Palliative Care in Oncology

Palliative Care in Oncology:The Patient and The Family : 

Palliative Care in Oncology:The Patient and The Family Lauren Lambrecht, M3 February 21, 2006

The Clinical Problem : 

The Clinical Problem Many adults will have one or more chronic illnesses with which they will live for years before they die. These years are characterized by: physical and psychological distress progressive functional dependence and frailty increased needs for family and external support Morrison, Sean, Meier, Diane. Palliative Care. NEJM 2004;350:2582-2590.

Role of Palliative Care : 

Role of Palliative Care Palliative care aims to relieve suffering and improve the quality of life for patients with advanced illnesses and their families through specific knowledge and skills, including: communication with patients and family members management of pain and other symptoms psychosocial, spiritual, and bereavement support coordination of an array of medical and social services Palliative care should be offered simultaneously with all other medical treatment. Morrison, Sean, Meier, Diane. Palliative Care. NEJM 2004;350:2582-2590.

Communication : 

Communication Communicating with patients is a core skill of palliative medicine. Typically, clinicians elicit fewer than half of patients' concerns, consistently fail to discuss patients' values, goals of care, and preferences with regard to treatment. If physicians use specific communication skills in enhancing disclosure of the issues of concern to a patient, decreasing anxiety, assessing depression, and improving a patient's well-being and the level of the patient's and the family's satisfaction with the treatment. Make eye contact with patients, asking open-ended questions, respond to a patient's affect, and demonstrate empathy Morrison, Sean, Meier, Diane. Palliative Care. NEJM 2004;350:2582-2590.

Adaptive Response to the Diagnosis of Cancer by Patients : 

Adaptive Response to the Diagnosis of Cancer by Patients Patients must adapt quickly to catastrophic news They must also control the level of emotional distress while making crucial treatment decisions Patients may experience reactions ranging from: Extreme anxiety Sadness Fear Anger Numbness and lack of reactivity Guilt and attribution mechanisms Cognitively, patients may become highly focused, seeking information aggressively, or become confused, paralyzed, and unable to concentrate. Somatic complaints may increase, and there is often disruption of daily activity, appetite, and sleep Sadock, Benjamin J., Sadock, Virginia A. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Lippincott Williams & Wilkins, 2005.

Responsibilities of the Family : 

Responsibilities of the Family Providing emotional support and containment-Family members are expected and expect themselves to contain their own reactions and to support the patient Sharing responsibility for decision making Concrete care taking: families receive little help or training Meeting financial costs Absorbing social costs Maintaining stability Adapting to change Sadock, Benjamin J., Sadock, Virginia A. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Lippincott Williams & Wilkins, 2005.

Adaptive Response to Diagnosis by Families : 

Adaptive Response to Diagnosis by Families Sometimes, functional impairment that can rival or even exceed that of the patient Acutely: Denial Pessimism Overvaluation Magical expectation Covert bargaining Disillusionment and anger Eventually, most families show generosity, courage, and resiliency However, as many as 25 to 30 percent would benefit from intervention Patients who reported having physicians who listened to the patient and caregiver reported fewer caregiver burdens Sadock, Benjamin J., Sadock, Virginia A. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Lippincott Williams & Wilkins, 2005. Emanuel EJ, Fairclough DL, Slutsman J, Emanuel LL. Understanding economic and other burdens of terminal illness: the experience of patients and their caregivers. Ann Intern Med 2000;132:451-459.

Interventions : 

Interventions

References : 

References Sadock, Benjamin J., Sadock, Virginia A. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Lippincott Williams & Wilkins, 2005. Emanuel EJ, Fairclough DL, Slutsman J, Emanuel LL. Understanding economic and other burdens of terminal illness: the experience of patients and their caregivers. Ann Intern Med 2000;132:451-459. Morrison, Sean, Meier, Diane. Palliative Care. NEJM 2004;350:2582-2590.