J Palliat Med 2017; 20:869-874. [DOI: 10.1089/jpm.2016.0448] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Yee Hway Ann
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ng Tze Ying
- Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Teo Yong Teck
- Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Hong Li Li
- Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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McConnell T, Porter S. The experience of providing end of life care at a children's hospice: a qualitative study. BMC Palliat Care 2017; 16:15. [PMID: 28193270 PMCID: PMC5307784 DOI: 10.1186/s12904-017-0189-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/02/2017] [Indexed: 12/05/2022] Open
Abstract
Background More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children’s hospice. Methods Qualitative research incorporating interviews and a focus group. Data were analysed using thematic analysis. Purposeful sampling led to a total of 15 care team staff recruited from a children’s hospice offering palliative and specialist care to life-limited children and young people. Results The hospice setting provides a model of excellence in supporting staff and mitigating challenging aspects of their role, which includes peer/organisational support, and regular ongoing training in key aspects of children’s palliative care. Key recommendations for improving their experience included advanced communication training and knowledge sharing with other children’s palliative care specialists within the acute setting. Conclusions Service and policy initiatives should encourage open, informal peer/organisational support among the wider children’s palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children’s hospices and hospital settings. Electronic supplementary material The online version of this article (doi:10.1186/s12904-017-0189-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tracey McConnell
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, United Kingdom.
| | - Sam Porter
- Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, UK
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Satija A, Bhatnagar S. Complementary Therapies for Symptom Management in Cancer Patients. Indian J Palliat Care 2017; 23:468-479. [PMID: 29123357 PMCID: PMC5661353 DOI: 10.4103/ijpc.ijpc_100_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cancer patients are often poly-symptomatic which distressingly affects their quality of lives (QOLs). Alhough, conventional management provides adequate symptom control, yet is coupled with some limitations. Complementary therapies (CTs) have shown beneficial effects in cancer patients for symptomatic relief. The aim of this article is to provide evidence-based review of commonly used CTs for symptom management in cancer care. Hypnosis has promising evidence to be used for managing symptoms such as pain, chemotherapy-induced nausea/vomiting, distress, fatigue, and hot flashes. Guided imagery increases comfort and can be used as a psycho-supportive therapy. Meditation substantially improves psychological function, mental health, and QOL. Cognitive behavioral therapies effectively reduce pain, distress, fatigue, anxiety, and depression; and improve subjective sleep outcomes along with mood and QOL. Yoga has short term beneficial effects for anxiety, depression, fatigue, perceived stress, QOL, and well-being. T'ai Chi and qigong are beneficial adjunctive therapies for supportive cancer care, but their role in reducing cancer pain is not well proven. Acupuncture is effective for reducing treatment related side-effects, pain and fatigue. Other therapies such as massage techniques, energy therapies, and spiritual interventions have also demonstrated positive role in managing cancer-related symptoms and improve overall well-being. However, the clinical effectiveness of these therapies for symptom management in cancer patients cannot be concluded due to poor strength of evidence. Nonetheless, these are relatively free from risks and hence can be given along with conventional treatments. Only by tailoring these therapies as per patient's beliefs and preferences, optimal patient-centered holistic care can be provided.
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Affiliation(s)
- Aanchal Satija
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Ng CG, Lai KT, Tan SB, Sulaiman AH, Zainal NZ. The Effect of 5 Minutes of Mindful Breathing to the Perception of Distress and Physiological Responses in Palliative Care Cancer Patients: A Randomized Controlled Study. J Palliat Med 2016; 19:917-24. [DOI: 10.1089/jpm.2016.0046] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Kiah Tian Lai
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Seng Beng Tan
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Nor Zuraida Zainal
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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10
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Rattner M, Berzoff J. Rethinking Suffering: Allowing for Suffering that is Intrinsic at End of Life. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2016; 12:240-258. [PMID: 27462954 DOI: 10.1080/15524256.2016.1200520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The dilemma so central to the work of providers of palliative and end-of-life care is the paradox of their professional and ethical duty to try to relieve suffering and the limitations of so doing. While the capacity to sit with suffering at the end of life is critical to clinical work, the idea that some intrinsic suffering cannot necessarily always be relieved may model for patients and families that suffering can be borne. Clinicians who encounter unrelievable suffering may feel a sense of failure, helplessness, moral distress, and compassion fatigue. While tolerating suffering runs counter to the aims of palliative care, acknowledging it, bearing it, and validating it may actually help patients and families to do the same. "Sitting with suffering" signals a paradigm shift within the discipline of palliative care, as it asks clinicians to rethink their role in being able to relieve some forms of psychosocial suffering intrinsic to dying.
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Affiliation(s)
| | - Joan Berzoff
- b Smith College School for Social Work , Northampton , Massachusetts , USA
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Tan SB, Loh EC, Lam CL, Ng CG, Lim EJ, Boey CCM. Psychological processes of suffering of palliative care patients in Malaysia: a thematic analysis. BMJ Support Palliat Care 2016; 9:e19. [PMID: 27098972 DOI: 10.1136/bmjspcare-2015-001064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/25/2016] [Accepted: 04/04/2016] [Indexed: 11/04/2022]
Abstract
Although suffering in palliative care has received increasing attention over the past decade, the psychological processes that underpin suffering remain relatively unexplored. OBJECTIVE To understand the psychological processes involved in the experiencing of suffering at the end phase of life. METHODS Semistructured interviews were conducted with 20 palliative care inpatients from an academic medical centre in Kuala Lumpur, Malaysia. The transcripts were thematically analysed with NVIVO9. RESULTS 5 themes of psychological processes of suffering were generated: (1) perceptions, (2) cognitive appraisals, (3) hope and the struggles with acceptance, (4) emotions and (5) clinging. A model of suffering formation was constructed. CONCLUSION The findings may inform the development of mechanism-based interventions in the palliation of suffering.
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Affiliation(s)
- Seng Beng Tan
- Unit of Palliative Medicine, Faculty of Medicine, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ee Chin Loh
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chee Loong Lam
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chong Guan Ng
- Department of Psychological Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ee Jane Lim
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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