ABSTRACT
OBJECTIVE: To compare Individual Meaning-Centered Psychotherapy-Palliative Care (IMCP-PC) to counselling-based psychotherapy in patients receiving home palliative care (PC). METHODS: Fifty-one patients with advanced-stage cancer receiving home PC were recruited for this. Two-arm (individual meaning-centered psychotherapy-palliative-IMCP-PC-care vs. counselling) randomized feasibility trial. Anxiety, depression, demoralization, and emotional distress were evaluated before and after three psychotherapy sessions. Patient perceptions of the treatment were assessed after completion of therapy. RESULTS: Thirty-two patients (16 in each group) completed all three sessions as well as the pre- and post-therapy questionnaires and were therefore included in the final analysis. All patients in the IMCP-PC group showed a significant decrease in levels of demoralization (despair), anxiety, depression, and emotional distress. By contrast, the only variable that significantly improved in the counselling group was demoralization. The post-treatment questionnaire revealed no significant between-group differences regarding patient perception of the structure, focus, or length of treatment. However, the IMCP-PC group rated the treatment more highly with regard to its value in helping them to find meaning in life. CONCLUSIONS: IMCP-PC is a specific psychotherapy tailored to the needs of patients with advanced cancer. The results of the present study indicate that this treatment is suitable for patients at end of life that are not able to attend outpatient sessions. Although more research is needed, the findings of this feasibility trial suggest that the IMCP-PC merits consideration for patients receiving home palliative care (PC).
Subject(s)
Neoplasms/psychology , Neoplasms/therapy , Palliative Care/methods , Psychotherapy/methods , Aged , Anxiety/etiology , Anxiety/psychology , Anxiety/therapy , Anxiety Disorders/etiology , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Feasibility Studies , Female , Hospice and Palliative Care Nursing , Humans , Male , Neoplasm Staging , Neoplasms/pathology , Pilot Projects , Precision Medicine/methods , Psychological Distress , Surveys and QuestionnairesABSTRACT
INTRODUCCIÓN: El final de vida constituye una situación de gran impacto emocional para pacientes y familiares. En estas circunstancias los pacientes ponen en marcha diferentes estrategias de afrontamiento para poder hacer frente a esta difícil y compleja situación. OBJETIVOS: Conocer el grado de malestar emocional de los pacientes en situación de final de vida, explorar las estrategias de afrontamiento que utilizan y comparar el malestar emocional y las estrategias que emplean los pacientes atendidos en un centro hospitalario con las de los pacientes atendidos en su domicilio. MÉTODO: Estudio transversal correlacional. La muestra está constituida por 75 pacientes en situación de final de vida, el 53,3 % fueron tratados en el domicilio y el 46,7 % en un centro hospitalario. Se realizó una entrevista individual con cada paciente donde se recogían sus datos sociodemográficos y clínicos y se administraban los cuestionarios de malestar emocional (DME) y de estrategias de afrontamiento (MINI-MAC y BRCS). RESULTADOS: El 73,3 % de los pacientes presentan malestar emocional y el 81,3 % expresan preocupaciones relacionadas principalmente con la familia (47,5 %). Las estrategias de afrontamiento más utilizadas son el espíritu de lucha (45,9 %) y la resiliencia (44 %). Cuando se comparan ambos grupos, los pacientes atendidos en el domicilio presentan puntuaciones significativamente más elevadas en las estrategias de preocupación ansiosa (p = 0,016) y desesperanza (p = 0,005), respecto a los pacientes ingresados en un centro hospitalario. CONCLUSIONES: A pesar de que son pacientes que presentan malestar emocional, una importante proporción de ellos utiliza estrategias de afrontamiento adaptativas. No obstante, la elevada proporción de malestar entre los pacientes del estudio nos sugiere la importancia de desarrollar intervenciones psicológicas preventivas para disminuir este malestar y proporcionar estrategias adaptativas que mejoren la calidad de vida del paciente al final de la vida
INTRODUCTION: The end of life represents a situation with a high emotional impact on patients and family members. Under these circumstances, patients set in motion a number of coping strategies to deal with this complex, difficult situation. OBJECTIVES: To assess emotional distress levels in patients at the end of life, to explore the coping strategies they use, and to compare emotional distress and coping strategies between home-care and hospitalized subjects. METHOD: This was a correlational, cross-sectional study. The sample included 75 patients at the end of life. Of these, 53.3% were being cared for in their homes, and 46.7% in health facilities. A one-on-one interview was carried out with each patient to collect sociodemographic and clinical data, and to administer emotional distress (DME) and coping strategies (MINI-MAC and BRCS) questionnaires. RESULTS: A total of 73.7% of patients have emotional distress, and 81.3% report concerns, primarily about their families (47.5%). The most commonly used coping strategies include a fighting spirit (45.5%) and resilience (44%). Patients cared for at home show significantly higher anxious worrying (p = 0.016) and hopelessness (p = 0.005) scores when compared to hospitalized individuals. CONCLUSIONS: Despite their having emotional distress, a significant proportion of these patients develop adaptive coping strategies. However, the high rate of distress found among study patients suggests the importance of developing preventive psychological interventions to reduce such distress and provide adaptive strategies to improve quality of life at the end of life
