Psychological challenges for the oncology clinician who has to break bad news

Work-related stress of the oncology clinician is not only due to heavy clinical and administrative duties, but also arises when breaking bad news. However, there is important interindividual variation in stress levels during patient encounters, mainly due to the significance the situation represents for the oncologist. A reflection on his own development, his professional identity, and ways of dealing with the patient's suffering can reduce his levels of stress and distress and prevent burnout and other psychiatric disturbances. This chapter summarizes the psychological challenges the oncology clinician is facing when he announces the diagnosis of cancer, deals with the deception of relapse, discusses the transition to palliative care, copes with progression of the disease and uncertainty, and cares for the dying who is facing the unknown. Ways of refiecting on and dealing with these situations from a psychological and communicational perspective are described and illustrated by case vignettes

Ethics of Psychotherapeutic Interventions in Palliative Care

Psychotherapeutic interventions are a cornerstone of modern palliative care. In this context, they are as diverse as psychotherapeutic approaches in general and encompass modalities from the psychoanalytic, cognitive behavioral, systemic, and existential traditions. All of these psychotherapies are based on inherent and often implicit values and are closely interrelated with philosophical traditions. In psychological practice in palliative care, professionals encounter a wide range of ethical questions that can be classified according to the four principles of biomedical ethics: beneficence, non-maleficence, respect for autonomy, and justice. This chapter highlights some of the most salient of these ethical questions to help the reader become aware and reflect on them

Suivi du patient oncologique, garant de la permanence de soi [Follow-up of the cancer patient, maintaining self-identity]

L'individu confronté au diagnostic de cancer subit un bouleversement brutal de ses repères et de ses habitudes. La maladie représente une menace pour son équilibre de vie et sa stabilité sociale. Sa capacité à faire face et à opérer différents remaniements dans sa façon d'être au monde et d'envisager l'avenir est en partie déterminée par ses ressources personnelles. Toutefois, le soutien émotionnel peut également représenter un moyen privilégié de donner du sens à cette expérience singulière qu'est la maladie. La reconstruction narrative dans un cadre soutenant, caractérisé par une écoute bienveillante, offre au patient la possibilité de reconnaître sa souffrance comme partie intégrante de lui-même. Un récit de vie qui intègre la maladie lui permet de se réapproprier son histoire. Cette démarche nécessite de la part du thérapeute une disponibilité psychique et temporelle et la capacité de soutenir le patient dans un processus de liaison à travers les différentes étapes de la maladie. The individual facing the diagnosis of cancer is subjected to abrupt changes with regard to his inner world, his life, habits and social relationships. The patient's capacity to cope, to integrate changes in the way of living and to face the future is determined by his personal resources. However, psychological support may also be an important mean to search for and find sense to the singular experience of the illness. The narrative reconstruction within a supportive setting provides the patient a possibility to recognise his sufferance as an integral part of himself. A life narrative, which integrates the illness, allows the patient to re-appropriate his history again. Such a therapeutic project necessitates from the therapist a psychological and temporal disponibility and a capacity to create links all along the different stages of the disease

Two clinicians for one patient, is it worth it? Patients’ perspective on receiving treatment from a pair of clinicians, in a psychiatric emergency and crisis unit

Abstract Background In the field of psychiatric crisis interventions, treatment is commonly provided by multidisciplinary teams in Western countries. However, empirical data on the processes involved in this type of intervention are lacking, in particular from a patient perspective. Our study aims to gain a better understanding of the patients’ experience of a treatment setting provided by a pair of clinicians in a psychiatric emergency and crisis intervention unit. Patients’ perspective could provide a broader understanding of its advantages (or disadvantages), as well as bring new insight on elements influencing patients’ treatment adherence. Methods We conducted 12 interviews with former patients treated by a pair of clinicians. The participants’ experience, explored with semi-structured questions on their views of the treatment setting, was analyzed by means of thematic analysis using an inductive approach. Results The majority of participants experienced this setting as advantageous. A broader comprehension of their issues is the benefit most often expressed. A minority experienced seeing two clinicians as disadvantageous (having to talk to several clinicians at a time, change interlocutors, repeat one’s story). Participants attributed joint sessions (with both clinicians) mainly to clinical reasons and separate sessions (with one clinician at a time) mainly to logistical ones. Conclusions This qualitative study provides first insights into patients’ experience of a setting including two clinicians providing emergency and crisis psychiatric care. The results show a perceived clinical gain of such a treatment setting for highly in crisis patients. However, further research is needed to evaluate the benefit of this setting, including the indication for joint or separate sessions as the patient’s clinical course evolves

Over- and underreporting of recent drug use in subjects entering an inpatient detoxification unit

Underreporting of drug use is commonly found more often than overreporting. Overreporting may, however, occur in particular settings, e.g. in subjects entering a detoxification program. METHODS: Self-reports (standardized semi structured interview) of recent drug use of 554 patients consecutively admitted to a drug detoxification inpatient unit were compared to urine screening results at admission. Overreporters were defined as indicating a consumption of a specific drug during the preceding 7 days (3 days for cocaine) which was not confirmed by the urine screening. Underreproters denied consumption but presented positive urine. RESULTS: Overreporting was especially prevalent for opiates, and relatively more frequent (59.9% heroin, 40% methadone) than underreporting (6.8% heroin, 20.4% methadone). Signs of intoxication at admission, current methadone substitution, and previous institutional detoxification experiences influenced opiate overreporting. CONCLUSIONS: Some of the retained parameters predicting overreporting of recent opiate consumption corroborated the hypothesis of patients trying to receive more consideration from the therapeutic team and to get more intensive pharmacological care