Supportive Psychotherapy for Healthcare Professionals in The Management of Acute Coronary Syndrome: The Use of Delphi Technique.

BACKGROUND: Supportive psychotherapy (SP) may increase the benefit of acute coronary syndrome (ACS) management, but there is no structured SP as a guideline for healthcare professionals. This study aimed to develop structured SP as a guideline for implementing psychotherapy in the management of ACS patients in intensive cardiac care unit (ICCU). METHODS:  This qualitative study used Delphi technique as a modified Delphi method to reach a consensus among experts of structured SP for healthcare professionals in the management of ACS during hospitalized in ICCU. This was developed using self-reflection, observation, and interview of SP implementation in daily psychosomatic practice, gathering literature reviews, doing focus group discussion (FGD) and interview with ACS survivors. During the Delphi rounds, we interviewed 50 informants as source people using valid questionnaires, to proceed a draft of the SP framework and the structured sessions. The SP framework draft and the structured sessions were evaluated and corrected by experts anonymously until the consensus was reached. The validity of the consensus was tested, using Likert psychometric scale to reach an agreement. Cronbach alpha test was used to assess construct validity with SPSS 20. RESULTS:  All of preparations conducted before the Delphi rounds showed that ACS patients had psychosomatic disorders during in ICCU, that required support. SP is very helpful to reduce the negative impact of this disorders.Off 50 informants answered a valid and reliable questionnaire which supports the above statement. The draft was made based on the above process. The development of SP for healthcare professionals of ACS managements was reached in a consensus of expert panelists in the second round of the Delphi with Cronbach alpha of 0.9. CONCLUSION: Supportive psychotherapy (SP) for healthcare professionals in the management of ACS in ICCU were developed and may be applied in clinical practice and research.

Factors Associated with Pain in Palliative Patients and the Role of Spiritual Services in Pain Management.

BACKGROUND: pain is one of the most often symptoms experienced by patients with advanced or chronic diseases which can cause a decrease in the quality of life of palliative patients. Pain in palliative patients has not yet received enough attention, especially factors associated with pain and its management. This study aimed to determine the factors associated with pain in palliative patients and also assess whether there is a two-way relationship between psychological factors and pain. In addition, we will also see whether spiritual services play a role in relieving pain. METHODS: cross-sectional study were used and secondary data were obtained from medical records of 285 palliative patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The data were processed to determine the psycho-socio-demographic characteristics, the reciprocal relationships of psychological and pain aspects, and the relationship of pharmacological therapy (opioids), non-pharmacological therapy (spiritual services), and combination of both therapies in pain management. RESULTS: of the 285 palliative patients, 60.3% had pain, which was found more in cancer patients (74.4% vs 25.6%). Pain was found more in patients aged 41-60 years (51.1%), women (51.2%), and unemployed (30.2%). The severity of the pain was found to be significant in patients with depressive symptoms (p=0.045), while patients with anxiety symptoms (p=0.155) and sleep disorders (p=0.619) had no significant relationship. Pain experienced by palliative patients was not statistically significant in causing depression (p=0.058), anxiety (p=0.107), and sleep disorder (p=0.639). Moreover, pain management with opioids, spiritual services, or combination of them turned out to have significant results (p=0.022). CONCLUSION: pain in palliative patients is mainly experienced by cancer patients and the elderly. Psychological factors affect the condition of pain, so the management that includes biopsychosocial aspect will be able to reduce pain significantly.