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 Effects of Dosage-Controlled Cannabis Capsules on Cancer-Related Cachexia and Anorexia Syndrome in Advanced Cancer Patients: Pilot Study.

Background: Cancer-related cachexia and anorexia syndrome (CACS) is a common phenomenon in cancer patients. Cannabis has been suggested to stimulate appetite but research on this issue has yielded mixed results. The current study aimed to evaluate the effect of dosage-controlled cannabis capsules on CACS in advanced cancer patients. Methods: The cannabis capsules used in this study contained two fractions of oil-based compounds. The planned treatment was 2 × 10 mg per 24 hours for six months of tetrahydrocannabinol (THC) 9.5 mg and cannabidiol (CBD) 0.5 mg. If patients suffered from side effects, dosage was reduced to 5 mg × 2 per day (THC 4.75 mg, CBD 0.25 mg). Participants were weighed on every physician visit. The primary objective of the study was a weight gain of ≥10% from baseline. Results: Of 24 patients who signed the consent form, 17 started the cannabis capsules treatment, but only 11 received the capsules for more than two weeks. Three of six patients who completed the study period met the primary end-point. The remaining three patients had stable weights. In quality of life quaternaries, patients reported less appetite loss after the cannabis treatment (p=0.05). Tumor necrosis factor-α (TNF-α) levels decreased after the cannabis treatment but without statistical significance. According to patients' self-reports, improvement in appetite and mood as well as a reduction in pain and fatigue was demonstrated. Conclusions: Despite various limitations, this preliminary study demonstrated a weight increase of ≥10% in 3/17 (17.6%) patients with doses of 5mgx1 or 5mgx2 capsules daily, without significant side effects. The results justify a larger study with dosage-controlled cannabis capsules in CACS.

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.

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.

A preliminary report on innovative group therapy in an oncology in-patient department: a patient-family-staff community meeting.

OBJECTIVE: The Community Meeting (CM) is a unique form of group therapy applied from Psychiatry to an Oncology in-patient department. It is designed to answer the needs of in-patients and family members for open communication and empathic interaction and to serve as a model for effective coping. METHODS: A weekly staff-patient-family open group was held, with facilitation based on an integrative crisis intervention model. After each CM, the staff meets to discuss implications. RESULTS: Frequent themes include patient and caregiver concerns about cancer, treatments, communication and coping difficulties. Subjective impressions of participants indicate positive outcomes. The CM seems to enhance positive interactions and perceived quality of care. It helps staff to identify distress, serves as a managerial tool and promotes collaboration among staff. CONCLUSIONS: The CM is a unique method for addressing the burdens of in-patient oncology members. A structured study is needed to substantiate these descriptive outcomes.

Treatment of lower extremity edema by subcutaneous drainage in palliative care of advanced cancer patients.

BACKGROUND: Lower extremity edema is a problem in patients with advanced cancer, causing decreased physical function and reduced movement. METHODS: Eight patients with advanced cancer were treated by subcutaneous needles inserted in the inner and outer sides of the ankles and attached to an enclosed drainage bag, or by creating subcutaneous tracts in both ankles. RESULTS: All patients lost weight after 24 hours. A total of 4 patients reported enhanced mobilization and 5 patients had significant improvement of mobilization that improved their quality of life. CONCLUSIONS: Subcutaneous drainage can improve edema in the lower limbs or the lower body segment, contributing to patient comfort at his end-of-life period. A prospective study with better evaluation of patient quality of life is ongoing in our center.

[Gynecomastia as a complication of hormonotherapy for prostate cancer: effect of prophylactic breast irradiation].

Gynecomastia is a benign condition characterized by proliferation of mammary glandular tissue. Hormonotherapy with bicalutamide for prostate cancer is one of the causes of gynecomastia. The well known aim of treatment is to decrease psychological distress and to improve cosmetic appearance. Prophylactic breast irradiation may prevent the appearance of gynecomastia.

Prevention of prescription errors by computerized, on-line surveillance of drug order entry.

AIMS: The present study was undertaken to quantify the impact of computerized drug order entry system (CDOE) connected to the patients' database, on the incidence and type of prescription errors (PEs) in the medical service, and to delineate the causes for remaining errors. METHODS: Drug orders were reviewed daily by a physician-reviewer, in a department of internal medicine that used for more than 3 years a CDOE (CDOEdept), and in a similar department in which drug orders were handwritten (HWdept). PEs were divided into those not related to the individual patient (type 1 PEs), and PEs resulting from drug-laboratory, drug-disease, and drug-allergy interactions (type 2 PEs). RESULTS: Ten thousand and two hospitalization days were evaluated. The incidence of type 1 PEs was 5.21 and 1.36 per 100 hospitalization days in the HWdept and CDOEdept, respectively (p<0.0001). Type 2 PEs were more common, 7.20 and 3.02 per 100 hospitalization days in the HWdept and CDOEdept, respectively (p<0.0001), and about 75% of them were due to few drug-laboratory interactions. Most of the remaining errors in the CDOEdept were due to inadequate adjustment of drugs and doses to renal function, or failure to perform adequate changes when new laboratory results became available. CONCLUSIONS: We conclude that linking the CDOE with few, specific, laboratory results has a large impact on the prevention of PEs. Combining the CDOE with a drug-laboratory alert system is expected to further reduce the incidence of PEs.