Do psychosocial interventions work in palliative care?

THIS MONTH’S EDITOR’S CHOICE FROM PALLIATIVE MEDICINE …

Marco Warth, Jens Kessler, Friederike Koehler, Corina Aguilar-Raab, Hubert J. Bardenheuer and Beate Ditzen from Heidelberg University Hospital, Heidelberg, Germany, explain the background to their longer article selected as Editor’s Choice in the March issue of Palliative Medicine

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Top row, left to right: Marco Warth, Friederike Koehler and Hubert J. Bardenheuer. Bottom row, left to right: Beate Ditzen, Jens Kessler and Corina Aguilar-Raab. 

With this definition, the World Health Organization describes a holistic understanding of health that palliative and hospice care has known and emphasized since its beginnings. Today, specialized palliative care providers equally deal with the physical, emotional, social, and spiritual needs of patients with a life-limiting illness. The psychosocial facets may encompass the urge to deal with unsolved relationship conflicts, the need to treat symptoms of depression, demoralization, or anxiety, as well as the wish to produce something lasting of oneself or to search for purpose and meaning in life. Besides voluntary workers, a wide range of professionals engage in meeting those needs, including psychologists, social workers, creative arts therapists, or chaplains. Surprisingly, psychosocial interventions specifically designed for palliative settings have only recently been described in scientific reports. In the March 2019 issue of Palliative Medicine, we therefore reviewed the latest evidence on the effectiveness of psychosocial interventions in palliative care within an interdisciplinary team of psychologists, physicians, and music therapists.

Reading previous review articles on this topic, we found that many findings could not be transferred to our clinical practice as they included patients with a longer life expectancy, or techniques with a higher number of sessions than we could typically hope for. Still, the question of how the psychosocial needs of patients with a short life expectancy could adequately be addressed remained highly important. We therefore focused our search on the effects of brief interventions on health outcomes related to quality of life. To be considered psychosocial, the intervention had to address psychological, social, or spiritual needs and to be carried out by a trained therapist or nurse (e.g. psychotherapy, mind-body interventions, creative arts therapies). Therapies mainly relying on a physical or sensory mechanism (e.g. physiotherapy, massages, aromatherapy) were not included. In addition, we defined a brief intervention as one that would require a maximum number of four sessions and a contact period of less than 21 days. We then performed a systematic review and meta-analysis to examine the effectiveness of psychosocial interventions.

We included 15 controlled clinical trials, with life review techniques (i.e. guided conversations on the biography, identity or beliefs of a patient) and music therapy (i.e. the systematic use of music within a therapeutic relationship) being the most frequently studied interventions. Overall, psychosocial approaches were effective in improving the quality of life and in reducing emotional and existential distress of patients receiving palliative care. There were no differences between the intervention types. Although the interventions may be brief, based on our findings we can encourage psychosocial approaches with terminally ill patients. Practitioners can apply interventions such as life review and creative arts-based techniques to access the emotional, spiritual and social needs of patients and their relatives. In palliative and hospice care, a patient’s wellbeing therefore is not only influenced by “the work of the body”, but also by “the work of the soul”.

READ THE FULL ARTICLE IN PALLIATIVE MEDICINE

This post relates to the longer article, ‘Brief psychosocial interventions improve quality of life of patients receiving palliative care: A systemaIssuestic review and meta-analysis’ by Marco Warth, Jens Kessler, Friederike Koehler, Corina Aguilar-Raab, Hubert J. Bardenheuer and Beate Ditzen, published in Palliative Medicine 2019 Volume: 33, issue: 3, page(s): 332-345. Article first published online: January 16, 2019. Issue published: March 1, 2019. https://doi.org/10.1177/0269216318818011

Read earlier Palliative Medicine Editor’s Choice posts on the EAPC blog.
Follow Palliative Medicine on Twitter @palliativemedj

More about the authors…

Marco Warth is a post-doctoral researcher; Friederike Koehler, a doctoral researcher; Corina Aguilar-Raab, a post-doctoral researcher; and Beate Ditzen is a professor and director. All work at the Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany.

Jens Kessler, a senior physician and post-doctoral researcher, and Hubert J. Bardenheuer,, a professor and chief physician, both work at the Centre of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.

EAPC MEMBERS CAN DOWNLOAD THE FULL ARTICLE FREE OF CHARGE
If you are currently an Individual or Associate EAPC Member you have full access to the EAPC website, and the chance to download a free PDF of all ‘Editor’s choice’ articles and many other papers too. Just click here; enter your email address and membership password and choose from the list of journal articles.

How to join as an Individual/Associate Member, or to renew your membership

Note: You can apply to be an Associate Member FREE of charge provided that you are a member of your country’s national palliative care association, and that the association is an EAPC National Association member.

 

 

This entry was posted in EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, PSYCHO-SOCIAL ISSUES, RESEARCH. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.