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.”
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 systematic 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
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.
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