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Sholevar R, Landerholm A, Kher H, Tung S, Braun I, Peteet J. Institutional Transference in Serious Illness Care. J Palliat Med 2024; 27:143-146. [PMID: 37729069 DOI: 10.1089/jpm.2023.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Institutional transference is a phenomenon describing patients' attitudes toward the institutions where they receive mental health or medical care. While transference toward individual clinicians in palliative care has been described, attitudes of patients with serious illness toward the institutions where they receive specialized care have not been described. Here, we present three cases which demonstrate the phenomenon of institutional transference in patients with serious illness and the resulting clinical implications, which include countertransferential responses of clinicians caring for them. We consider three conditions: (1) the idealized reputation of the academic cancer center, often a tertiary referral center; (2) loss of an institutional connection during care transitions; and (3) countertransferential reactions to institutional transference. We highlight characteristics and personality styles of individuals with cancer that may complicate and intensify institutional transference and identify potential interventions to address common challenges associated with institutional transference.
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Affiliation(s)
- Roxanne Sholevar
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Landerholm
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Hema Kher
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephanie Tung
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ilana Braun
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - John Peteet
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Sholevar R, Peteet J, Sanders J, Beaussant Y. Disruption as an opportunity or threat: A qualitative analysis of factors influencing the attitudes of experts in serious illness care toward psychedelic-assisted therapies. Palliat Support Care 2023:1-6. [PMID: 37818641 DOI: 10.1017/s1478951523001475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND Psychedelic-assisted therapies (PAT) are emerging as a promising treatment for psycho-existential distress in patients with serious illness. A recent qualitative analysis of perspectives of 17 experts in serious illness care and/or PAT research identified divergent views on the therapeutic potential and safety of PAT in patients with serious illness. This paper further analyzes the factors that may influence these views. OBJECTIVES To identify factors underlying the attitudes of experts in serious illness care and/or PAT toward PAT and its potential role in serious illness care. METHODS Semi-structured interviews of 17 experts in serious illness care and/or PAT from the United States and Canada were analyzed to identify factors cited as influencing their views on PAT. RESULTS Five factors were identified as influencing experts' attitudes toward PAT: perception of unmet need, knowledge of empirical studies of PAT, personal experience with psychedelics, professional background, and age/generation. In addition, an integrative theme emerged from the analysis, namely PAT's disruptive potential at 4 levels relevant to serious illness care: patient's experience of self, illness, and death; relationships with loved ones and health-care providers; existing clinical models of serious illness care; and societal attitudes toward death. Whether this disruptive potential was viewed as a therapeutic opportunity, or an undue risk, was central in influencing experts' level of support. Experts' perception of this disruptive potential was directly influenced by the 5 identified factors. SIGNIFICANCE OF RESULTS Points of disruption potentially invoked by PAT in serious illness care highlight important practical and philosophical considerations when working to integrate PAT into serious illness care delivery in a safe and effective way.
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Affiliation(s)
- Roxanne Sholevar
- Department of Psychosocial Oncology and Palliative Care, The Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - John Peteet
- Department of Psychosocial Oncology and Palliative Care, The Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - Justin Sanders
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care, The Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
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Sholevar R, Landerholm A, Tung S, Peteet J. Psychodynamic Lessons for Modern Cancer Care: The Role of Institutional Transference in the Psychiatric Care of Cancer Patients. J Acad Consult Liaison Psychiatry 2022. [DOI: 10.1016/j.jaclp.2022.03.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Castro L, Peteet J, Balboni T, Koenig H, Cintra F. 725 Serious Illness, Sleep Quality, and Spirituality: an exploratory study in a multicultural inpatient setting. Sleep 2021. [DOI: 10.1093/sleep/zsab072.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Spiritual well-being can impact quality of life and survival among diseased populations, similarly to sleep. Despite beneficial effects of spiritual-based practices on sleep, few studies have investigated an association between these attributes. Our goal was to explore correlations between measures of sleep quality and spirituality among severe medical inpatients hospitalized for different reasons, testing whether sleep could be a mechanism by which spirituality influences clinical outcomes.
Methods
Patients (18+ years) admitted in two units of the University’s hospital between Oct/2018 and Aug/2019 were invited to participate. Semi-structured interviews included the Duke Religiousness Index, the Belief into Action Scale, the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being, the Pittsburgh Sleep Quality Index (PSQI), and the Short Form Six-Dimension (SF-6D) health index. Diagnoses were defined by the International Classification of Diseases. We used the Chi-square test, bivariate correlations, and Generalized Linear Models.
Results
A total of 146 consecutive patients were included (46.8±15.9 years, 51% men), 28% admitted for cardiovascular diseases, 26% for cancer, 20% rheumatologic disorders, and 26% for other conditions including hematological, nephro-urological, infectious, among other diseases. The mean PSQI was 10.1±4.7 and 55% of patients rated their sleep as poor. Average sleep duration was 6.5±1.9 hours. Insomnia (64%) was the most frequent sleep complaint, followed by nocturia (43%), pain (42%), and discomfort breathing (29%). There was a modest correlation between sleep quality and spiritual well-being (-0.23; p<0.01). Maintenance insomnia correlated with less spiritual peace/meaning (-0.27; p<0.01) and faith (-0.21; p=0.01), whereas pain, with more social (0.21; p=0.01) and private (0.24; p<0.01) religious activities. Initial insomnia also correlated with private activities (0.18; p=0.04). Seep quality (0.43; 0.25–0.62), spiritual peace/meaning (-0.21; -0.40-[-0.01]), and social religious activities (0.18; 0.04–0.32) were independent indicators of higher SF-6D scores, additional to an interacting effect between sleep quality and spiritual well-being predicting better quality of life.
Conclusion
Subjective sleep quality is associated with spiritual well-being and quality of life, independently of the nature and severity of the medical disease. Our findings also suggest that patients suffering from nocturnal pain and trouble falling asleep might be more engaged with religious activities.
Support (if any)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Braun IM, Wright A, Peteet J, Meyer FL, Yuppa DP, Bolcic-Jankovic D, LeBlanc J, Chang Y, Yu L, Nayak MM, Tulsky JA, Suzuki J, Nabati L, Campbell EG. Medical Oncologists' Beliefs, Practices, and Knowledge Regarding Marijuana Used Therapeutically: A Nationally Representative Survey Study. J Clin Oncol 2018; 36:1957-1962. [PMID: 29746226 DOI: 10.1200/jco.2017.76.1221] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Although almost every state medical marijuana (MM) law identifies cancer as a qualifying condition, little research supports MM's use in oncology. We hypothesized that the discrepancy between these laws and the scientific evidence base poses clinical challenges for oncologists. Oncologists' beliefs, knowledge, and practices regarding MM were examined in this study. Methods In November 2016, we mailed a survey on MM to a nationally-representative, random sample of 400 medical oncologists. Main outcome measures included whether oncologists reported discussing MM with patients, recommended MM clinically in the past year, or felt sufficiently informed to make such recommendations. The survey also queried oncologists' views on MM's comparative effectiveness for several conditions (including its use as an adjunct to standard pain management strategies) and its risks compared with prescription opioids. Bivariate and multivariate analyses were performed using standard statistical techniques. Results The overall response rate was 63%. Whereas only 30% of oncologists felt sufficiently informed to make recommendations regarding MM, 80% conducted discussions about MM with patients, and 46% recommended MM clinically. Sixty-seven percent viewed it as a helpful adjunct to standard pain management strategies, and 65% thought MM is equally or more effective than standard treatments for anorexia and cachexia. Conclusion Our findings identify a concerning discrepancy between oncologists' self-reported knowledge base and their beliefs and practices regarding MM. Although 70% of oncologists do not feel equipped to make clinical recommendations regarding MM, the vast majority conduct discussions with patients about MM and nearly one-half do, in fact, recommend it clinically. A majority believes MM is useful for certain indications. These findings are clinically important and suggest critical gaps in research, medical education, and policy regarding MM.
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Affiliation(s)
- Ilana M Braun
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Alexi Wright
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - John Peteet
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Fremonta L Meyer
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - David P Yuppa
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Dragana Bolcic-Jankovic
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Jessica LeBlanc
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Yuchiao Chang
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Liyang Yu
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Manan M Nayak
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - James A Tulsky
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Joji Suzuki
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Lida Nabati
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Eric G Campbell
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
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Sanders JJ, Chow V, Enzinger AC, Lam TC, Smith PT, Quiñones R, Baccari A, Philbrick S, White-Hammond G, Peteet J, Balboni TA, Balboni MJ. Seeking and Accepting: U.S. Clergy Theological and Moral Perspectives Informing Decision Making at the End of Life. J Palliat Med 2017; 20:1059-1067. [PMID: 28387570 DOI: 10.1089/jpm.2016.0545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with serious illness frequently rely on religion/spirituality to cope with their diagnosis, with potentially positive and negative consequences. Clergy are uniquely positioned to help patients consider medical decisions at or near the end of life within a religious/spiritual framework. OBJECTIVE We aimed to examine clergy knowledge of end-of-life (EOL) care and beliefs about the role of faith in EOL decision making for patients with serious illness. DESIGN Key informant interviews, focus groups, and survey. SETTING/SUBJECTS A purposive sample of 35 active clergy in five U.S. states as part of the National Clergy End-of-Life Project. MEASUREMENT We assessed participant knowledge of and desire for further education about EOL care. We transcribed interviews and focus groups for the purpose of qualitative analysis. RESULTS Clergy had poor knowledge of EOL care; 75% desired more EOL training. Qualitative analysis revealed a theological framework for decision making in serious illness that balances seeking life and accepting death. Clergy viewed comfort-focused treatments as consistent with their faith traditions' views of a good death. They employed a moral framework to determine the appropriateness of EOL decisions, which weighs the impact of multiple factors and upholds the importance of God-given free will. They viewed EOL care choices to be the primary prerogative of patients and families. Clergy described ambivalence about and a passive approach to counseling congregants about decision making despite having defined beliefs regarding EOL care. CONCLUSIONS Poor knowledge of EOL care may lead clergy to passively enable congregants with serious illness to pursue potentially nonbeneficial treatments that are associated with increased suffering.
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Affiliation(s)
- Justin J Sanders
- 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.,11 Brigham and Women's Hospital , Boston, Massachusetts
| | - Vinca Chow
- 2 Department of Anesthesia, Duke University , Durham, North Carolina
| | - Andrea C Enzinger
- 3 Departments of Medical Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts
| | - Tai-Chung Lam
- 4 Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, University of Hong Kong , Hong Kong, China
| | - Patrick T Smith
- 5 Harvard Medical School Center for Bioethics , Boston, Massachusetts.,6 Gordon-Conwell Theological Seminary , South Hamilton, Massachusetts
| | - Rebecca Quiñones
- 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts
| | | | - Sarah Philbrick
- 8 Kirksville College of Osteopathic Medicine, A.T. Still University , Kirksville, Missouri
| | | | - John Peteet
- 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts
| | - Tracy A Balboni
- 10 Department of Radiation Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts.,11 Brigham and Women's Hospital , Boston, Massachusetts.,12 Initiative on Health, Religion, and Spirituality within Harvard, Boston, Massachusetts
| | - Michael J Balboni
- 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.,12 Initiative on Health, Religion, and Spirituality within Harvard, Boston, Massachusetts
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Mitchell CM, Epstein-Peterson ZD, Bandini J, Amobi A, Cahill J, Enzinger A, Noveroske S, Peteet J, Balboni T, Balboni MJ. Developing a Medical School Curriculum for Psychological, Moral, and Spiritual Wellness: Student and Faculty Perspectives. J Pain Symptom Manage 2016; 52:727-736. [PMID: 27693904 PMCID: PMC5319601 DOI: 10.1016/j.jpainsymman.2016.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/31/2016] [Accepted: 05/20/2016] [Indexed: 11/30/2022]
Abstract
CONTEXT Although many studies have addressed the integration of a religion and/or spirituality curriculum into medical school training, few describe the process of curriculum development based on qualitative data from students and faculty. OBJECTIVES The aim of this study is to explore the perspectives of medical students and chaplaincy trainees regarding the development of a curriculum to facilitate reflection on moral and spiritual dimensions of caring for the critically ill and to train students in self-care practices that promote professionalism. METHODS Research staff conducted semiscripted and one-on-one interviews and focus groups. Respondents also completed a short and self-reported demographic questionnaire. Participants included 44 students and faculty members from Harvard Medical School and Harvard Divinity School, specifically senior medical students and divinity school students who have undergone chaplaincy training. RESULTS Two major qualitative themes emerged: curriculum format and curriculum content. Inter-rater reliability was high (kappa = 0.75). With regard to curriculum format, most participants supported the curriculum being longitudinal, elective, and experiential. With regard to curriculum content, five subthemes emerged: personal religious and/or spiritual (R/S) growth, professional integration of R/S values, addressing patient needs, structural and/or institutional dynamics within the health care system, and controversial social issues. CONCLUSION Qualitative findings of this study suggest that development of a future medical school curriculum on R/S and wellness should be elective, longitudinal, and experiential and should focus on the impact and integration of R/S values and self-care practices within self, care for patients, and the medical team. Future research is necessary to study the efficacy of these curricula once implemented.
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Affiliation(s)
- Christine M Mitchell
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Julia Bandini
- Department of Sociology, Brandeis University, Waltham, Massachusetts, USA
| | - Ada Amobi
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Cahill
- Theology Department, Boston College, Chestnut Hill, Massachusetts, USA
| | - Andrea Enzinger
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah Noveroske
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - John Peteet
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tracy Balboni
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael J Balboni
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Bandini J, Mitchell C, Epstein-Peterson ZD, Amobi A, Cahill J, Peteet J, Balboni T, Balboni MJ. Student and Faculty Reflections of the Hidden Curriculum. Am J Hosp Palliat Care 2016; 34:57-63. [DOI: 10.1177/1049909115616359] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The hidden curriculum, or the socialization process of medical training, plays a crucial role in the development of physicians, as they navigate the clinical learning environment. The purpose of this qualitative study was to examine medical faculty and students’ perceptions of psychological, moral, and spiritual challenges during medical training in caring for critically ill patients. Focus groups were conducted with 25 Harvard Medical School (HMS) students, and interviews were conducted with 8 HMS faculty members. Five major themes emerged as important in shaping students’ medical training experiences. First, students and faculty discussed the overall significance of the hidden curriculum in terms of the hierarchy of medicine, behavioral modeling, and the value placed on research versus clinical work. Second, respondents articulated values modeled in medicine. Third, students and faculty reflected on changes in student development during their training, particularly in terms of changes in empathy and compassion. Fourth, respondents discussed challenges faced in medical school including professional clinical education and the psychosocial aspects of medical training. Finally, students and faculty articulated a number of coping mechanisms to mitigate these challenges including reflection, prayer, repression, support systems, creative outlets, exercise, and separation from one’s work. The results from this study suggest the significance of the hidden curriculum on medical students throughout their training, as they learn to navigate challenging and emotional experiences. Furthermore, these results emphasize an increased focus toward the effect of the hidden curriculum on students’ development in medical school, particularly noting the ways in which self-reflection may benefit students.
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Affiliation(s)
- Julia Bandini
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | - Christine Mitchell
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | | | - Ada Amobi
- Harvard Medical School Boston, Boston, MA, USA
| | | | - John Peteet
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School Boston, Boston, MA, USA
| | - Tracy Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School Boston, Boston, MA, USA
| | - Michael J. Balboni
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School Boston, Boston, MA, USA
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Balboni MJ, Bandini J, Mitchell C, Epstein-Peterson ZD, Amobi A, Cahill J, Enzinger AC, Peteet J, Balboni T. Religion, Spirituality, and the Hidden Curriculum: Medical Student and Faculty Reflections. J Pain Symptom Manage 2015; 50:507-15. [PMID: 26025271 PMCID: PMC5267318 DOI: 10.1016/j.jpainsymman.2015.04.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/13/2015] [Accepted: 04/24/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT Religion and spirituality play an important role in physicians' medical practice, but little research has examined their influence within the socialization of medical trainees and the hidden curriculum. OBJECTIVES The objective is to explore the role of religion and spirituality as they intersect with aspects of medicine's hidden curriculum. METHODS Semiscripted, one-on-one interviews and focus groups (n = 33 respondents) were conducted to assess Harvard Medical School student and faculty experiences of religion/spirituality and the professionalization process during medical training. Using grounded theory, theme extraction was performed with interdisciplinary input (medicine, sociology, and theology), yielding a high inter-rater reliability score (kappa = 0.75). RESULTS Three domains emerged where religion and spirituality appear as a factor in medical training. First, religion/spirituality may present unique challenges and benefits in relation to the hidden curriculum. Religious/spiritual respondents more often reported to struggle with issues of personal identity, increased self-doubt, and perceived medical knowledge inadequacy. However, religious/spiritual participants less often described relationship conflicts within the medical team, work-life imbalance, and emotional stress arising from patient suffering. Second, religion/spirituality may influence coping strategies during encounters with patient suffering. Religious/spiritual trainees described using prayer, faith, and compassion as means for coping whereas nonreligious/nonspiritual trainees discussed compartmentalization and emotional repression. Third, levels of religion/spirituality appear to fluctuate in relation to medical training, with many trainees experiencing an increase in religiousness/spirituality during training. CONCLUSION Religion/spirituality has a largely unstudied but possibly influential role in medical student socialization. Future study is needed to characterize its function within the hidden curriculum.
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Affiliation(s)
- Michael J Balboni
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Julia Bandini
- Department of Sociology, Brandeis University, Waltham, Massachusetts, USA
| | - Christine Mitchell
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Ada Amobi
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Cahill
- Theology Department, Boston College, Chestnut Hill, Massachusetts, USA
| | - Andrea C Enzinger
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - John Peteet
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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LeBaron VT, Cooke A, Resmini J, Garinther A, Chow V, Quiñones R, Noveroske S, Baccari A, Smith PT, Peteet J, Balboni TA, Balboni MJ. Clergy Views on a Good Versus a Poor Death: Ministry to the Terminally Ill. J Palliat Med 2015; 18:1000-7. [PMID: 26317801 DOI: 10.1089/jpm.2015.0176] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Clergy are often important sources of guidance for patients and family members making medical decisions at the end-of-life (EOL). Previous research revealed spiritual support by religious communities led to more aggressive care at the EOL, particularly among minority patients. Understanding this phenomenon is important to help address disparities in EOL care. OBJECTIVE The study objective was to explore and describe clergy perspectives regarding "good" versus "poor" death within the participant's spiritual tradition. METHODS This was a qualitative, descriptive study. Community clergy from various spiritual backgrounds, geographical locations within the United States, and races/ethnicities were recruited. Participants included 35 clergy who participated in one-on-one interviews (N = 14) and two focus groups (N = 21). Semistructured interviews explored clergy viewpoints on factors related to a "good death." Principles of grounded theory were used to identify a final set of themes and subthemes. RESULTS A good death was characterized by wholeness and certainty and emphasized being in relationship with God. Conversely, a "poor death" was characterized by separation, doubt, and isolation. Clergy identified four primary determinants of good versus poor death: dignity, preparedness, physical suffering, and community. Participants expressed appreciation for contextual factors that affect the death experience; some described a "middle death," or one that integrates both positive and negative elements. Location of death was not viewed as a significant contributing factor. CONCLUSIONS Understanding clergy perspectives regarding quality of death can provide important insights to help improve EOL care, particularly for patients highly engaged with faith communities. These findings can inform initiatives to foster productive relationships between clergy, clinicians, and congregants and reduce health disparities.
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Affiliation(s)
| | - Amanda Cooke
- 3 Beth Israel Deaconness Medical Center , Boston, Massachusetts
| | | | | | - Vinca Chow
- 6 Brigham & Women's Hospital , Boston, Massachusetts
| | - Rebecca Quiñones
- 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts
| | - Sarah Noveroske
- 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts
| | | | - Patrick T Smith
- 8 Gordon-Conwell Theological Seminary , Boston, Massachusetts
| | - John Peteet
- 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts
| | - Tracy A Balboni
- 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts
| | - Michael J Balboni
- 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts
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Balboni T, Balboni M, Paulk ME, Phelps A, Wright A, Peteet J, Block S, Lathan C, Vanderweele T, Prigerson H. Support of cancer patients' spiritual needs and associations with medical care costs at the end of life. Cancer 2011; 117:5383-91. [PMID: 21563177 DOI: 10.1002/cncr.26221] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/29/2011] [Accepted: 03/31/2011] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although spiritual care is associated with less aggressive medical care at the end of life (EOL), it remains infrequent. It is unclear if the omission of spiritual care impacts EOL costs. METHODS A prospective, multisite study of 339 advanced cancer patients accrued subjects from September 2002 to August 2007 from an outpatient setting and followed them until death. Spiritual care was measured by patients' reports that the health care team supported their religious/spiritual needs. EOL costs in the last week were compared among patients reporting that their spiritual needs were inadequately supported versus those who reported that their needs were well supported. Analyses were adjusted for confounders (eg, EOL discussions). RESULTS Patients reporting that their religious/spiritual needs were inadequately supported by clinic staff were less likely to receive a week or more of hospice (54% vs 72.8%; P = .01) and more likely to die in an intensive care unit (ICU) (5.1% vs 1.0%, P = .03). Among minorities and high religious coping patients, those reporting poorly supported religious/spiritual needs received more ICU care (11.3% vs 1.2%, P = .03 and 13.1% vs 1.6%, P = .02, respectively), received less hospice (43.% vs 75.3% ≥1 week of hospice, P = .01 and 45.3% vs 73.1%, P = .007, respectively), and had increased ICU deaths (11.2% vs 1.2%, P = .03 and 7.7% vs 0.6%, P = .009, respectively). EOL costs were higher when patients reported that their spiritual needs were inadequately supported ($4947 vs $2833, P = .03), particularly among minorities ($6533 vs $2276, P = .02) and high religious copers ($6344 vs $2431, P = .005). CONCLUSIONS Cancer patients reporting that their spiritual needs are not well supported by the health care team have higher EOL costs, particularly among minorities and high religious coping patients.
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Affiliation(s)
- Tracy Balboni
- Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Balboni MJ, Babar A, Dillinger J, Phelps AC, George E, Block SD, Kachnic L, Hunt J, Peteet J, Prigerson HG, VanderWeele TJ, Balboni TA. "It depends": viewpoints of patients, physicians, and nurses on patient-practitioner prayer in the setting of advanced cancer. J Pain Symptom Manage 2011; 41:836-47. [PMID: 21276700 PMCID: PMC3391979 DOI: 10.1016/j.jpainsymman.2010.07.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 07/19/2010] [Accepted: 07/29/2010] [Indexed: 11/19/2022]
Abstract
CONTEXT Although prayer potentially serves as an important practice in offering religious/spiritual support, its role in the clinical setting remains disputed. Few data exist to guide the role of patient-practitioner prayer in the setting of advanced illness. OBJECTIVES To inform the role of prayer in the setting of life-threatening illness, this study used mixed quantitative-qualitative methods to describe the viewpoints expressed by patients with advanced cancer, oncology nurses, and oncology physicians concerning the appropriateness of clinician prayer. METHODS This is a cross-sectional, multisite, mixed-methods study of advanced cancer patients (n=70), oncology physicians (n=206), and oncology nurses (n=115). Semistructured interviews were used to assess respondents' attitudes toward the appropriate role of prayer in the context of advanced cancer. Theme extraction was performed based on interdisciplinary input using grounded theory. RESULTS Most advanced cancer patients (71%), nurses (83%), and physicians (65%) reported that patient-initiated patient-practitioner prayer was at least occasionally appropriate. Furthermore, clinician prayer was viewed as at least occasionally appropriate by the majority of patients (64%), nurses (76%), and physicians (59%). Of those patients who could envision themselves asking their physician or nurse for prayer (61%), 86% would find this form of prayer spiritually supportive. Most patients (80%) viewed practitioner-initiated prayer as spiritually supportive. Open-ended responses regarding the appropriateness of patient-practitioner prayer in the advanced cancer setting revealed six themes shaping respondents' viewpoints: necessary conditions for prayer, potential benefits of prayer, critical attitudes toward prayer, positive attitudes toward prayer, potential negative consequences of prayer, and prayer alternatives. CONCLUSION Most patients and practitioners view patient-practitioner prayer as at least occasionally appropriate in the advanced cancer setting, and most patients view prayer as spiritually supportive. However, the appropriateness of patient-practitioner prayer is case specific, requiring consideration of multiple factors.
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Affiliation(s)
- Michael J Balboni
- Center for Psycho-Oncology and Palliative Care Research, Department of Psycho-Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts 02120, USA.
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Abstract
In this article we review practice models for treating common mental disorders in primary care. Novel treatment approaches by primary care providers and specialty providers, including collaborative care and telepsychiatric models, show considerable promise. An understanding of remaining barriers to improved care suggests several possible solutions and future directions for outpatient psychosomatic medicine.
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Abstract
Clinicians have traditionally viewed neutrality as the primary means of promoting patient autonomy, and by extension mental health. But patients also require expert direction, want other values incorporated into their treatment, and benefit from collaborating with clinicians toward shared therapeutic objectives. A historical perspective on the physician-patient relationship reveals an evolving richness in the concepts of autonomy and neutrality. Formal, or authentic, autonomy is more descriptive of mental health than individual autonomy, and nurture is a more effective strategy for promoting it than neutrality, although technical neutrality remains an indispensable tactic. This model of mental health treatment is comprehensive, relational, and developmental.
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Affiliation(s)
- Leigh Bishop
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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Affiliation(s)
- John Peteet
- Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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Affiliation(s)
- John Peteet
- Dana-Farber Cancer Institute, 44 Binney Street, Gossman 411, Boston, MA 02115, USA.
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Abstract
Life-threatening illnesses such as cancer may precipitate marital crises in vulnerable relationships, and oncology clinicians often feel uncertain about how to approach them. This paper presents a framework for initial intervention based on the nature of the principal threat to the relationship. Immature relationships need distance and support for their identity as a couple; hostile dependent couples need to find consensus in order to structure communication; physically abusive relationships require monitoring in order to promote safety; and estranged couples need help in understanding their disappointment and identifying available support. Clinicians working in oncology can help couples in crisis by promoting a realistic balance of independence and dependence, clarifying the complexity of factors contributing to the crisis, considering referral for couples treatment, communicating with the team while respecting patients' confidences, and by choosing clear and compatible clinical roles. Primary clinicians can stabilize and treat marital crises, but need access to medically knowledgeable couples' therapists.
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Affiliation(s)
- J Peteet
- Department of Psychosocial Services and Social Work, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Abstract
Forty-six orthopedic patients were studied to determine the incidence, natural history, and risk factors associated with post-operative delirium. Pre-operatively, patients were given a neuropsychological screening evaluation, the Mood Adjective Checklist (MACL), the Zung Depression Scale, the Anxiety Inventory Scale, and the Health Assessment Questionnaire (HAQ). A psychiatrist interviewed each patient on post-op day four for evidence of delirium as defined by DSM III criteria. Of the patients studied, thirteen (26%) were possibly or definitely delirious following surgery. Treatment with propranolol, scopolamine, or flurazepam (Dalmane) conferred a relative risk for delirium of 11.7 (p = 0.0028). Delirium was associated with increased post-operative complications (p = 0.01), poorer post-operative mood (p = 0.06), and an increase of about 1.5 days in length of stay (not significant). Delirious patients were significantly less likely than matched controls to improve in function at six months compared with a pre-operative baseline HAQ (t = 6.43, p less than 0.001).
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Affiliation(s)
- M P Rogers
- Psychiatry Division, Brigham and Women's Hospital, Boston, MA 02115
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Abstract
Thirty of 100 consecutive outpatients at a comprehensive cancer center were assessed by their physicians as having pain due to cancer severe enough to require regular or narcotic medication. These 30 patients and their physicians then were approached with a semistructured questionnaire about pain characteristics and management. Pain severity correlated only with age older than 55 years. Patients tended to rate their pain as more severe than did their physicians, but believed that pain medications generally were effective. Side effects of pain medication and patient fears of dependence on medication appeared to be more important limiting factors in achieving complete pain relief from medication than undermedication by physicians. Both patients and physicians acknowledged a relationship between emotional state and pain, but there was a greater appreciation among patients than physicians of the usefulness of techniques such as relaxation and distraction in pain control.
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Abstract
A seminar for psychotherapy supervision of residents employed videotapes of interviews as the focus. When patients and therapists together reviewed the tapes, a number of therapeutically valuable results ensued including a) retelling of corrected histories and new commitment to the therapy; b) increased awareness of denied areas of experience and insight into transference, defense, hidden affects and so on; c) a variety of forms of confrontation. In addition, this report reviews indications, difficulties, problems, and failures encountered with this technique.
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Gutheil TG, Mikkelsen EJ, Peteet J, Shiling D, White H. Patient viewing of videotaped psychotherapy. Part II. Aspects of the supervisory process. Psychiatr Q 1981; 53:227-34. [PMID: 7330132 DOI: 10.1007/bf01070096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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