Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

Background: Cancer and its therapy is commonly associated with a variety of side effects that impact eating behaviors that reduce nutritional intake. This review will outline potential causes of chemotherapy and radiation damage as well as approaches for the amelioration of the side effects of cancer during therapy. Methods: Information for clinicians, patients, and their caregivers about toxicity mitigation including nausea reduction, damage to epithelial structures such as skin and mucosa, organ toxicity, and education is reviewed. Results: How to anticipate, reduce, and prevent some toxicities encountered during chemotherapy and radiation is detailed with the goal to improve eating behaviors. Strategies for health care professionals, caregivers, and patients to consider include (a) the reduction in nausea and vomiting, (b) decreasing damage to the mucosa, (c) avoiding a catabolic state and muscle wasting (sarcopenia), and (d) developing therapeutic alliances with patients, caregivers, and oncologists. Conclusions: Although the reduction of side effects involves anticipatory guidance and proactive team effort (e.g., forward observation, electronic interactions, patient reported outcomes), toxicity reduction can be satisfying for not only the patient, but everyone involved in cancer care.

Therapist Use of Self and the Development of a Culturally-Aware Professional in Family Therapy

It has been well established that strong therapeutic alliances correlate with positive outcomes in the course of any therapy. For therapists who seek to enhance their professional development, the contribution of familial alliances to therapy necessitates information about their proclivities with different types of family systems. Since the early days of family therapy, the genogram has served as a tool for identifying family patterns, resources, and potential hindrances. More recently, genograms have aided trainees to better understand how cultural, gender and other biases and assumptions affect administration of therapy. In this manuscript, we introduce the theoretical framework of a new model where the family-of-origin forms an important resource for the professional development of the therapist in training.

Inter-Brain Synchronization During Sandplay Therapy: Individual Analyses

Interactions between the client (Cl) and therapist (Th) evolve therapeutic relationships in psychotherapy. An interpersonal link or therapeutic space is implicitly developed, wherein certain important elements are expressed and shared. However, neural basis of psychotherapy, especially of non-verbal modalities, have scarcely been explored. Therefore, we examined the neural backgrounds of such therapeutic alliances during sandplay, a powerful art/play therapy technique. Real-time and simultaneous measurement of hemodynamics was conducted in the prefrontal cortex (PFC) of Cl-Th pairs participating in sandplay and subsequent interview sessions through multichannel near-infrared spectroscopy. As sandplay is highly individualized, and no two sessions and products (sandtrays) are the same, we expected variation in interactive patterns in the Cl–Th pairs. Nevertheless, we observed a statistically significant correlation between the spatio-temporal patterns in signals produced by the homologous regions of the brains. During the sandplay condition, significant correlations were obtained in the lateral PFC and frontopolar (FP) regions in the real Cl-Th pairs. Furthermore, a significant correlation was observed in the FP region for the interview condition. The correlations found in our study were explained as a “remote” synchronization (i.e., unconnected peripheral oscillators synchronizing through a hub maintaining free desynchronized dynamics) between two subjects in a pair, possibly representing the neural foundation of empathy, which arises commonly in sandplay therapy (ST).

Health providers’ experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial

ObjectiveDespite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telepsychiatry services may be a viable option to increase access to mental healthcare. The aim of this qualitative process evaluation embedded in a randomised controlled feasibility trial was to explore health providers’ experiences with a mental healthcare model integrating mental health specialist video consultations (MHSVC) and primary care.MethodsA qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact and context, was applied to investigate the data.ResultsConsidering (1) the implementation, participants evaluated the consultations as feasible, easy to use and time saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients’ improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared with same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention’s context, shorter travel distances for patients positively affected the implementation, while technical failures, that is, poor Internet connectivity, emerged as the main barrier.ConclusionsMHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimise engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving MHSVC (eg, leveraging non-verbal cues for therapeutic purposes).Trial registration numberDRKS00015812; Results.

Substance related offending behaviour programme (SROBP): exploring male prisoner’s experiences of treatment and application of learning

Purpose Cognitive-behavioural interventions, such as the substance related offending behaviour programme (SROBP), are being implemented across forensic contexts in an attempt to address the detrimental economic, social and personal impacts of substance use and offending. Whilst support exists for the effectiveness of such treatment, there remains to be limited knowledge of offenders’ experiences of treatment and factors that promote treatment efficacy and support desistance. This study aims to develop an idiographical understanding of those processes. Design/methodology/approach Six prisoners who had completed the SROBP were interviewed via a semi-structured schedule to collate their individual experiences of engaging in treatment. Interviews transcripts were analysed by the lead researcher using interpretative phenomenological analysis, and external auditing analysis was conducted by the research supervisors. Findings Three superordinate themes resulted: “Therapeutic processes and relationships,” “Therapeutic outcomes” and “Threats to post treatment recovery.” Participants identified factors which facilitated the effectiveness of treatment and were effective in meeting their needs, although there were other factors that required improvement. Practical implications The important role of motivation at various stages of treatment as this engenders commitment to treatment aims and longer-term recovery. Treatment efficacy is linked with perceived relevance and value of treatment outcomes in supporting desistence from substance use. Pro-social peer relationships are important for effective application of learning and recovery. Attentiveness to participants specific needs is required. The lack of post-programme support has the potential to threaten therapeutic alliances and reinforce experiences of rejection and abandonment. The management of the exit phase from programmes is critical. Originality/value Results are discussed in light of their implications for future working practices in supporting therapeutic processes and rehabilitative culture.

OTs' Perspectives on Family-Centered Care and Meaningful Relationships Within Complex Family Contexts

Date Presented 04/13/21 The value of family-centered care is identified in the literature, highlighting the need for therapists to use a variety of approaches. However, there is limited evidence as to how to best provide care with families dealing with complex contexts such as language, cultural, and socioeconomic differences. This session will provide the perspectives of eight OTs who identified strategies to support the primary caregiver and ways in which to build therapeutic alliances. Primary Author and Speaker: Tamera Keiter Humbert Additional Authors and Speakers: Patricia A. Henton Contributing Authors: Shelley Dean

Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice

Background: Pelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education.Objectives: My study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM).Method: Various databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements.Results: My study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another.Conclusion: Biomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice.Clinical implications: Incorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.

Psychopharmacology and refugees, asylum seekers, and migrants

Refugee, asylum seeker, and migrant populations may have experienced many adverse life events during time in their country and during the time of migration. As a result, many will experience common mental health problems, including anxiety, post-traumatic stress disorder, and depression. This chapter reviews the genetic and environmental factors that impact pharmacological interventions for the common mental health problems of these groups. Cultural and explanatory models may play a role in help-seeking, as well as therapeutic alliances and adherence. Cultures may carry different explanations for the use of medication. Pharmacodynamics and pharmacokinetic properties will vary across cultures. These will be affected by dietary factors, as well as genetic and biological factors. Recommendations are also included regarding the safe and effective approaches for treating these groups of patients with psychotropic medications.

Patient and parent perspectives on transition from paediatric to adult healthcare in rheumatic diseases: an interview study

ObjectivesTo describe the experiences, priorities, and needs of patients with rheumatic disease and their parents during transition from paediatric to adult healthcare.SettingFace-to-face and telephone semistructured interviews were conducted from December 2018 to September 2019 recruited from five hospital centres in Australia.ParticipantsFourteen young people and 16 parents were interviewed. Young people were included if they were English speaking, aged 14–25 years, diagnosed with an inflammatory rheumatic disease (eg, juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, panniculitis, familial Mediterranean fever) before 18 years of age. Young people were not included if they were diagnosed in the adult setting.ResultsWe identified four themes with respective subthemes: avoid repeat of past disruption (maintain disease stability, preserve adjusted personal goals, protect social inclusion); encounter a daunting adult environment (serious and sombre mood, discredited and isolated identity, fear of a rigid system); establish therapeutic alliances with adult rheumatology providers (relinquish a trusting relationship, seek person-focused care, redefine personal–professional boundaries, reassurance of alternative medical supports, transferred trust to adult doctor) and negotiate patient autonomy (confidence in formerly gained independence, alleviate burden on patients, mediate parental anxiety).ConclusionsDuring transition, patients want to maintain disease stability, develop a relationship with their adult provider centralised on personal goals and access support networks. Strategies to comprehensively communicate information between providers, support self-management, and negotiate individualised goals for independence during transition planning may improve satisfaction, and health and treatment outcomes.