Issues in Palliative Care.

Through this column, we hope that practitioners in general medical settings will gain a more complete knowledge of the many patients who are likely to benefit from brief psychotherapeutic interventions. A close working relationship between primary care and psychiatry can serve to enhance patient outcome.

Remote psychotherapy for terminally ill cancer patients.

We conducted a feasibility study of remote psychotherapy in 10 terminally ill cancer patients with diagnoses of adjustment disorder or major depression. Subjects received six sessions of individual cognitive therapy with the same therapist. Sessions alternated between face-to-face sessions and remote sessions delivered by analogue videophone. After each therapy session, a brief questionnaire was used to evaluate the subjects' level of satisfaction with the session, sense of connectedness to the therapist and overall progress being made in the therapy. Nine patients completed the study. Of 53 completed therapy sessions, 21 were by videophone and 32 were conducted face to face. Participants reported strong positive perceptions and acceptance after almost all therapy sessions, regardless of service delivery mode. The study suggests that there may be a role for the delivery of psychotherapy using low-bandwidth videophones.

Prescribing Brief Psychotherapy.

Brief psychotherapy has demonstrated its effectiveness in treating emotional disorders and helping with problems that typically present to primary care physicians. Because practitioners receive little instruction about this treatment option and often have erroneous preconceived ideas about it, psychotherapy remains underprescribed. Effective brief therapy enables the patient to problem-solve, facilitates the relationship with the provider, and ultimately clarifies the patient's situation. Referral of appropriate patients for psychotherapy will enhance the effectiveness of the doctor in primary care.