Group support for patients with metastatic cancer. A randomized outcome study.
01 May 1981-Archives of General Psychiatry (American Medical Association)-Vol. 38, Iss: 5, pp 527-533
TL;DR: Objective evidence is provided that a supportive group intervention for patients with metastatic cancer results in psychological benefit and mechanisms underlying the effectiveness of this group intervention are explored.
Abstract: • The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this intervention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mooddisturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.
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TL;DR: Both the therapeutic CPAP and the placebo–CPAP groups showed significant improvements in POMS total score, tension, fatigue, and confusion, but could not show a specific beneficial impact of CPAP treatment on mood in OSA patients.
Abstract: Obstructive sleep apnea (OSA) is a common disease with significant medical and psychiatric comorbidities. The literature documenting the effects of continuous positive airway pressure (CPAP) treatment on mood in OSA patients is mixed. We previously observed that 1 week of CPAP treatment did not result in improvements in mood beyond those observed in a group treated with placebo–CPAP. This study examined the effect of a 2 week CPAP treatment on mood in a placebo-controlled design in OSA patients. Fifty patients with untreated sleep apnea were evaluated by polysomnography and completed the Profile of Mood States (POMS) pre-/post-treatment. The patients were randomized for 2 weeks to either therapeutic CPAP or placebo–CPAP (at insufficient pressure). Both the therapeutic CPAP and the placebo–CPAP groups showed significant improvements in POMS total score, tension, fatigue, and confusion. No significant time × treatment effect was observed for either group. We could not show a specific beneficial impact of CPAP treatment on mood in OSA patients.
46 citations
TL;DR: A substantial subgroup of home hospice patients expressed problems dealing with their approaching death, such as fear of death, unresolved issues, parting with family, and pain, which are amenable to psychological treatment.
Abstract: Objective: To determine how home hospice patients deal with their impending death and whether there is a need for greater involvement of mental health professionals in the care of patients dying at home. Method: In a pilot study, 12 female home hospice patients with advanced cancer and a median survival time of 42 days were assessed using structured interviews and brief questionnaires. Topics of inquiry included facing death, fear of death, pain, fatigue, depression, and anxiety. Three key themes were extracted from the information reported by the women: ~1! confronting the issue of death, ~2! fear of dying and death and its correlates, and ~3! spirituality0religious faith and its role in mitigating fear of death. Results: First, all subjects reported thinking about their approaching death. For half of them, this thought was bothersome and these women were frequently troubled by unresolved issues and higher anxiety, pain, and fatigue. The majority of the subjects expressed a desire to actively discuss their impending death. Second, more than half of the patients reported being afraid of death and high death anxiety was associated with fear of dying in pain, high peak or usual pain, unresolved issues, and difficulty in parting with family in death. Third, most subjects experienced their religious faith as an important source of comfort and strength. Significance of results: A substantial subgroup of home hospice patients expressed problems dealing with their approaching death. These problems are amenable to psychological treatment, such as fear of death, unresolved issues, parting with family, and pain. The findings, thus, highlight the need for close collaboration of mental health professionals with home hospice institutions.
46 citations
Cites background from "Group support for patients with met..."
...…that discussion of existential issues, such as fear of death, results in lower mood disturbance, less maladaptive coping, and less phobic anxiety ~Spiegel et al., 1981!. Based on the finding that thinking about death was common and discussion of death-related thoughts desired by the women in the…...
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TL;DR: It is suggested that nurses can take an active role in preventing and managing cancer-related depression in direct care environments by developing critical pathways for screening, prevention, treatment, and outcomes assessment using theory-based research.
Abstract: The incidence of depression is rising worldwide, possibly due to urban crowding and insufficient resources. This pandemic raises the possibility that disabling depression among patients with cancer will increase. Already, about one-third of patients with cancer present with depression. Although many progressive cancer centers are instituting psychooncology services, the projected decline in numbers of psychiatrists in the coming decade suggests that these programs may flounder unless nurses are able to provide adjuvant support. Consequently, this article describes the theoretical and emerging research data base regarding the treatment of cancer-related depression with cognitive-behavioral therapy. Implications drawn from this review suggest that nurses can take an active role in preventing and managing cancer-related depression in direct care environments by developing critical pathways for screening, prevention, treatment, and outcomes assessment using theory-based research.
46 citations
TL;DR: The findings suggest that there are significant issues and difficulties facing women with advanced breast cancer, culminating in feelings of isolation and the experience of living with the fear of advancing disease.
Abstract: Much of the literature on women's experiences of breast cancer relates to diagnosis and initial treatment. The aim of this research was to develop a theory to explain the meaning and experience of living with advanced breast cancer. A grounded theory approach was used and ten women under the care of one hospice explained their experiences during semi-structured interviews. The findings suggest that there are significant issues and difficulties facing women with advanced breast cancer, culminating in feelings of isolation and the experience of living with the fear of advancing disease. A theory, living on the outside looking in, was developed to explain the experiences of the participants. This integrates the following five categories: reconciling a different me; time bomb; media effect; professional waning; rescuers. The category 'reconciling a different me' was identified as the core variable and had an explicatory relationship to the other four categories. The findings raise issues regarding appropriate support.
44 citations
TL;DR: Anxiety and sleep disorders in the oncology setting are described and their clinical presentation, assessment, aetiology and treatment are described to distinguish normal adjustment to cancer from altered reactions to the disease.
Abstract: Even though most cancer patients do not meet diagnostic criteria for any specific mental disorder [1], many experience symptoms such as anxiety and sleep disturbances that may interfere with their overall adjustment to their disease. Anxiety is a common reaction to a cancer diagnosis and a normal response to perceived threats like loss of body functions, alterations in appearance, family disruption, death, etc. Anxiety may persist throughout the disease process, affecting the patient’s quality of life significantly, and often coexists with depression in cancer patients. Anxiety tends to appear or worsen at critical points during the course of the illness (diagnosis, beginning and end of treatment, recurrence, survival and terminal stage).
Sleep disorders are frequently associated with the psychological impact of cancer as well as with the physical illness itself, pain, hospitalisation and specific medical treatments. Altered sleep adversely affects emotional wellbeing and daytime performance, and may be an early sign of delirium in the oncology setting. In the general population, persistent insomnia has been associated with a higher risk of developing clinical anxiety or depression [2].
To effectively adjust patient needs to optimal treatment interventions, health-care professionals must be able to distinguish normal adjustment to cancer from altered reactions to the disease. This paper will focus on anxiety and sleep disorders in the oncology setting and will describe their clinical presentation, assessment, aetiology and treatment.
44 citations
References
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TL;DR: In this paper, the effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it, and individuals may also differ in generalized expectancies for internal versus external control of reinforcement.
Abstract: The effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it. Acquisition and performance differ in situations perceived as determined by skill versus chance. Persons may also differ in generalized expectancies for internal versus external control of reinforcement. This report summarizes several experiments which define group differences in behavior when Ss perceive reinforcement as contingent on their behavior versus chance or experimenter control. The report also describes the development of tests of individual differences in a generalized belief in internal-external control and provides reliability, discriminant validity and normative data for 1 test, along with a description of the results of several studies of construct validity.
21,451 citations
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01 Jan 1969
TL;DR: In this article, the implications of terminal illness for patients and for those involved in their care were discussed, and patients invited to talk about their experience found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace.
Abstract: Although most areas of human experience are nowadays discussed freely and openly, the subject of death is still surrounded by conventional attitudes and reticence that offer only fragile comfort because they evade the real issues. The dying may thus be denied the opportunity of sharing their feelings and discussing their needs with family, friends, or hospital staff. Although receiving devoted medical care, a dying patient is often socially isolated and avoided, since professional staff and students can find contact painful and embarrasing.
Aware of the strains imposed on all sides by this situation, Dr Kubler-Ross established a seminar at the University of Chicago to consider the implications of terminal illness for patients and for those involved in their care. Patients invited to talk about their experience often found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace. The seminar, initially composed of students of medicine, sociology, psychology, and theology, but later joined by hospital staff and relatives of patients, enabled many members to come to terms with their own feelings and to respond constructi to what the patients had to teach them.
5,220 citations
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TL;DR: A study of 800 outpatient visits to Children's Hospital of Los Angeles as discussed by the authors explored the effect of verbal interaction between doctor and patient on patient satisfaction and follow-through on follow-up.
Abstract: Study of 800 outpatient visits to Childrens Hospital of Los Angeles to explore the effect of the verbal interaction between doctor and patient on patient satisfaction and follow-through on...
947 citations