Some differences between social work, spiritual care, and psychology: Content variance in end-of-life conversations.

OBJECTIVES: Within the multidisciplinary team, there can sometimes be lack of clarity as to the specific different contributions of each of the psycho-social-spiritual professionals: social workers, psychologist, and spiritual caregivers. This study examined the content of their end-of-life conversations with patients. METHODS: A total of 180 patients with terminal cancer received standard multidisciplinary care, including conversations with a social worker, psychologist, and spiritual caregiver. After each patient's death, these professionals reported using a structured tool which content areas had arisen in their conversations with that patient. RESULTS: Across all content areas, there were significant differences between social work and spiritual care. The difference between social work and psychology was slightly smaller but still quite large. Psychology and spiritual care were the most similar, though they still significantly differed in half the content areas. The differences persisted even among patients who spoke with more than 1 kind of professional. The 6 content areas examined proved to subdivide into 2 linked groups, where patients speaking about 1 were more likely to speak about the others. One group, "reflective" topics (inner and transpersonal resources, interpersonal relationships, one's past, and end of life), included all those topics which arose more often with spiritual caregivers or psychologists. The second group, "decision-making" topics (medical coping and life changes), was comprised of those topics which arose most commonly with social workers, bridging between the medical and personal aspects of care and helping patients navigate their new physical, psychological, and social worlds. SIGNIFICANCE OF RESULTS: These findings help shed light on the differences, in practice, between patients' conversations with social workers, psychologists, and spiritual caregivers and the roles these professionals are playing; can aid in formulating individualized care plans; and strengthen the working assumption that all 3 professions contribute in unique, complementary ways to improving patients' and families' well-being.

Associations Between Psycho-Social-Spiritual Interventions, Fewer Aggressive End-of-Life Measures, and Increased Time After Final Oncologic Treatment.

BACKGROUND: Little is known about the impact of spiritual caregivers, psychologists, and social workers on desired end-of-life (EoL) medical outcomes, such as reduced use of aggressive care in the final 2 weeks of life, having more time between the last active oncological treatment and death, and increased hospice use. PATIENTS AND METHODS: We conducted a prospective study of 180 patients with cancer and their families, their interactions with social work, psychology, and spiritual care, and the above three treatment outcomes. RESULTS: We found that having one or more spiritual care visits (adjusted odds ratio (AOR) = 2.02; P = .04), having more quality visits with the psychologist (P = .01), and speaking with someone about one's inner resources (AOR = 2.25; P = .03) all correlated with reduced EoL aggressive care. The key interventions correlating with increased time after final treatment were more visits with the spiritual caregiver or the social worker (AOR = 1.30; P < .001), and speaking about the medical treatment (AOR = 1.54; P < .001) and about interpersonal relationships (AOR = 2.28; P < .001). A subjectively good-quality connection with the spiritual caregiver correlated with increased hospice use (AOR = 10.00; P = .01). CONCLUSIONS: Patients with cancer who availed themselves of the spiritual care, psychology, and social work services, each profession in distinct ways, had significantly different outcomes in their EoL medical treatment, including undergoing fewer futile aggressive measures, having more time after their last active treatment, and using hospice services more. These outcomes directly bear on improved quality of life and reduced costs.

The perception and attitudes of Israeli cancer patients regarding advance care planning.

OBJECTIVES: Advance care planning (ACP) allows patients to acknowledge and document their preferences regarding end-of-life care and to ensure their fulfilment. Several factors were found to be related to patients' motivation regarding this process, such as their fear of being a burden on family members; however, the completion rate of the ACP forms is partial. The current study aimed to evaluate the barriers and motives among Israeli cancer patients regarding ACP, including many older adults. SETTING AND MEASUREMENTS: Advanced cancer patients participated in the study. All completed an initial questionnaire to evaluate their basic knowledge regarding the issue. Participants who agreed to talk with a social worker completed a semi open-ended questionnaire which investigated their main motives and barriers regarding the issue. RESULTS: Most of the patients who completed the ACP forms were older and had lung cancer. They mentioned information and open communication with family and staff members as the main enabling factors. Their main motives were to ensure that the best medical decisions would be made and to avoid unnecessary medical procedures. The main reasons for not completing the forms was no close relative who would agree to take the responsibility as well as timing. Most of the participants did not hear about the issue from sources outside the oncology division. CONCLUSIONS: Despite several limitations, the current findings may have important implications regarding ways to establish a more suitable ACP process, adjusted to older patients' needs. This may assist in promoting patients' cooperation with ACP and its implementation in the medical system, including older adults.

The Effect of Inquiry-Based Stress Reduction on Teacher Burnout: A Controlled Trial.

Burnout is a well-known phenomenon with significant social, biological and economic costs. In particular, teacher burnout is associated with unfavorable mental health outcomes and economic costs due to reduced hours and teacher turnover. This study investigated the effect of an Inquiry-Based Stress Reduction (IBSR) cognitive-reframing program on teacher burnout using a quasi-experimental design. Fifty-three teachers participated in a prospective intervention with a passive control group. The intervention group completed a 12-week IBSR program with 4.5 h of weekly engagement. Relative to control, teachers in the intervention group showed greater improvements in emotional exhaustion (18.8 ± 5.2 to 15.9 ± 5.7 vs. 16.0 ± 4.8 to 17.4 ± 4.8; p = 0.01) and personal accomplishment (21.8 ± 5.0 to 24.6 ± 4.3 vs. 21.9 ± 4.5 to 22.8 ± 4.3; p = 0.04). Significant correlations were found between change in emotional exhaustion and negative affect (positive correlation; r = 0.32; p = 0.034) and between personal accomplishment and perceived stress (negative correlation; r = -0.451; p = 0.002). This study demonstrates the potential of IBSR to improve teacher well-being. Future randomized studies are needed to evaluate the causality of IBSR in reducing burnout among teachers and other high-stress workplaces.

The perception of Israeli oncology staff members regarding advance care planning.

BACKGROUND: Advance care planning (ACP) defines end-of-life care in accordance with the patients' preferences. It is highly important during mental and/or physical deterioration, which prevents patients from expressing their wishes. Despite various attempts worldwide to promote the issue, it is not well established, suggesting various challenges in the implementation of the process in the medical system. The current study aimed to evaluate the perception of Israeli oncology staff members regarding the process. METHODS: Physicians and nurses from a division of oncology participated in the study. They completed the study's questionnaires, which included quantitative items regarding staff and patients' motives and barriers, as well as qualitative questions to better evaluate their understanding regarding the process. RESULTS: According to staff members, the optimal time to complete the forms is during the final stages of the disease. Making the right medical decisions and avoiding unnecessary medical procedures were rated as the main motives for patients in the process. The communication factor was perceived as the main barrier for patients, as well as the main motive and barrier for staff. The central role of communication was demonstrated in the qualitative section as well. Various differences were demonstrated between staff members who talked with patients about ACP and those who did not. CONCLUSION: The study demonstrated the central role of communication in the process of ACP from the staff's perception. This highlights the need to further promote training programs for staff members to establish better interactions and communication skills when dealing with end-of-life issues.

The effects of Inquiry-Based Stress Reduction (IBSR) on mental health and well-being among a non-clinical sample.

BACKGROUND: Mental problems are highly common among the general population. Mind-body interventions were found to be highly effective in treating them. The current study assessed the effect of Inquiry-Based Stress Reduction (IBSR) meditation on psychological parameters in a general population sample. METHODS: Ninety-seven Participants enrolled in a 28-day workshop and completed a set of self-administered measures before and after the workshop. Outcome measures included Beck Depression Inventory-II (BDI-II), Quick Inventory of Depressive Symptomology-Self Report (QIDS-SR16), Outcome Questionnaire OQ-45.2, The Quality of Life Inventory (QOLI), State-Trait Anxiety Inventory Form (STAI), State-Trait Anger Expression Inventory (STAXI) (State), Subjective Happiness Scale (SHS), Eating Attitudes Test (EAT). RESULTS: BDI scale decreased significantly before and after the intervention. QIDS scale improved significantly from T1 to T2 (p < 0.001). Outcome questionnaire decreased significantly at T2. Quality of life scores improved significantly between T1 and T2 (p < 0.001). Anxiety state and trait scores decreased significantly after the intervention (p < 0.001) All the subscales of anger decreased significantly after the intervention (p < 0.001).Subjective happiness improved significantly (p < 0.001). CONCLUSIONS: IBSR meditation improved various psychological scales among a general population sample. Further controlled studies should evaluate the clinical implementation of IBSR among the general population.

Cannabis-related cognitive impairment: a prospective evaluation of possible influences on patients with cancer during chemotherapy treatment as a pilot study.

OBJECTIVES: In patients with cancer, the use of medical cannabis has increased significantly during the recent years. There is evidence that cannabis consumption may affect cognitive performance; however, this potential effect has not been investigated prospectively in patients with cancer to date. We aimed to evaluate the effect of cannabis consumption on cognitive abilities as well as on symptom relief in patients with cancer during chemotherapy treatment. PATIENTS AND METHODS: A prospective study was carried out on a group of 17 patients on cannabis treatment (case) who were compared with 17 patients not on cannabis treatment (control). Participants completed self-reported questionnaires (the Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, European Organization of Research and Treatment of Cancer core questions on the Quality of Life Questionnaire) and underwent the following neurocognitive tests: Montreal Cognitive Assessment, Digit Symbol Substitution subtest (WAIS III) and Digital-Finger Tapping Test. The evaluation was conducted before the initiation of cannabis consumption and 3 months later during the period of cannabis use. RESULTS: Improvement in executive functioning was demonstrated in the case group. In aspects of symptoms, improvement in fatigue, appetite and sleep disorder was demonstrated after cannabis consumption. Patients consuming cannabis did not differ from the control group in cognitive functioning over 3 months of use. No significant cognitive decline was observed in either group over time. CONCLUSION: These preliminary findings suggest that the short-term use of cannabis during chemotherapy treatment improved disease-related symptoms and did not affect cognitive skills in patients with cancer.

Attachment Orientation and Relationships With Physicians and Nurses Among Israeli Patients With Advanced Cancer.

OBJECTIVES: To examine the association between attachment orientation and relationships with physicians and nurses among Israeli patients with advanced cancer. SAMPLE & SETTING: 52 patients with advanced cancer during active oncologic treatment. METHODS & VARIABLES: Eligible patients who agreed to participate in the study completed the Experience in Close Relationships Scale, Working Alliance Inventory-Short Revised, and a list of topics, which were defined by the research team as central and common to patients' coping. RESULTS: A correlation was found between avoidant attachment orientation and working alliance with nurses. In addition, patients' attachment orientation was found to be correlated with the type of topics they chose to share with the staff. IMPLICATIONS FOR NURSING: Knowledge regarding the theoretical concepts of attachment orientation may assist nurses in providing tailored and beneficial communication patterns with patients.

Medical students' attitudes towards participating in a palliative medicine course: A new specialty in Israel.

BACKGROUND: Palliative medicine is a growing field in Israel, and its training program is still in process. The current study aimed to evaluate students' attitudes regarding a course in palliative care established in a division of oncology. METHOD: Some 45 medical students in their 5th to 6th years participated in a one-week course on palliative care. At the end of each training week, students were asked to complete a questionnaire, evaluating their attitudes regarding different aspects of the program content, such as its importance and relevance to their training as physicians, as well as the contribution of specific parts of the program to their knowledge regarding palliative care. RESULTS: The overall satisfaction of the 45 students was high. The most contributory parts of the course were the multidisciplinary team and the complementary and alternative medicine. Participating in the staff meetings and accompanying physicians in their daily work were scored as the least contributory parts.Significance of resultsThis preliminary study demonstrated students' overall high satisfaction with the newly established palliative care course and their need for more practical skills. Future studies should investigate and evaluate educational programs in palliative care in order to establish suitable training for medical students.

Understanding the Attitudes of Patients with Cancer Toward Complementary and Alternative Therapies.

BACKGROUND: The high prevalence of complementary and alternative medicine (CAM) use among patients with cancer can be explained by reasons such as growing scientific evidence and improved regulation. However, subjective considerations are also relevant for practicing CAM and perceiving its effectiveness. The current study aimed at qualitatively estimating patients' prior beliefs and expectations, as well as their level of satisfaction after the treatment. PATIENTS AND METHODS: Patients with cancer who received six weekly sessions of CAM during their oncologic treatments participated in the study. They detailed their prior expectations and their level of posttreatment satisfaction. The open-ended answers were analyzed using interpretative phenomenological analysis. In addition, the contents before and after the intervention were compared. RESULTS: Over a 2-year period, 163 patients entered the study, 135 of whom completed all six CAM sessions. The content analysis of the pretreatment expectations revealed four main categories: emotional, physical, external, and aspects related to the practice of CAM. After the intervention, patients referred to the therapeutic encounter as a significant aspect, in addition to the emotional and physical ones. CONCLUSION: CAM sessions encouraged emotional and relational aspects in patients' perspectives, which may be highly relevant for their coping process. Encouraging personal motives may increase treatment efficacy and ensure optimal use of health care resources.

The association between the strength of the working alliance and sharing concerns by advanced cancer patients: a pilot study.

OBJECTIVES: A strong therapeutic alliance between cancer patients and medical staff is associated with treatment adherence, better health outcomes, and an emotional acceptance of a terminal illness. Given its significant role, the current study investigated the association between the working alliance and sharing concerns by advanced cancer patients. METHODS: Advanced cancer patients completed the Working Alliance Inventory-Short Revised and a checklist of topics in which they rated their degree of concern about the topics and the degree of sharing them with their physician/nurse. RESULTS: Fifty-two patients completed the study. The working alliance was found to be strong with respect to treating physicians and nurses. The four topics that concerned patients the most were family coping with their illness (81%), fear of future suffering (71%), symptom control (67%), and the oncological treatment (65%). Patients with a strong working alliance with their physician shared to a higher extent the personal and main concern regarding their family's coping, and a significant correlation was found between them (r = 0.53, p < .01). In addition, sharing fears of future suffering was also correlated with a strong working alliance with the physician (r = 0.28, p < .05). A strong working alliance with the nurse was correlated with discussing symptoms control (r = 0.30, p < .05). CONCLUSION: These findings provide preliminary support for an association between the strength of the working alliance and the type of concerns that advanced cancer patients choose to discuss with their medical staff and highlight the importance of follow-up studies to further explore this association.

Perceptions of the working alliance among medical staff and cancer patients.

OBJECTIVE: A working alliance (WA) is considered an essential factor in therapeutic relationships, relating to the mutual and interactive aspects of the relationship. In the medical setting, a WA has been found to be related to various positive outcomes; however, it has previously been investigated solely from the patient's perspective. The aim of the current study was to measure the concept from both sides of the patient-medical staff interaction. METHOD: Physicians, nurses, and advanced cancer patients completed the Working Alliance Inventory-Short Revised. RESULTS: Some 32 physicians, 39 nurses, and 52 advanced cancer patients completed the study. Senior staff members rated the WA higher than trainees, both among physicians and nurses. Physicians and nurses rated the "bonds" subscale highest, while patients rated "goals" at the highest level. In addition, a significant difference was demonstrated between physicians and patients, with patients rating the WA higher. CONCLUSIONS: These preliminary findings demonstrate different perspectives among advanced cancer patients and medical staff interactions. Future studies should investigate the interactive aspects of the WA concept in the medical setting. SIGNIFICANCE OF RESULTS: Awareness of the working alliance in patient-staff interactions may improve the quality of treatment given to patients confronting cancer.

[The effects of "The Work" meditation technique on psychological scales among a non-clinical sample].

BACKGROUND: "The Work" is a meditative technique developed by Byron Katie in 1986 and is practiced by hundreds of thousands of people in more than 30 countries. The technique trains individuals to identify the thoughts that cause stress and suffering in a systematic and comprehensive way and to meditatively "investigate" these thoughts, thus enabling them to experience a different interpretation of reality. GOALS: The current study aimed to assess the effect of "The Work" meditation on psychological scales among a non-clinical sample. METHODS: This was a prospective research study conducted without a control group. The intervention consisted of a 9-day workshop of "The Work" meditation technique. Fifty-eight participants completed the following questionnaires before and after the intervention: satisfaction with life (SWLS), sense of coherence (SOC), general well-being (MHI), self-esteem (SES) and demographics. RESULTS: A significant improvement was obtained in all measures after "The Work" intervention: SWLS (21.6 to 25.07, p<0.001); SOC-comprehensibility subscale (4.05 to 4.55, p<0.001), SOC-manageability subscale (4.39 to 4.9, p<0.001) and meaningfulness subscale (4.58 to 5.07, p<0.001); SES (17.61 to 21.56, p<0.001); General wellbeing-well-being subscale (4.34 to 4.87, p<0.001) and distress subscale (3.42 to 2.79, p<0.001). DISCUSSION: A sense of coherence is an important resource for coping with challenging life events and promoting well-being and health. This resource can be influenced by mind-body interventions. Satisfaction with life is a subjective judgment of satisfaction with one's life in relation to one's own unique criteria. It is a central resource in mental and physical health promotion. "The Work" meditation technique includes cognitive conceptualization and processes, which may have contributed to the increase demonstrated in this scale. Psychological well-being scales also improved--a finding which has health, social and economic implications in the general population. The findings of the current study should be evaluated in light of its limitations, mainly the lack of a control group. CONCLUSIONS: The current pilot study shows the potentially beneficial effects of "The Work" technique as a method of intervention for improving results on psychological scales and promoting mental health among the general population. Future randomized controlled studies should examine the effectiveness of "The Work" intervention in this population.

The effects of "The Work" meditation (Byron Katie) on psychological symptoms and quality of life--a pilot clinical study.

OBJECTIVES: "The Work" is a meditative technique that enables the identification and investigation of thoughts that cause an individual stress and suffering. Its core is comprised of four questions and turnarounds that enable the participant to experience a different interpretation of reality. We assessed the effect of "The Work" meditation on quality of life and psychological symptoms in a non-clinical sample. DESIGN: This study was designed as a single-group pilot clinical trial (open label). Participants (n = 197) enrolled in a nine-day training course ("The School for The Work") and completed a set of self-administered measures on three occasions: before the course (n = 197), after the course (n = 164), and six months after course completion (n = 102). OUTCOME MEASURES: Beck Depression Inventory-II (BDI-II), Subjective Happiness Scale (SHS), Quality of Life Inventory (QOLI), Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16), Outcome Questionnaire 45.2 (OQ-45.2), State-Trait Anger Expression Inventory-2 (STAXI-2), and State-Trait Anxiety Inventory (STAI). RESULTS: A mixed models analysis revealed significant positive changes between baseline compared to the end of the intervention and six-month follow-up in all measures: BDI-II (t = 10.24, P < .0001), SHS (t = -9.07, P <.0001), QOLI (t = -5.69, P < .0001), QIDS-SR16 (t = 9.35, P < .0001), OQ-45.2 (t = 11.74, P < .0001), STAXI-2 (State) (t = 3.69, P = .0003), STAXI-2 (Trait) (t = 7.8, P < .0001), STAI (State) (t = 11.46, P < .0001), and STAI (Trait) (t = 10.75, P < .0001). CONCLUSIONS: The promising results of this pilot study warrant randomized clinical trials to validate "The Work" meditation technique as an effective intervention for improvement in psychological state and quality of life in the general population.

Perceptions of a patient-staff-caregiver group among inpatients in a radiotherapy unit.

OBJECTIVE: Coping with cancer and its treatments has significant psychological implications for patients, and hospitalization can lead to emotional distress. Based on a community meeting (CM), a common therapeutic intervention in psychiatric wards, a unique patient-staff-caregiver group is held weekly on the radiotherapy unit of our hospital. The goals are to strengthen patient coping abilities and prompt open communications. The present study aimed at quantitatively estimating the effect of the community meeting by gauging the perceptions with respect to several therapeutic aspects. METHOD: A questionnaire was developed for patients who participated in CMs during their hospitalization based on four theoretical factors: illness perception, relations with the main caregiver, relations with other participants, and relations with unit staff. RESULTS: Participants' general satisfaction with the meetings was found to be positive. The most significant aspect of the meetings, as perceived by participants, was relationships with the staff. Patients born in Israel perceived relationships with other participants more positively. SIGNIFICANCE OF RESULTS: Attentive interaction with medical staff and open communications are highly important for patients and contribute to their general satisfaction with the meetings.

The effect of complementary and alternative medicine on quality of life, depression, anxiety, and fatigue levels among cancer patients during active oncology treatment: phase II study.

BACKGROUND: During the past decade, there has been growing interest in complementary and alternative medicine (CAM) among cancer patients and it is being integrated more frequently within conventional cancer centers. The long-term effect of mind-body therapies on quality of life (QoL), depression, anxiety, and fatigue was tested prospectively in this study. PATIENTS AND METHODS: Cancer patients who received six weekly sessions of CAM during their oncological treatments participated in the study. The Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI) and QoL-EORTC-C30 were completed during the intervention and follow-up period. RESULTS: Over a two-year period, 163 patients entered the study, 135 of whom completed all six CAM sessions. An improvement was demonstrated in the median of BFI from 4.8 to 3.9 (p < 0.001), HADS-Anxiety from 8 to 7 (p < 0.001) and HADS-Depression from 7 to 6 (p < 0.001) after 12 weeks. In addition, the median of global QoL improved from 50 to 67 (p < 0.001), and a significant improvement was noticed in several parameters on the functioning and symptoms scales of the QoL-EORTC-C30. CONCLUSION: Cancer patients who completed six weekly sessions of CAM improved significantly on measured outcomes, regardless of their demographic characteristics.

"Balint group" meetings for oncology residents as a tool to improve therapeutic communication skills and reduce burnout level.

Medical training, particularly residency, may pose many challenges and may lead to burnout. Oncology training may be more stressful, given the prolonged exposure to death and dying. Balint group is an intervention method common in medical training, aimed at improving communication skills and strengthening doctor-patient relationships. We arranged for our oncology residents, guided by a senior oncologist and a clinical psychologist, to meet monthly for a discussion of personal cases from the residents' experiences. At the beginning of the year, higher measures in two burnout parameters were found in junior residents compared to senior residents. At the end of the year, the gap in Maslach Burnout Inventory scores between junior and senior residents had decreased, while burnout level decreased slightly during the year in junior residents. It was felt that participation in a Balint group could improve communication abilities of residents and contribute to their feelings of self-accomplishment as doctors.