Psychological Distress and Psychiatric Comorbidities in Palliative Care

2012 ◽  
pp. 23-48
Author(s):  
Raphael J. Leo ◽  
Maria Theresa Mariano
Keyword(s):  
Palliative Care ◽  
Psychological Distress ◽  
Psychiatric Comorbidities

Construal level, rumination, and psychological distress in palliative care

2011 ◽  
Vol 21 (6) ◽  
pp. 680-683 ◽  
Author(s):  
John M. Galfin ◽  
Edward R. Watkins
Keyword(s):  
Palliative Care ◽  
Psychological Distress ◽  
Construal Level

scholarly journals Prevalence and severity of sleep difficulty in patients with a CNS cancer receiving palliative care in Australia

2019 ◽  
Vol 6 (6) ◽  
pp. 499-507 ◽  
Author(s):  
Megan S Jeon ◽  
Haryana M Dhillon ◽  
Joseph Descallar ◽  
Lawrence Lam ◽  
Samuel Allingham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Psychological Distress ◽  
Multilevel Models ◽  
Point Of Care ◽  
Clinical Status ◽  
Symptom Assessment ◽  
Sleep Difficulty ◽  
Patient Reported ◽  
Care Outcomes ◽  
Sleep Difficulties

Abstract Background The literature describing the incidence of sleep difficulty in CNS cancers is very limited, with exploration of a sleep difficulty symptom trajectory particularly sparse in people with advanced disease. We aimed to establish the prevalence and longitudinal trajectory of sleep difficulty in populations with CNS cancers receiving palliative care nationally, and to identify clinically modifiable predictors of sleep difficulty. Methods A consecutive cohort of 2406 patients with CNS cancers receiving palliative care from sites participating in the Australian national Palliative Care Outcomes Collaboration were evaluated longitudinally on patient-reported sleep difficulty from point-of-care data collection, comorbid symptoms, and clinician-rated problems. Multilevel models were used to analyze patient-reported sleep difficulty. Results Reporting of mild to severe sleep difficulties ranged from 10% to 43%. Sleep scores fluctuated greatly over the course of palliative care. While improvement in patients’ clinical status was associated with less sleep difficulty, the relationship was not clear when patients deteriorated. Worsening of sleep difficulty was associated with higher psychological distress (P < .0001), greater breathing problems (P < .05) and pain (P < .05), and higher functional status (P < .001) at the beginning of care. Conclusions Sleep difficulty is prevalent but fluctuates widely in patients with CNS cancers receiving palliative care. A better-tailored sleep symptom assessment may be needed for this patient population. Early interventions targeting psychological distress, breathing symptoms, and pain for more functional patients should be explored to see whether it reduces sleep difficulties late in life.

Interdisciplinary palliative care for patients with lung cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 130-130
Author(s):  
Betty R. Ferrell ◽  
Virginia Sun ◽  
Arti Hurria ◽  
Mihaela C. Cristea ◽  
Dan Raz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Psychological Distress ◽  
Supportive Care ◽  
Usual Care ◽  
Usual Care Group ◽  
Intervention Group ◽  
Well Being ◽  
Care Group ◽  
Ambulatory Care Setting

130 Background: Palliative care, including symptom management and attention to quality of life (QOL) concerns, should be addressed throughout the trajectory of a serious illness such as lung cancer. This study tested the effectiveness on an interdisciplinary palliative care intervention for patients with stage I-IV non-small cell lung cancer (NSCLC). Methods: Patients undergoing treatments for NSCLC were enrolled in a prospective, quasi-experimental study whereby the usual care group was accrued first followed by the intervention group. Patients in the intervention group were presented at interdisciplinary care meetings and appropriate supportive care referrals were made. They also received four educational sessions. In both groups, QOL, symptoms, and psychological distress were assessed at baseline and 12 weeks using surveys which included the FACT-L, FACIT-Sp-12, LCS, and the Distress Thermometer. Results: A total of 491 patients were included in the primary analysis. Patients who received the intervention had significantly better scores for QOL (109.1 vs. 101.4; p < .001), symptoms (25.8 vs. 23.9; p < .001), spiritual well-being (38.1 vs. 36.2; p < .001), and lower psychological distress (2.2 vs. 3.3; p < .001) at 12 weeks, after controlling for baseline scores, compared to patients in the usual care group. Patients in the intervention group also had significantly higher numbers of completed advance care directives (44% vs. 9%; p < .001), and overall supportive care referrals (61% vs. 28%; p < .001). Conclusions: Interdisciplinary palliative care in the ambulatory care setting resulted in significant improvements in QOL, symptoms, and distress for NSCLC patients.

Emotion and Symptom-focused Engagement (EASE): A randomized pilot trial of an integrated psychosocial and palliative care intervention for individuals with acute leukemia (AL).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 7041-7041 ◽  
Author(s):  
Gary Rodin ◽  
Carmine Malfitano ◽  
Anne Rydall ◽  
Christopher Lo ◽  
Aaron David Schimmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Psychological Distress ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Pilot Trial ◽  
Physical Symptoms ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Symptom Screening ◽  
Physical Distress

7041 Background: Individuals diagnosed with AL may experience severe physical and psychological distress due to the illness and its treatment, the threat of relapse and treatment failure, and a high risk of mortality. To alleviate psychological and physical distress in this population, we developed a novel, 8-week, manualized intervention called EASE. This includes: 1) EASE-psy- a tailored psychotherapeutic component to reduce psychological distress; and 2) EASE-phys-symptom screening, with moderate to severe physical symptoms triggering early palliative care. Methods: To assess the feasibility and preliminary efficacy of EASE, patients were recruited within 2 weeks of admission to a comprehensive cancer center and randomized to receive either EASE or usual care (UC). Physical and psychological symptoms were assessed at baseline, 4, 8 (primary endpoint), and 12 weeks. Intervention patients received 6-10 psychotherapy sessions over 8 weeks, weekly assessment of physical symptoms, and consultation and follow-up by palliative care, when needed. One-way ANOVA was performed to assess mean change scores over time between groups. Results: Forty-two patients were randomized to EASE (n = 22) or UC (n = 20). Predefined feasibility outcomes were all met: > 86% (19/22) of EASE participants (goal > 64%) completed > 50% of proposed EASE-psy sessions; 64% (14/22) completed symptom screenings (goal > 50%); and 100% of those with moderate to severe symptoms had > 1 meeting with the EASE-phys team (goal 100%). There were statistically significant findings favoring EASE vs. UC for satisfaction with care at 8 and 12 weeks (Δ: -3.12 vs 7.39, p < 0.04; -6.1910 vs 0.0125 p < 0.03). There were trends favoring EASE vs. UC for traumatic stress symptoms, depressive symptoms, quality of life, attachment security, and number, severity, and distress related to physical symptoms at 4, 8, and 12 weeks. Conclusions: Although not powered for statistical significance, this randomized pilot trial of EASE for AL showed promising reductions in psychological and physical distress and supports the feasibility and need for a larger randomized controlled trial. Clinical trial information: NCT02353559.

scholarly journals Measurement of psychological distress in palliative care

2006 ◽  
Vol 20 (8) ◽  
pp. 779-789 ◽  
Author(s):  
Brian Kelly ◽  
Susan McClement ◽  
Harvey Max Chochinov
Keyword(s):  
Palliative Care ◽  
Psychological Distress

scholarly journals Effect of dignity therapy on end-of-life psychological distress in terminally ill Portuguese patients: A randomized controlled trial

2017 ◽  
Vol 15 (6) ◽  
pp. 628-637 ◽  
Author(s):  
Miguel Julião ◽  
Fátima Oliveira ◽  
Baltazar Nunes ◽  
António Vaz Carneiro ◽  
António Barbosa
Keyword(s):  
Palliative Care ◽  
Randomized Controlled Trial ◽  
Psychological Distress ◽  
End Of Life ◽  
Controlled Trial ◽  
Terminally Ill ◽  
Control Group ◽  
Randomized Controlled ◽  
Dignity Therapy ◽  
Desire For Death

ABSTRACTObjective:Dignity therapy (DT) is a brief form of psychotherapy developed for patients living with a life-limiting illness that has demonstrated efficacy in treating several dimensions of end-of-life psychological distress. Our aim was to determine the influence of DT on demoralization syndrome (DS), the desire for death (DfD), and a sense of dignity (SoD) in terminally ill inpatients experiencing a high level of distress in a palliative care unit.Method:A nonblinded phase II randomized controlled trial was conducted with 80 patients who were randomly assigned to one of two groups: the intervention group (DT + standard palliative care [SPC]) or the control group (SPC alone). The main outcomes were DS, DfD, and SoD, as measured according to DS criteria, the Desire for Death Rating Scale, and the Patient Dignity Inventory (PDI), respectively. All scales were assessed at baseline (day 1) and at day 4 of follow-up. This study is registered with http://www.controlled-trials.com/ISRCTN34354086.Results:Of the 80 participants, 41 were randomized to DT and 39 to SPC. Baseline characteristics were similar between the two groups. DT was associated with a significant decrease in DS compared with SPC (DT DS prevalence = 12.1%; SPC DS prevalence = 60.0%; p < 0.001). Similarly, DT was associated with a significant decrease in DfD prevalence (DT DfD prevalence = 0%; SPC DfD prevalence = 14.3%; p = 0.054). Compared with participants allocated to the control group, those who received DT showed a statistically significant reduction in 19 of 25 PDI items.Significance of results:Dignity therapy had a beneficial effect on the psychological distress encountered by patients near the end of life. Our research suggests that DT is an important psychotherapeutic approach that should be included in clinical care programs, and it could help more patients to cope with their end-of-life experiences.

scholarly journals Determining the prevalence of palliative needs and exploring screening accuracy of depression and anxiety items of the Integrated Palliative care Outcome Scale – a multi-centre study

2019 ◽  
Author(s):  
Bárbara Pereira Antunes ◽  
Pedro Pereira Rodrigues ◽  
Irene J. Higginson ◽  
Pedro Lopes Ferreira
Keyword(s):  
Palliative Care ◽  
Psychological Distress ◽  
Area Under The Curve ◽  
Psychological Needs ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Multi Centre Study ◽  
Palliative Care Outcome Scale ◽  
Screening Accuracy ◽  
Care Outcome

Abstract Background: patients with palliative needs often experience high symptom burden which causes suffering to themselves and their families. Depression and psychological distress should not be considered a “normal event” in advanced disease patients and should be screened, diagnosed, acted on and followed-up. Psychological distress has been associated with greater physical symptom severity, suffering, and mortality in cancer patients. A holistic, but short measure should be used for physical and non-physical needs assessment. The Integrated Palliative care Outcome Scale is one such measure. This work aims to determine palliative needs of patients and explore screening accuracy of two items pertaining to psychological needs. Methods: multi-centred observational study using convenience sampling. Data were collected in 9 Portuguese centres. Inclusion criteria: ≥18 years, mentally fit to give consent, diagnosed with an incurable, potentially life-threatening illness. Exclusion criteria: patient in distress ("unable to converse for a period of time"), cognitively impaired. Descriptive statistics used for demographics. Receiving Operator Characteristics curves and Area Under the Curve for anxiety and depression discriminant properties against the Hospital Anxiety and Depression Scale. Results: 1703 individuals were screened between July 1st, 2015 and February 2016. A total of 135 (7.9%) were included. Main reason for exclusion was being healthy (75.2%). The primary care centre screened most individuals, as they have the highest rates of daily patients and the majority are healthy. Mean age is 66.8 years (SD 12.7), 58 (43%) are female. Most patients had a cancer diagnosis 109 (80.7%). Items scoring highest (=4) were: family or friends anxious or worried (36.3%); feeling anxious or worried about illness (13.3%); feeling depressed (9.6%). Using a cut-off score of 2/3, Area Under the Curve for depression and anxiety items were above 70%. Conclusions: main palliative needs were psychological, family related and spiritual. This suggests that clinical teams may better manage physical issues and there is room for improvement regarding non-physical needs. Using the Integrated Palliative care Outcome Scale systematically could aid clinical teams screening patients for distressing needs and track their progress in assisting patients and families with those issues. Trial Registration: Not applicable. This was not an intervention study.

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