Difficult pain

2021 ◽  
pp. 188-201
Author(s):  
Renee McCulloch ◽  
Charles Berde
Keyword(s):  
Palliative Care ◽  
Medical Treatment ◽  
Severe Pain ◽  
Multimodal Approach ◽  
Individual Child ◽  
Spiritual Issues ◽  
The Individual ◽  
Interventional Therapies ◽  
Prevalent Symptom ◽  
Existential Concerns

A child in pain needs not only appropriate medical treatment, but specific attention to psychosocial, cultural, and spiritual issues in order to allow meaningful exploration of wider fears or concerns. Management requires a collaborative, multimodal approach; optimal use of non-pharmacological strategies, targeted analgesic pharmacotherapy, and if necessary, specific interventional therapies. Although managing pain is only one aspect of providing palliative care for children, however, it is a core task. The experience of severe pain demands an individual’s whole attention, leaving little chance of addressing wider psychosocial or existential concerns while it remains uncontrolled. Difficult pain is a highly prevalent symptom among children with life-limiting conditions (LLC). It is complex, usually multifactorial and multifaceted. It is encountered in every dimension; the physical perception and experience of pain will be dictated by the existential and psychosocial context in which it occurs for the individual child.

Spiritual and Existential Issues in the Care of the Dying

2014 ◽  
pp. 115-126
Author(s):  
William S. Breitbart
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Spiritual Community ◽  
Psychotherapeutic Interventions ◽  
Existential Distress ◽  
Spiritual Issues ◽  
Cognitive Therapies ◽  
Loss Of Dignity ◽  
Existential Issues ◽  
Existential Concerns

Spirituality is important in the lives of patients with serious illnesses. Terminally patients may experience a number of spiritual issues, including lack of meaning, guilt, shame, hopelessness, loss of dignity, loneliness, anger toward God, abandonment by God, feeling out of control, grief, and spiritual suffering. Assessment of a patient’s spiritual beliefs, assessing the importance of spirituality in his or her life, exploring whether he or she belongs to a spiritual community, and offering chaplaincy referral or connection with the patient’s religious or spiritual leaders comprise essential components of a spiritual assessment. Psycho-oncologists should seek both specialized training, as well as referrals to appropriate sources, in order to help patients deal more effectively with the often complicated and painful spiritual issues that arise as a consequence of serious illness. Existential concerns are intrinsic to the human experience of facing mortality in palliative care settings. Patients diagnosed with terminal cancer often confront universal existential issues such as death anxiety, isolation, and meaninglessness. Psycho-oncologists must therefore be familiar with these existential concerns, their manifestations, and approaches to deal with existential issues. Psycho-oncologists have the unique ability to use a variety of psychotherapeutic interventions to alleviate existential distress in palliative care settings including cognitive therapies to help patients and families modify their appraisal of their lives with terminal illness, known as cognitive restructuring, life review techniques to facilitate a constructive reappraisal of life events, dignity-conserving therapies, and meaning-centered therapies have been shown to effectively reduce existential distress in this patient population.

The support needs of parent caregivers of children with a life-limiting illness and approaches used to meet their needs: A scoping review

2020 ◽  
pp. 026921632096759
Author(s):  
Fenella J Gill ◽  
Zahraa Hashem ◽  
Roswitha Stegmann ◽  
Samar M Aoun
Keyword(s):  
Palliative Care ◽  
Scoping Review ◽  
English Language ◽  
Support Needs ◽  
Care Needs ◽  
Caregiver Support ◽  
Paediatric Palliative Care ◽  
Heterogenous Population ◽  
Parent Caregivers ◽  
The Individual

Background: Provision of paediatric palliative care is complex and optimally covers meeting the individual needs of a heterogenous population of children and their parent caregivers throughout a life-limiting illness. It is unclear whether existing approaches comprehensively address parent caregivers’ needs. Aim: To examine support needs of parents caring for children with life limiting illnesses and identify specific approaches used to identify and address needs. Design: A scoping review Data sources: MEDLINE, EMBASE, PsycINFO, CINAHL and ProQuest Central, were searched for peer reviewed English language full text research published from 2008 to 2019. Study quality appraisal was undertaken. Fourteen quantitative, 18 qualitative and 12 mixed methods studies were synthesised and themed using summative content analysis and mapped to the Parent Supportive Care Needs Framework (PSCNF). Results: Themes were communication, choice, information, practical, social, psychological, emotional and physical. Communication and choice were central and additional to domains of the PSCNF. Unmet were needs for supporting siblings, for respite care, out of hours, psychological, home and educational support. Six articles reported using instruments to identify parent carer support needs. Conclusion: Support needs of parent caregivers of children with life limiting illnesses are substantial and heterogenous. While studies report evidence of burden and distress in parent caregivers, this rarely translates into improvements in practice through the development of interventions. A systematic and regular assessment of individual parent caregiver support needs is required by using instruments appropriate to use in clinical practice to move the focus to palliative care interventions and improved services for parents.

Identifying problematic severe asthma in the individual child - does lung function matter?

2010 ◽  
Vol 99 (3) ◽  
pp. 404-410 ◽  
Author(s):  
AM Lang ◽  
J Konradsen ◽  
K-H Carlsen ◽  
C Sachs-Olsen ◽  
P Mowinckel ◽  
...  
Keyword(s):  
Lung Function ◽  
Severe Asthma ◽  
Individual Child ◽  
The Individual

Are palliative cancer patients willing and able to participate in a physical exercise program?

2005 ◽  
Vol 3 (4) ◽  
pp. 281-287 ◽  
Author(s):  
LINE M. OLDERVOLL ◽  
JON H. LOGE ◽  
HANNE PALTIEL ◽  
MAY B. ASP ◽  
UNNI VIDVEI ◽  
...  
Keyword(s):  
Palliative Care ◽  
Physical Exercise ◽  
Training Program ◽  
Cancer Patients ◽  
Physical Training ◽  
Exercise Program ◽  
Group Exercise ◽  
Medical Problems ◽  
Incurable Cancer ◽  
The Individual

Objective: The primary aim of the present article was to identify palliative care patient populations who are willing to participate in and able to complete a group exercise/physical training program designed specifically for the individual patient.Method: We conducted a prospective phase II intervention study examining the willingness and ability of palliative care cancer patients to participate in a group exercise physical training program. Patients who were diagnosed with incurable cancer and had a life expectancy of less than 1 year at two outpatient clinics were invited to participate in an exercise program in the hospitals. The groups met twice a week over a 6-week period.Results: One hundred one consecutive patients were asked for inclusion. Sixty-three patients agreed to participate. Sixteen (25%) of the 63 patients dropped out after consent was given, but before the program started due to medical problems, social reasons, or death. Thus, 47 patients started the exercise program. Thirteen patients withdrew during the program due to sudden death, medical problems, or social reasons. The most frequent reasons for withdrawal were increased pain or other symptoms. Thirty-four patients completed the exercise program.Significance of results: A high proportion of incurable cancer patients were willing to participate (63%) in a structured exercise program. The attrition rate was high, but despite being severely ill, 54% of the patients completed the exercise period. This shows that a physical exercise program tailored to the individual patient is feasible in this population.

scholarly journals Homeopathic products and homeopathic treatment in veterinary medicine in Republic of Slovenia

2010 ◽  
Vol 64 (1-2) ◽  
pp. 143-149
Author(s):  
Silvestra Kobal
Keyword(s):  
Veterinary Medicine ◽  
Medical Treatment ◽  
Point Of View ◽  
Homeopathic Treatment ◽  
Individual Point ◽  
The World ◽  
The Individual ◽  
Homeopathic Drugs ◽  
Selection Of

Doctors and veterinarians in many countries of the world have an opportunity to select between allopathic or homeopathic drugs. The selection of an appropriate method for medical treatment should be performed from the individual point of view. .

scholarly journals Art Therapy in Oncology and Palliative Care – Overview of Empirical Results And A Case Vignette

2018 ◽  
Vol 2 (19) ◽  
Keyword(s):  
Palliative Care ◽  
Public Relations ◽  
Art Therapy ◽  
Psychosocial Treatment ◽  
Case Vignette ◽  
Scientific Development ◽  
Psychotherapeutic Interventions ◽  
Individual Client ◽  
The Individual ◽  
Perception Of Health

Research background. In the spectrum of psychotherapeutic interventions, artistic therapies such as painting, clay modelling, music, dance therapy, as well as poetry and bibliotherapy have become an essential part of psychosocial treatment in a wide variety of medical and therapeutic indications. Artistic therapies enable patients to express stressful emotions in a protected environment, to regulate their own experiences, to learn about resources and to better process the psychologically restrictive consequences of the illness. Empirical evidence of efficacy is still lacking in many fields of Arts Therapies. However, recent, partially controlled randomized studies on art therapy in oncology show a significant reduction in anxiety and depression, a lesser degree of experiencing stress, improved perception of health, and improved disease management. A case Vignette shows how sustainable artistic experiences can have a therapeutic effect and how significant they can become for the individual client. Conclusion. Art therapy, especially in the field of oncology and palliative care, offers special opportunities for therapeutic accompaniment, through which central objectives can be met in the context of the overall treatment. It requires further practical and scientific development work as well as good public relations in order to draw attention to the potential of art therapy and to further validate and establish it as a fixed therapeutic component in oncology and palliative medicine, both inpatient and outpatient. Keywords: art therapy, oncology, palliative care, case report.

scholarly journals Investigation Of Spiritual Well-Being Palliative Care Of Patients

2019 ◽  
Vol 9 (7) ◽  
pp. 496-513 ◽  
Author(s):  
Fadime Çinar*, Turgay Sirin
Keyword(s):  
Palliative Care ◽  
Personal Information ◽  
Healing Process ◽  
Well Being ◽  
Term Treatment ◽  
Long Term Treatment ◽  
Spiritual Well Being ◽  
Life Threatening ◽  
The Difference ◽  
The Individual

Background: One of the indispensable aspects of the philosophy of holistic care,and negative situations such as life-threatening illness, spiritual well-being, which isdefined as the search for a relationship with a divine soul, is a requirement that mustbe met in order to maintain the existence of the individual. The patient's need forsocial and spiritual well-being increases even more in cases of long-term treatment,such as cancer, that reduce the quality of life. Determining and meeting the spiritualneeds of the individual in the difficult times of the crisis can be realized bydetermining the spiritual well-being levels of the individuals and by providing theindividual spiritual care. This study was conducted to determine the level of thespiritual well-being of palliative care patients diagnosed with cancer. Methods: Thisis a descriptive study. The population of the study consisted of 124 patientsdiagnosed with cancer who were hospitalized in the palliative unit between Januaryand August 2018 and were treated in two state hospitals operating on the Europeanside of Istanbul. The sample consisted of 111 people with voluntary participationand communication. Personal Information Form and Spiritual Well-being Scalewere used to collect data. Data were evaluated by one-way analysis of variance (one-way anova) and significance (t-test) of the difference between the two means.Results: The total score averages from the spiritual good scale of individualsparticipating in the Study were determined to be good with x = 4,15. In terms ofthe level of education of Scale scores, only "Anomi" is significantly differentiatedbetween groups of age, with a total score of the scale, In the sub-dimension oftranscendity and the subdimension of "Harmony with Nature" according to thevariable metastasis (p > 0.05). Conclusion: Spiritual Well-being has a positive effecton the healing process of individuals with impaired health. It helps individuals whohave a crisis in life threatening diseases such as Cancer to cope with this crisis and toprovide spiritual well-being in the sense of life. In This process, spiritual careinitiatives by healthcare professionals can be transformed into a part of the healingprocess and the spiritual goodness of the individual can be increased. Furtherresearch in This area is projected to contribute to the richening of the relevantliterature in Turkey.Key words: Spiritual, spiritual well-being, palliative care, palliative care unit

scholarly journals 4 Designing dying well: toward a new architectural approach of in-patient palliative care environments

2018 ◽  
Vol 8 (3) ◽  
pp. 361.1-361
Author(s):  
Annie Bellamy
Keyword(s):  
New York ◽  
Palliative Care ◽  
Design Research ◽  
Ethnographic Study ◽  
List Type ◽  
Yale University ◽  
Body Memory ◽  
The Social ◽  
The Individual ◽  
Architectural Research

Neither a ‘hospital’ nor a ‘home’; the in-patient hospice has a unique architectural identity remaining largely undocumented. There is a plethora of architectural research regarding more common-place healthcare buildings such as hospitals and care-homes. (RIBA n.d) However the architecture of in-patient hospices is misunderstood in the role it can play in supporting the holistic principles of palliative care as backdrops for ‘not just a good death but a good life to the very end’ (Gawande 2014, pg. 245).Reconciling the social and spatial this research aims to establish an authentic identity for in-patient hospices; developing opportunities and situations for environments that become ‘sympathetic extensions of our sense of ourselves’ (Bloomer KC + Moore CW 1977, pg. 78) enabling those at the end of their life to dwell with dignity.An ethnographic study involving practise led design research; the research engages with experiences of the researcher and users of Welsh in-patient hospices alongside interrogations of existing architectural strategies. This inter-disciplinary methodology will provide a ‘back and forth’ movement to reflect with the community of practise upon design projects and fieldwork.Foundation work concluded that ‘homely’ is a too broad and subjective concept with which to define meaningful architectural responses for the variety of users and uses of in-patient hospices. Building upon this initial visits to Welsh in-patient hospices and design primers of key moments of inhabitation aims to provide conclusions on how architecture can create and balance the individual phenomenological experiences and needs of patients family and staff.References. RIBA. Health buildings and hospitals [Online] (n.d). Available at https://www.ribabookshops.com/books/health-buildings-and-hospitals/010503/ (Accessed: 31 May 2018). Gawande A. Being mortal: Medicine and what matters in the end2014;245. New York: Metropolitan Books Henry Holt and Company.. Kent BC, Charles MW. Body memory and architecture1977;78. New Haven & London: Yale University Press.

The PROVIEW+ tool: Developing and validating a tool to predict risk of poor performance status and severe symptoms in cancer patients over time.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12095-12095
Author(s):  
Hsien Seow ◽  
Rinku Sutradhar ◽  
Lisa Catherine Barbera ◽  
Peter Tanuseputro ◽  
Dawn Guthrie ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Cancer Patients ◽  
Severe Pain ◽  
Performance Status ◽  
Well Being ◽  
Assessment System ◽  
Low Performance ◽  
Performance Scale ◽  
Over Time

12095 Background: There are numerous predictive cancer tools that focus on survival. However, no tools predict risk of low performance status or severe symptoms, which are important for patient decision-making and early integration of palliative care. The aim of this study was to develop and validate a model for all cancer types that predicts the risk for having low performance status and severe symptoms. Methods: A retrospective, population-based, predictive study using linked administrative data from cancer patients from 2008-2015 in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). The derivation cohort was used to develop a multivariable logistic regression model to predict the risk of having the reported outcomes in the subsequent 6 months. Model performance was assessed using discrimination and calibration plots. The main outcome was low performance status using the Palliative Performance Scale. Secondary outcomes included severe pain, dyspnea, well-being, and depression using the Edmonton Symptom Assessment System. Outcomes were recalculated after each of 4 annual survivor marks. Results: We identified 255,494 cancer patients (57% female; median age of 64; common cancers were breast (24%) and lung (13%)). At diagnosis, the risk of having low performance status, severe pain, well-being, dyspnea, and depression in 6-months is 1%, 3%, 6%, 13% and 4%, respectively for the reference case (i.e. male, lung cancer, stage I, no symptoms). Generally these covariates increased the outcome risk by > 10% across all models: obstructive lung disease, dementia, diabetes; radiation treatment; hospital admission; high pain; depression; Palliative Performance Scale score of 60-10; issues with appetite; or homecare. Model discrimination was high across all models. Conclusions: The model accurately predicted changing cancer risk for low performance status and severe symptoms over time. Providing accurate predictions of future performance status and symptom severity can support decision-making and earlier initiation of palliative care, even alongside disease modifying therapies.

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