Abstract
Dumont I, Kissane D: Techniques for framing questions in conducting family meetings in palliative care. Palliat Support Care 2009;7:163–170.
Family therapy has developed several methods and approaches to framing questions within family meetings but little has been adapted for palliative care. In this article, the authors focused on the application of questioning techniques from systemic family therapy to palliative care, describing and giving examples of the model asking questions developed by Karl Tomm through its application in Family Focused Grief Therapy. Methodology used included exploring the types of questions used across the course of therapy based on the interventive questioning model, then providing a case example to demonstrate the use and adaptation of this model in the palliative care setting. Results demonstrated that at the beginning of therapy, the most frequent questions were linear and circular, moving around the family in an effort to build up a picture from the consensus and perspective of everyone involved. As for the frequency of reflexive and strategic questions, these increased as therapy progressed, brining the family to new perspectives that they may not have considered or observed. Finally, the case example fleshed out the importance of each type of question, all of which have a proper and valued place in the course of therapy. The authors conclude that their illustrations highlight the value of having a model of questioning styles to guide the clinician when exploring palliative care issues, such a care provision, coping and grief, and intimacy. Consequently, this framework could be useful in providing supervisors, trainees, and clinicians the platform to build or solidify skills and optimize their interventions in a palliative care setting.
Cheung WY, Zimmerman C: Symptom clusters in patients with advanced cancers. Support Care Cancer 2009;17:1223–1230.
Pain and symptom control are important tenets of palliative care, especially for patients with advanced cancer. However, most research has focused one single symptoms rather than a symptom complex that may occur with many patients. In this study, the authors attempted to explore symptom clusters among outpatients with different advanced cancers. Symptom scores utilizing the Edmonton Symptom Assessment Scale (ESAS) were collected for 1366 patients (50% male, 50% female) attending the Oncology Palliative Care Clinics at Princess Margaret Hospital in Toronto, Canada from January 2005 to October 2007. Results demonstrated the most common site of primary malignancy was gastrointestinal (27%), lung (14%), and breast (11%). The three most distressful symptoms were fatigue, poor general well-being, and decreased appetite. Principal component analysis of symptoms for the entire patient cohort revealed two major symptom clusters: (1) fatigue, drowsiness, nausea, decreased appetite, and dyspnea, which accounted for 45% of the total variance and (2) anxiety and depression, which accounted for 10% of the total variance. The authors conclude that in patients with advanced cancers, distinct symptom clusters can be identified, which are influenced by primary cancer site, and that treatments directed at symptom clusters rather than individual symptoms may provide greater therapeutic benefit.
Cheng JO, Lo RSK, Chan FMY, Woo J: An exploration of anticipatory grief in advanced cancer patients. Psychooncology (in press).
Patients who face death grieve not only for an impending loss of life, but also for the losses of functioning, autonomy, hope, dreams, and a future with loved ones. Such losses can engender complex grief reactions such as denial, anger, bargaining, and depression. In this article, the authors present qualitative “thick descriptions” of the experience of patients with advanced cancer of anticipatory grief (AG) and explore how it is experienced in the family context. Seven patients with advanced incurable cancer were recruited from a day hospice, with five patients comprising the final sample. Participants were invited to attend focus groups and individual interviews to discuss their experience of terminal illness, thoughts and feelings related to AG, and how they coped with losses and grief in the family. Results demonstrated that two interrelated themes of AG were identified: the first main theme (subjective experience of AG) comprised confrontations with death and multiple losses, and resistance against death and loss—the second main theme (experience of AG in the family) explored the patient's role in the family interaction patterns and interpersonal processes. The authors conclude that an understanding in the subjective experience of AG in terminally ill patients and their experience of AG in the family may contribute to the development of psychotherapeutic interventions.
Jeldres C, Latouff JB, Saad F: Predicting life expectancy in prostate cancer patients. Curr Opin Support Palliat Care 2009;3:166–169.
Due to an invariably long natural history, prostate cancer illustrates the need for tools that adequately predict life expectancy. In this review, the authors analyzed the tools available for clinicians involved in the application of therapeutic decisions in newly diagnosed prostate cancer and examined their accuracy to provide individual life expectancy. The tools analyzed included life tables, comorbidity indices, and multivariate prognostic models. The authors note that accuracy of life tables (60.9%) and comorbidity indices (accuracy unknown) may be as weak as clinician-derived life expectancy predictions (69%), with statistical models providing the highest accuracy (69%–84.3%). The authors conclude that as the accuracy of clinician-derived life expectancy prediction is relatively modest, clinicians may benefit from assisted life expectancy prediction by life tables and statistical tools in their daily clinical practice.
Gibbins J, McCoubrie R, Maher J, Forbes K: Incorporating palliative care into undergraduate curricula: Lessons for curriculum development. Med Educ 2009;43:776–783.
Palliative care is an emerging subspecialty that permeates all medical and surgical specialties, and should be incorporated into undergraduate medical curricula. In the United Kingdom, the General Medical Council has issued recommendations for core teaching on the relief of pain and distress, and the care of terminally ill patients. However, some medical schools have incorporated teaching programs, others have not, with the reasons for such variability unknown. In this study, the authors attempted to explore the factors that either help or hinder the incorporation of palliative care teaching at the undergraduate level in the United Kingdom. Semistructured interviews were carried out with a sample of coordinators of palliative care teaching in 14 medical schools in the United Kingdom. Results demonstrated there were several factors promoting or inhibiting palliative care teaching at the undergraduate level that were common to the development of teaching about any specialty; however, the study also revealed several factors that were distinctive to palliative care. These factors included: (1) need for an individual lead or champion; (2) the curriculum; (3) patient characteristics and exposure; (4) local colleagues and setup service; (5) university support; and (6) the influence of students. The authors conclude that the incorporation of palliative care into the medical undergraduate curriculum involves a complex process of individual, institutional, clinical, patient, and curricular factors.