Background: Although integrated care for existential suffering is an essential part of palliative care, little is known about its concept and efficacy as perceived by professionals. A questionnaire survey was carried out to 1) explore the underlying structure of psychosocial interventions recommended by specialists, 2) identify the professionally perceived effectiveness of each intervention for specific existential distress, and 3) examine the effects of specialty on their recommendations. Methods: A questionnaire with three scenarios representing terminally ill cancer patients with uncertainty-related anxiety, guilt feelings, and dependency-related meaninglessness was mailed to 701 Japanese psychiatrists, 118 psychologists, and 372 palliative care nurses. Results: A total of 456 responses were obtained (response rate = 38%). Recommended psychosocial interventions were classified into six subcategories: ’a supportive-expressive approach,fl’providing comfortable environments,fl’meaning-centered approach,fl’being,fl’education and coping skills training,fland ’a religious approach.flA ’supportive-expressive approachflwas consistently recommended in all vignettes. On the other hand, ’providing comfortable environmentsflwas most recommended for patients with uncertainty-related anxiety, and a ’meaning-centered approachfland ’beingflwere most recommended for patients feeling dependency-related meaninglessness. Psychiatrists estimated the effectiveness of psychopharmacological treatment significantly higher than psychologists and nurses, while nurses evaluated efficacy of all other interventions significantly higher than psychiatrists and psychologists. Conclusions: Experts evaluated a variety of clinical interventions as effective in palliating existential suffering, although the perceived levels of efficacy of each intervention differed according to the nature of suffering and their specialties. To effectively alleviate existential suffering in terminally ill cancer patients, an integrated care by an interdisciplinary team is necessary.
Morita T, Tsunoda J, Inoue S, Chihara S. An exploratory factor analysis of existential suffering in Japanese terminally ill cancer patients. Psycho-oncology2000; 9: 164–168.
2.
Steinhauser KE, Christakis NA, Clipp EC, et al. Preparing for the end of life: Preferences of patients, families, physicians, and other care providers. J Pain Symptom Manage2001; 22: 727–737.
3.
Cole B, Pargament K. Re-creating your life: a spiritual/ psychotherapeutic intervention for people diagnosed with cancer. Psycho-oncology1999; 8: 395–407.
4.
Cunningham AJ, Edmonds CV. Group psychotherapy or cancer patients: a point of view, and discussion of the hierarchy of options. Int J Psychiatry Med1996; 26: 51–82.
5.
Kearney M, Mount B. Spiritual care for the dying patient. In Chochinov HM, Breitbart W eds. Handbook of psychiatry in palliative medicine. Oxford University Press, 2000: 357–374.
6.
Kissane DW, Bloch S, Miach P, Smith GC, Seddon A, Keks N. Cognitive-existential group therapy for patients with primary breast cancer-techniques and themes. Psycho-oncology1997; 6: 25–33.
7.
Leszcz M, Goodwin PJ. The rationale and foundations of psychotherapy for women with metastatic breast cancer. Int J Group Psychother1998; 48: 245–273.
8.
Spiegel D, Spira JL. Methods of intervention for therapeutists. In Topics commonly discussed by groups supportive-expressive group therapy: a treatment manual of psychosocial intervention for women with recurrent breast cancer. Stanford: Stanford University, 1993: 46–58, 67–116.
9.
Chochinov HM. Dignity-conserving care - a new model for palliative care: helping the patient feel valued. JAMA2002; 287: 2253–2260.
10.
Millison MB, Dudley JR. The importance of spirituality in hospice work: a study of hospice professionals. Hosp J1990; 6: 63–78.
11.
Taylor EJ, Highfield M, Amenta M. Attitudes and beliefs regarding spiritual care: a survey of cancer nurses. Cancer Nurs1994; 17: 479–489.
12.
Morita T, Tei Y, Inoue S, Chihara S. Care for spiritual and existential suffering of terminally ill cancer patients: Integration by systematic review (in Japanese). Jpn J Palliat Med2001; 3: 444–456.
13.
Takahashi M, Hara M, Shimoinaba K, Tsuneto S. A survey of spiritual pain and care among hospice inpatients (in Japanese with English abstract). Jpn J Clin Res Death Dying1996; 19: 53–56.
14.
van Der Maas PJ, van Delden JJ, Pijnenborg L, Looman CW. Euthanasia and other medical decisions concerning the end of life. Lancet1991; 338: 669–674.
15.
Back AL, Wallace JI, Starks HE, Pearlman RA. Physician-assisted suicide and euthanasia in Washington State. JAMA1996; 275: 919–925.
16.
Meier DE, Emmons CA, Wallenstein S, Quill T, Morrison RS, Cassel CK. A national survey of physician-assisted suicide and euthanasia in the United States. New Engl J Med1998; 338: 1193–1201.
17.
Anderson BL. Psychological interventions for cancer patients to enhance the quality of life. J Consult Clin Psychol1992; 60: 552–568.
18.
Burton M, Watson M. Counseling people with cancer. New York: John Wiley and Sons, 1998.
19.
Spiegel D. Essentials of psychotherapeutic intervention for cancer patients. Support Care Cancer1995; 3: 252–256.
20.
Classen C, Butler LD, Koopman C, et al. Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial. Arch Gen Psychiatry2001; 58: 494–501.
21.
Bindemann S, Soukop M, Kaye SB. Randomised controlled study of relaxation training. Eur J Cancer1991; 27: 170–174.
22.
Cherny NI, Coyle N, Foley KM. The treatment of suffering when patients request elective death. J Palliat Care1994; 10: 71–79.
23.
Clark R. Forgiveness in the hospice setting. Palliat Med1990; 4: 305–310.
24.
Breitbart W. Spirituality and meaning in supportive care: spirituality and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer2002; 10: 272–280.
25.
Greenstein M. The house that's on fire: meaningcentered psychotherapy pilot group for cancer patients. Am J Psychother2000; 54: 501–511.
26.
Babler JE. A comparison of spiritual care provided by hospice social workers, nurses, and spiritual care professionals. Hosp J1997; 12: 15–27.
27.
Reese DJ, Brown DR. Psychological and spiritual care in hospice: differences between nursing, social work, and clergy. Hosp J1997; 12: 29–41.
