Managing pain and psychological issues in palliative care

2001 ◽  
Vol 15 (2) ◽  
pp. 235-251 ◽  
Author(s):  
George J. Olt
Keyword(s):  
Palliative Care ◽  
Psychological Issues

Hospice Referral Practices for Children With Cancer: A Survey of Pediatric Oncologists

2006 ◽  
Vol 24 (7) ◽  
pp. 1099-1104 ◽  
Author(s):  
Kimberly Fowler ◽  
Katherine Poehling ◽  
Dean Billheimer ◽  
Rodney Hamilton ◽  
Huiyun Wu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Electronic Mail ◽  
Response Rate ◽  
Oncology Group ◽  
Children With Cancer ◽  
Referral Patterns ◽  
Psychological Issues ◽  
Mail Surveys ◽  
Referral Practices ◽  
Hospice Referral

Purpose To examine hospice referral patterns among pediatric oncologists and identify barriers to referral. Methods A self-administered survey was sent to 1,200 pediatric oncologists who are members of Children's Oncology Group. Two electronic mail messages followed by traditional mail surveys were sent to eligible physicians. Pediatricians and pediatric oncologists developed, pretested, and modified the survey for item clarification. Results Of 944 eligible pediatric oncologists surveyed, 632 replied, yielding a response rate of 67%. Most respondents reported having access to palliative care programs (65%) and hospice services (85%), but few (27%) had access to inpatient hospice services. More respondents reported feeling comfortable managing end-of-life pain than psychological issues (86% v 67%, respectively). Many pediatric oncologists (62%) reported that half or more of their patients died in the hospital. In multivariate analysis, physicians with access to hospice that accepts patients receiving chemotherapy had more patients die at home than in hospital compared with physicians without access to such services (P = .007). The probability of hospice referral was positively associated with the presence of a hospice facility (P < .001) and with a larger size oncology group (P = .024). Only 2.5% of respondents referred patients at the time of relapse. Continued therapy was cited as the most common reason for not making a referral, and was significantly higher when hospice did not admit children receiving chemotherapy (P = .002). Conclusion Hospice referral for children with cancer is usually made late in the course of their disease and might improve if hospice admits patients who are actively receiving chemotherapy.

Total palliative care for a patient with multiple cerebral infarctions that occurred repeatedly in association with gastric cancer (Trousseau's syndrome)

2012 ◽  
Vol 11 (2) ◽  
pp. 169-172 ◽  
Author(s):  
Katsuyuki Ukai ◽  
Akiko Okajima ◽  
Aya Yamauchi ◽  
Eiji Sasaki ◽  
Yohsuke Yamaguchi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Palliative Care ◽  
Psychological Symptoms ◽  
Panic Attacks ◽  
Psychological Issues ◽  
Trousseau’S Syndrome ◽  
Knowledge Based ◽  
Self Mutilation ◽  
Nonbacterial Thrombotic Endocarditis ◽  
Multiple Cerebral Infarctions

AbstractObjective:Malignancy-related thromboembolism, also referred to as Trousseau's syndrome, can present as acute cerebral infarction, nonbacterial thrombotic endocarditis (NBTE), and migratory thrombophlebitis. Therefore, many physical, neurological, and psychological symptoms associated with Trousseau's syndrome may occur in the clinical course.Method:To illustrate this, we report a case of a male patient in his 50s with carcinomatous peritonitis caused by gastric cancer, with multiple cerebral infractions that developed during disease progression. The patient was admitted to our hospital for the treatment of side effects of chemotherapy, although he strongly hoped to go home as soon as possible. In addition to making social supports plans, we were required to perform intensive total palliative care, because of his physical pain, general fatigue, anorexia, abdominal and neck pain, and psychological issues (insomnia, delirium, depression, suicidal thoughts, self-mutilation, panic attacks, agoraphobia, fear of death, and feelings of hopelessness).Results:To the best of our knowledge, based on the literature search, this is the first reported case of Trousseau's syndrome described in the context of total palliative care, especially psychological care.Significance of results:We propose that neurological symptoms of Trousseau's syndrome cause these extensive mental disorders. Furthermore, because of the prognosis of Trousseau's syndrome, we should utilize our expertise fulfill the patient's wishes.

scholarly journals Psychiatry and Terminal Illness

2000 ◽  
Vol 45 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Harvey Max Chochinov
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Terminal Illness ◽  
Empirical Studies ◽  
Life Care ◽  
Care Providers ◽  
Psychological Issues ◽  
Dying Patients

Objective: To provide an overview of the palliative care literature salient to the psychiatric aspect of end-of-life care. Method: A literature review was conducted, targeting primarily empirical studies that addressed the following topics: 1) psychological issues pertaining to life-threatening conditions; 2) family issues in the context of palliative care; 3) psychological issues and challenges faced by end-of-life health care providers; and 4) psychiatric disorders, including depression, anxiety, and organic mental disorders, in people with terminal illness. Results: There is a small but emerging literature that can guide psychiatrists in their role of providing care to dying patients. Conclusions: While psychiatry has made tremendous inroads toward providing care to patients throughout the life cycle, its presence is only just beginning to be felt in end-of-life care. Within the domain of palliative care, psychiatry has an expanded and important role to play.

Clinical evaluation of the Mood and Symptom Questionnaire (MSQ) in a day therapy unit in a palliative support centre in the United Kingdom

2008 ◽  
Vol 6 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Elizabeth Chapman ◽  
Judith Whale ◽  
Annette Landy ◽  
David Hughes ◽  
Margaret Saunders
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Care Center ◽  
Psychosocial Interventions ◽  
Physical Symptoms ◽  
Clinical Tool ◽  
Psychological Issues ◽  
Training Tool ◽  
Symptom Questionnaire

ABSTRACTObjective:To evaluate the use of the Mood and Symptom Questionnaire (MSQ) within a program of structured psychosocial interventions in a Supportive and Palliative Care Center. Palliative care patients have a range of psychological symptoms as well as physical symptoms. Considerable expertise in controlling pain and fear of pain, other physical symptoms, and psychosocial distress has been built up in hospices and palliative care units. This expertise can be used even at late stages in the patient's illness to improve quality of life.Method:We evaluated the usefulness of the MSQ to record patient responses, as an aid to patient/staff discussions, and as a staff-training tool. The questionnaire consisted of visual analog scales completed by the patient with a staff member present. Using the tool increased the opportunities for staff and patients todiscussproblematic psychosocial issues. Where possible, we obtained data at two time points and compared the responses.Results:The MSQ was rapidly accepted as a clinical tool in the day therapy setting by staff and the patients. Theprocessof completing the questionnaire encouraged patients to face and discuss difficult issues. Discussion of the issues raised on the questionnaire had a wider effect, influencing interactions and communications through the unit and facilitating wider discussion of other nonpain symptoms. The medical psychotherapist associated with the unit used the MSQ responses as a training tool to increase staff awareness and knowledge and understanding of psychological issues related to the patients' total pain experience by discussing the questionnaires with them.Significance of results:The use of this tool helped to identify some psychological issues that proved relatively straightforward to address once uncovered. Patients benefited from this opportunity when their remaining time was relatively short. Their quality of life at the end of their lives was improved.

scholarly journals Needs of the caregivers of people requiring palliative care in an urban area of Pondicherry, South India

2018 ◽  
Vol 5 (6) ◽  
pp. 2259 ◽  
Author(s):  
Praveena Daya A. ◽  
Sonali Sarkar ◽  
Sitanshu Sekhar Kar
Keyword(s):  
Palliative Care ◽  
Urban Area ◽  
Assessment Tool ◽  
Social Issues ◽  
Psychological Issues ◽  
Care Services ◽  
Care Giving ◽  
Palliative Care Services ◽  
Financial Issues

Background: There is an increasing need to provide palliative care services globally. All these chronic, life limiting diseases not only affect the patients but also affect their caregivers in various aspects. The aim of the study was to assess the needs of caregivers of people requiring palliative care in an urban area of Pondicherry, South India.Methods: An exploratory descriptive study was conducted in 1004 households with 3554 individuals in two selected areas under an urban PHC in Pondicherry. Needs of the 21 caregivers who provided care for 22 patients were studied using Needs Assessment Tool: Progressive Disease (NAT: PD). Data was analysed using IBM SPSS Software version 20. Levels of concern for various domains were rated subjectively as none, some, significant and expressed in proportions. Content analysis was done for the qualitative data after translation and transcription.Results: Caregivers faced physical, psychological, financial, social and spiritual issues related to care-giving. Physical issues reported were sleeplessness, fatigue and back pain. Common psychological issues reported were depression, hopelessness and getting tensed frequently. Financial issues of caregivers were related to loss of income and loss of family savings for the treatment charges of patients. Social issues observed were avoiding going out or attending festivals, lack of social support and lack of time to spend enough time with their spouse and children.Conclusions: Caregivers are exposed to a long-term stress starting from the diagnosis of the patient’s illness continuing even after the death of patient. So in this way the caregivers are exposed to higher level of stress than the patients, which needs to be addressed appropriately. 

Book Review: Psychological issues in palliative care

2003 ◽  
Vol 17 (8) ◽  
pp. 727-728
Author(s):  
Juliet Spiller
Keyword(s):  
Palliative Care ◽  
Psychological Issues

scholarly journals Psychosocial problems and needs of patients in palliative care center

2018 ◽  
Vol 5 (4) ◽  
pp. 1385 ◽  
Author(s):  
Arun T. Mithrason ◽  
Gomathy Parasuraman ◽  
Ramesh Harihara Iyer ◽  
Suresh Varadarajan
Keyword(s):  
Palliative Care ◽  
Social Problems ◽  
Hospice Care ◽  
Care Center ◽  
Psychosocial Problems ◽  
The Body ◽  
Care Centre ◽  
Psychological Issues ◽  
Physical Suffering ◽  
Study Questionnaire

Background: Number of cancer cases in India is rising every year and also the sufferings caused by the disease. The patients not only require physical control of disease and symptoms, but, also need help to cope up with other elements caused by the disease. Psychosocial aspect of the patient is usually left unmet.Methods: This study was done in ‘Jeevodaya Hospice Care Centre’, Chennai, India. 60 patients were included in this study. Questionnaire on problems and needs in palliative care was used. The questionnaire consists of eleven elements which deal with psychological issues and fourteen elements which deal with social problems and needs.Results: The five most common psychological problems, perceived by palliative care patients in descending order were; depressed mood (96.7%), fear of metastasis (95%), unpredictability of future (93.3%), not experiencing pleasure (91.5%), and, fear of physical suffering (85%). The five most common social problems perceived by the patients were; loneliness (93.3%), experiencing too little support from others (61.7%), difficulty in talking about the disease for not wanting to bother others (56.7%), finding others not receptive while talking about the disease (53.3%) and difficulty in finding someone confidential to talk to (46.7%).Conclusions: These psychological and social problems along with fear of death causes disruption of the sensitive balance between the body and mind. Proper communication, treatment and counselling helps in a great way to tackle such issues.

Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

2019 ◽  
Vol 28 (3) ◽  
pp. 1356-1362
Author(s):  
Laurence Tan Lean Chin ◽  
Yu Jun Lim ◽  
Wan Ling Choo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Multidisciplinary Team ◽  
Biopsychosocial Model ◽  
Family Members ◽  
Clinical Decisions ◽  
Goals Of Care ◽  
Complex Needs ◽  
Aspiration Risk ◽  
Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

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