Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives

Loneliness in Advanced Life-Threatening Illness: An Integrative Review

CONTEXT

To inform supportive interventions, experiences of loneliness must be understood specifically from the perspective of those with advanced life-threatening illness and their caregivers.

OBJECTIVES

To identify the causes, experiences, and impacts of loneliness among adults with advanced life-threatening illnesses and caregivers, and which modifiable factors might mitigate loneliness.

METHODS

Systematic searching of six databases (CINHAL, Web of science, Cochrane central, Medline, HMIC and Proquest) was supplemented by backward citation searching from Jan 2014-Jan2024. This was followed by screening and selection based on the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Studies were imported into NVivo version 1.6 for data management. An inductive approach was used to facilitate the synthesis. Quality assessment with diverse studies (QuADS) was used. The review protocol was registered with Prospero, ID: CRD42023493999.

RESULTS

Ninteen observational studies and 6 intervention studies were included in this review. Evidence confirms that the causes, impacts and outcomes of loneliness are multifaceted and interact dynamically. Risk factors on a micro level include psychological and existential factors such as emotional distress and fear of death; potentially modifiable factors include efforts to enhance communication and befriending programs. On meso level physical and social factors are risk factors such as symptom burden and social withdrawal, potentially modifiable factors include utilizing technology to make home an accessible place to maintain social connections. On a macro level environmental and societal risk factors include mobility restrictions and stigma; potentially modifiable factors include increasing societal engagement through community programs CONCLUSION: This integrative review will help healthcare providers, policymakers and the public understand the causes, experiences and impact of loneliness in adults with advanced life-threatening illnesses and their caregivers. The evidence suggests that an integrated approach that combines personal, social, and systemic efforts is needed which includes enhanced communication, targeted interventions, robust support systems, and community engagement. Rigorous research studies are required which include patient and public involvement from inception to completion to ensure that the study designs and methodologies are purposeful for those they intend to serve.

Exploring the concept of Total Pain in contemporary oncology palliative care: a qualitative study on patients' resources

BACKGROUND

According to the concept of Total Pain proposed by Cicely Saunders (1967), the treatment of pain for patients in need of palliative care requires considering its multidimensional nature, encompassing physical, social, psychological, and spiritual aspects. The aim of this study was to update the concept of Total Pain and explore the resources used by patients with cancer.

METHODS

Fourteen semi-structured interviews were conducted in one oncology center and one oncology rehabilitation center (median age = 70.5, range [55-77]; 8 women). The interview guide explored various dimensions of suffering, including physical (e.g., pain), social (e.g., isolation), psychological (e.g., emotional state), and spiritual (e.g., the role of spirituality in illness experience), as well as connections to nature, and patients' internal and external resources related to each sphere of suffering. Interpretative Phenomenological Approach (IPA) was employed to analyze the interviews.

RESULTS

The findings highlight several important aspects of suffering: the unpredictability of pain (physical sphere), loss of social roles (social sphere), negative affects (psychological sphere), evocation of the end of life (spiritual sphere), and loss of contact with nature. Besides in terms of resources, the study identifies several key coping mechanisms, such as mind-body practices for relieving physical and psychological pain, distraction engaging with the environment, nature as a source of positive emotions, and the search for meaning.

CONCLUSIONS

Despite experiencing total pain, some patients utilize internal and external protective resources in the face of life-threatening illness. These findings underscore the importance of viewing Total Pain under its multidimensional aspect and as a dynamic process involving the individual's connection with their community and environment.

TRIAL REGISTRATION

This study received approval from the Ethical Committee of CPP SUD EST 1 (National number: 2019-A02263-54).

Palliative care, COVID-19, and the suffering quotient

OBJECTIVES

The COVID-19 pandemic presented many challenges for patients with palliative care needs and their care providers. During the early days of the pandemic, visitors were restricted on our palliative care units. These restrictions separated patients from their families and caregivers and led to considerable suffering for patients, families, and health-care providers. Using clinical vignettes that illustrate the suffering caused by visiting restrictions during the pandemic, the introduction of a new concept to help predict when health-care providers might be moved to advocate for their patients is introduced.

METHODS

We report 3 cases of patients admitted to a palliative care unit during the COVID-19 pandemic and discuss the visiting restrictions placed on their families. In reviewing the cases, we coined a new concept, the "Suffering Quotient" (SQ), to help understand why clinical staff might be motivated to advocate for an exemption to the visiting restrictions in one situation and not another.

RESULTS

This paper uses 3 cases to illustrate a new concept that we have coined the Suffering Quotient. The Suffering Quotient (SQ) = Perceived Individual (or small group) Suffering/Perceived Population Suffering. This paper also explores factors that influence perceived individual suffering (the numerator) and perceived population suffering (the denominator) from the perspective of the health-care provider.

SIGNIFICANCE OF RESULTS

The SQ provides a means of weighing perceived patient and family suffering against perceived contextual population suffering. It reflects the threshold beyond which health-care providers, or other outside observers, are moved to advocate for the patient and ultimately how far they might be prepared to go. The SQ offers a potential means of predicting observer responses when they are exposed to multiple suffering scenarios, such as those that occurred during the COVID-19 pandemic.

"I couldn't": A phenomenological exploration of ethical tensions experienced by bereaved family members during the pandemic

INTRODUCTION

The COVID-19 pandemic entailed significant changes in accompaniment, end-of-life, and bereavement experiences. In some countries, public health measures prevented or restricted family caregivers from visiting their dying loved ones in residences, long-term care institutions, and hospitals. As a result, family members were faced with critical decisions that could easily lead to ethical dilemmas and moral distress.

AIM

This study aimed to understand better the experience of ethical dilemmas among family caregivers who lost a loved one.

METHDS

We interviewed twenty bereaved family caregivers and analysed their narratives using Interpretative phenomenological analysis.

RESULTS

Our analysis suggests that family caregivers struggled with their multiple responsibilities (collective, relational, and personal) and had to deal with the emotional cost of their choices. Results display three emerging themes describing the experience of ethical struggles: (1) Flight or fight: Struggling with collective responsibility; (2) Being torn apart: Assuming relational responsibility and (3) "Choosing" oneself: The cost of personal responsibility.

DISCUSSION/CONCLUSION

Results are discussed and interpreted using an ethical, humanistic, and existential conceptual framework.