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Elderly patients with cancer face unique physical and psychiatric challenges in coping with their illness. Optimal psychosocial therapy for older cancer patients requires recognizing certain enhanced psychological capacities such as coping better with illness, which is associated with older age. This strength can be combined with the most appropriate cognitive coping strategies to develop a model intervention. This paper describes such a model, which integrates Erik Erikson's eighth and final psychosocial developmental life stage, in which the task is to achieve ego integrity (equanimity) or to experience despair (sadness, regrets), with Susan Folkman's cognitive coping paradigm, which utilizes reappraisal. This theoretical model addresses older cancer patients who are struggling with depression, isolation, and despair related to aging and illness, and utilizes cognitive reappraisal in a group setting to foster relatedness, acceptance of illness, and a sense of meaningful integration.
The combination of a difficult early diagnosis, few treatment options, and high mortality rate could make the experience of pancreatic cancer different from the experience of other cancers, both for patients and families. To design effective interventions for families with a diagnosis of pancreatic cancer, there is need for a model of family members' adjustment to cancer that is specific to these unique aspects of pancreatic cancer.
Trained clinical interviewers and a genetic counselor conducted phone interviews with 22 first-degree relatives—parents, siblings, and offspring—from a pool of participating family members. The interview transcripts were analyzed using qualitative coding methods.
Participants expressed both similar and different themes compared with other literature on adjustment to cancer. Relatives struggled through both the initial diagnosis and its aftermath, seeking to balance their own strong feelings with the needs of the ailing family member. Support systems were identified as very important, regardless of the source of the support, and those without them reported more intense difficulties. Many family members felt that everything was happening too fast to slow down and process what was going on.
Significance of results:
Pancreatic cancer families may be unable to cope by taking one day at a time and must find other ways of dealing with stress. Also, the compressed timeline between diagnosis and death may heighten certain coping behaviors, such as the reevaluation of one's priorities.
Self-reported health-related quality of life (HRQoL) is an important predictor of survival alongside clinical variables and physicians' prediction. This study assessed whether better prediction is achieved using generic (SF-36) HRQoL measures or cancer-specific (EORTC QLQ-C30) measures that include symptoms.
Fifty-four lung and 46 colorectal patients comprised the sample. Ninety-four died before study conclusion. EORTC QLQ-C30 and SF-36 scores and demographic and clinical information were collected at baseline. Follow-up was 5 years. Deaths were flagged by the Office of National Statistics. Cox regression survival analyses were conducted. Surviving cases were censored in the analysis.
Univariate analyses showed that survival was significantly associated with better EORTC QLQ-C30 physical functioning, role functioning, and global health and less dyspnea and appetite loss. For the SF-36, survival was significantly associated with better emotional role functioning, general health, energy/vitality, and social functioning. The SF-36 summary score for mental health was significantly related to better survival, whereas the SF-36 summary score for physical health was not. In the multivariate analysis, only the SF-36 mental health summary score remained an independent, significant predictor, mainly due to considerable intercorrelations between HRQoL scales. However, models combining the SF-36 mental health summary score with diagnosis explained a similar amount of variance (12%–13%) as models combining diagnosis with single scale SF-36 Energy/Vitality or EORTC QLQ-C30 Appetite Loss.
Significance of results:
HRQoL contributes significantly to prediction of survival. Generic measures are at least as useful as disease-specific measures including symptoms. Intercorrelations between HRQoL variables and between HRQoL and clinical variables makes it difficult to identify prime predictors. We need to identify variables that are as independent of each other as possible to maximize predictive power and produce more consistent results.
Objective: Women with ovarian cancer face a poor prognosis, with prolonged periods of treatment but relatively high levels of physical functioning. Their thoughts and feelings regarding the prospect of dying are complex and have not been adequately studied. Various demographic, medical and psychosocial factors were examined to determine their independent associations with fear of dying and hopelessness in a cross-sectional design.
Method: Two hundred fifty-four ovarian cancer patients were assessed at the beginning of a new chemotherapy regimen. Separate logistic regressions were performed for worry about dying and loss of hope. For each analysis, psychosocial variables were entered after the demographic and medical variables to determine whether the psychosocial variables had an independent association with the respective outcome.
Results: Fifty-five percent of the sample acknowledged fear of dying, and 31.6% acknowledged loss of hope in the fight against their illness. Being younger (p = .001), being of non-Hispanic White ethnicity (p = .026), and having poorer physical well-being (p = .000) were significantly associated with worry about dying after controlling for all other variables in the model. Regarding loss of hope, depressive symptoms (p = .002), lack of social support/well-being (p = .001), and number of treatments (p = .04) were significant.
Significance of results: This is one of the largest studies to examine end-of-life concerns in a sample of advanced cancer patients. Our results underscore the importance of demographic and psychosocial variables in the examination of ovarian cancer patients' end-of-life concerns. Their fears and concerns should be openly acknowledged, even when the clinical focus is still on curative treatment.
The purpose of this study was to qualitatively examine the content of the psychological responses in interviews with breast cancer outpatients receiving initial medical consultation.
The participants were 180 people who visited the breast cancer outpatient clinic at Kitasato University Hospital between November 2004 and August 2005. The remaining 176 participants (39 breast cancer patients and 137 benign tumor patients; average age ± SD: 50.7 ± 12.4 years) were analyzed. Two clinical psychologists carried out the interview, asking the participants to speak freely about their anxieties, worries, thoughts, and feelings up until the medical examination. This study used a content analysis of interviews to chronologically examine psychological response of cancer patients seeking medical consultation at three points in time.
Patients at the time of their first outpatient breast cancer consultation experience negative feelings before the examination, directly influenced by the suspicion of cancer. These include anxiety and worries, fear, evasion, depression, and impatience. These tendencies do not change at the time of consultation. However, in addition to negative feelings, some people also possess positive feelings, either simultaneously or at a different point in time. Further, many patients tend to talk at length about psychological responses before seeking treatment, understanding the process they went through to come to seek treatment as an important event.
Significance of results:
It is important for medical workers to bear in mind the psychological conflicts that patients may undergo before seeking treatment and ensure that sufficient communication takes place.
Several studies have reported high levels of distress in family members who have made health care decisions for loved ones at the end of life. A method is needed to assess the readiness of family members to take on this important role. Therefore, the purpose of this study was to develop and validate a scale to measure family member confidence in making decisions with (conscious patient scenario) and for (unconscious patient scenario) a terminally ill loved one.
On the basis of a survey of family members of patients with amyotrophic lateral sclerosis (ALS) enriched by in-depth interviews guided by Self-Efficacy Theory, we developed six themes within family decision making self-efficacy. We then created items reflecting these themes that were refined by a panel of end-of-life research experts. With 30 family members of patients in an outpatient ALS and a pancreatic cancer clinic, we tested the tool for internal consistency using Cronbach's alpha and for consistency from one administration to another using the test–retest reliability assessment in a subset of 10 family members. Items with item to total scale score correlations of less than .40 were eliminated.
A 26-item scale with two 13-item scenarios resulted, measuring family self-efficacy in decision making for a conscious or unconscious patient with a Cronbach's alphas of .91 and .95, respectively. Test–retest reliability was r = .96, p = .002 in the conscious senario and r = .92, p = .009 in the unconscious scenario.
Significance of results:
The Family Decision-Making Self-Efficacy Scale is valid, reliable, and easily completed in the clinic setting. It may be used in research and clinical care to assess the confidence of family members in their ability to make decisions with or for a terminally ill loved one.
This article presents a validation study of the Demoralization Scale, a 24-item, 5-point response questionnaire developed by Kissane et al. in 2004 to assess demoralization in advanced cancer patients.
One hundred Irish inpatients with advanced palliative cancer completed the Demoralization Scale and measures of depression, hopelessness, quality of life, and personal hopefulness.
Principal component analysis of the Demoralization Scale yielded four similar factors found by Kissane et al. (2004), namely, loss of meaning, dysphoria, disheartenment, and sense of failure. A new factor, the hopelessness factor, was also found in the current study. The reliability of the five factors was good, ranging from .72 to .93. Contrary to the findings of Kissane et al.'s (2004) study, divergent validity of the Demoralization Scale was not supported. Demoralized patients were significantly more likely to be depressed than those that did not score highly on the Demoralization Scale. In addition, this study found significantly lower levels of demoralization in general compared with Kissane et al.'s (2004) study.
Significance of results:
The results of the current study show that, in an Irish palliative care context, demoralization is not differentiated from depression. Additional factor analytic studies are needed to validate the Demoralization Scale.
The induction of sedation at the end of life is a much debated practice and not very documented. The goal of this study was to explore the practice from both a clinical and ethical point of view.
Data were collected through semistructured interviews with 19 Quebec physicians working in palliative care.
Doctors' first priority was their patients, not patients' families. Clinically, the therapeutic aim of sedation was strictly to relieve suffering on the part of the patient. Ethically, getting the patient's consent was imperative. The family's consent was only required in cases of incapacity. Generally, sedation and euthanasia were seen as two distinct practices.
Significance of the research:
There are still very few guidelines regarding end-of-life sedation in Québec, and its normative framework is more implicit than explicit. It should be noted that most of the respondents regarded sedation and euthanasia as two distinct practices.
Our objective was to determine the knowledge, attitudes, and practices of physicians and nurses on Palliative Care (PC) in Lebanon, across specialties.
We performed a cross-sectional descriptive survey using a self-administered questionnaire; the total number of completed and returned questionnaires was 868, giving a 23% response rate, including 74.31% nurses (645) and 25.69% physicians (223).
Significant differences were found between medical and surgical nurses and physicians concerning their perceptions of patients' and families' outbursts, concerns, and questions. Knowledge scores were statistically associated with practice scores and degree. Practice scores were positively associated with continuing education in PC, exposure to terminally ill patients, and knowledge and attitude scores. Acute critical care and oncology were found to have lower practice scores than other specialties.
Significance of results:
Formal education in palliative care and development of palliative care services are very much needed in Lebanon to provide holistic care to terminally ill patients.
The aim of this study was to investigate the primary concerns of terminally ill cancer patients in a Short-Term Life Review among Japanese, Koreans, and Americans to develop intervention programs to be tailored to patients in other countries.
Twenty Japanese, 16 Korean, and 7 American terminally ill cancer patients who were in the hospice wards of general Christian hospitals in each country participated in this study. Medical staff members (nurses, social workers, clinical psychologists) performed Short-Term Life Review Interviews with each patient. Patients reviewed their lives in the first session, the interviewers made simple albums for each patient in the week following the first session, and patients and interviewers then confirmed the contents of the album. The treatment period was 1 week. Measurement instruments included the Functional Assessment Chronic Illness Therapy–Spiritual (FACIT-Sp) and the Hospital Anxiety and Depression Scale (HADS). The contents of each interview session were transcribed, and correspondence analysis and a significance test were conducted on these data to select characteristic words or phrases.
Using the FACIT-Sp scores, the following concerns were chosen, in descending order of frequency. In Japan, primary concerns consisted of such ideas as “good human relationships and transcendence,” “achievements and satisfaction,” “good memories and important things,” and “bitter memories.” In Korea, “religious life,” “right behavior for living,” “strong consideration for children and will,” and “life for living” were primary concerns. In the United States, “love, pride, will to children,” “good, sweet memories,” and “regret and a feeling of loss” were primary concerns.
Significance of results:
We clarify the differences among the primary concerns from the Short-Term Life Reviews, arguing that we can improve the spiritual well-being of terminally ill cancer patients by focusing on the primary concerns within each country.
This study explored the experiences, perspectives, and reflections of five nurse-specialists in palliative home care, whose dual role includes caring for patients in their daily practice as well as sharing their knowledge, skills, expertise, and experiences with other home care nurses in the community.
A qualitative research design, incorporating face-to-face semistructured interviews, was used. Interviews were based on open-ended questions such as: “What is your experience in providing palliative home care to patients and their families? How do you feel about sharing your expertise and experiences with home care nurses?” Data were content analyzed using the constant comparative method.
Three major themes and a number of subthemes emerged: (1) acknowledging one's own limitations and humanness: (a) calling for backup, (b) learning as we go along, (c) coping with emotional demands, and (d) interacting with family members; (2) building a collaborative partnership: (a) working collaboratively, (b) sharing information, (c) guiding home care nurses, and (d) being nonjudgmental; and (3) teamwork and implementing palliative home care teams.
Significance of results:
Nurse-specialists play a key role in palliative home care as both carers and as resources of expert knowledge for other home care nurses caring for palliative patients. As the population ages, the health care system will be faced with increasing requests for high-quality palliative home care. The results of this study demonstrate that, from the perspective of the nurse-specialists of NOVA-Montréal (a nonprofit social and health service organization), nurse-specialists can work collaboratively with home care nurses to improve patients' quality of care and their quality of life. Moreover, patients and their families would benefit from the more widespread establishment of palliative care teams within community health organizations.
Objective: The objective of this review is to describe the current status of research on hope in palliative care.
Methods: Integrative review was conducted to determine current knowledge on the topic. CINAHL and PubMed MEDLINE databases were used to find the articles relevant to this review. The data consisted of 34 articles on hope and palliative care published in peer-reviewed journals. A qualitative approach utilizing content analysis was used in this review.
Results: There are at least two overarching themes of patients' hope in the palliative context: “living with hope” and “hoping for something” which however are not separate contents. Several instruments for measuring hope in a palliative context have been produced. However, future research is needed to gather further validity evidence for these instruments. Factors related to patients, other people (e. g. significant others), illness, care and context contribute to or threaten patient hope. Hope of the significant other was defined as an inner force. However, the main concern for caregivers was “hanging on to hope” in spite of eroding effects on hope caused by different factors, for example in the health care system. Also significant others' hope in a palliative care context has been measured, but the results of the studies appear inconsistent. Nurses' reflection in action, affirmation of the patient's worth, working with the patient, considering the patient in a holistic sense were the main hope-engendering interventions generated from this review.
Significance of the research: Hope is important in both living and dying. The majority of the hope research in a palliative context focuses on patient hope and factors influencing patient hope. Research on hope in significant others and nurses in palliative care is scant. More research is needed about the factors threatening patient hope, hope in significant others, and interventions to engender hope in palliative and their outcomes.