Advertisement

Distress in palliative care patients: Developing patient-centred approaches to clinical management

  • Mari Lloyd-Williams
    Correspondence
    Corresponding author: Tel.: +44 0 151 794 5605; fax: +44 0 151 794 4709.
    Affiliations
    Academic Palliative and Supportive Care Studies Group, University of Liverpool, School of Population, Community and Behavioural Sciences, 2nd Floor Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK
    Search for articles by this author
  • Joanne Reeve
    Affiliations
    Academic Palliative and Supportive Care Studies Group, University of Liverpool, School of Population, Community and Behavioural Sciences, 2nd Floor Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK
    Search for articles by this author
  • David Kissane
    Affiliations
    Alfred P. Sloan Chair, Attending Psychiatrist and Chairman, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, United States

    Weill Medical College of Cornell University, New York, United States
    Search for articles by this author
Published:March 25, 2008DOI:https://doi.org/10.1016/j.ejca.2008.02.032

      Abstract

      It is widely recognised by clinicians that depression is a difficult symptom to identify amongst patients with advanced illness. Many of the symptoms of depression are difficult to elicit in patients who are approaching the end of life. Additionally, many believe that a ‘degree’ of depression is almost normal as patients approach life’s end. More recently the concept of demoralization as a separate entity to depression has been described which can be briefly described as a disorder of meaning and hope. In this paper, we review these diagnoses together with the latest screening tools which can help clinicians to recognise better such pathologies in their patients and discuss interventions that can be utilised to help patients with depression or demoralization to have a better quality of life.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chochinov H.M.
        Depression in cancer patients.
        Lancet Oncol. 2001; 2: 499-505
        • Brouwer C.
        • Maille A.
        • Rovers M.
        • Grobbee D.
        • Sanders E.
        • Schilder A.
        Health-related quality of life in children with otitis media.
        Int J Pediatr Otorhinolaryngol. 2005; 69: 1031-1041
        • Nash J.
        • Williams D.
        • Nicholson R.
        • Trask P.
        The contribution of pain-related anxiety to disability from headache.
        J Behav Med. 2006; 29: 61-67
        • Sterk C.
        • Theall K.
        • Elifson K.
        The impact of emotional distress on HIV risk reduction among women.
        Subst Use Misuse. 2006; 4: 157-173
        • Tschann J.
        • Flores E.
        • Pasch L.
        • Marin B.V.
        Emotional distress, alcohol use, and peer violence among Mexican-American and European-American adolescents.
        J Adolesc Health. 2005; 37: 11-18
        • Lloyd-Williams M.
        • Dennis M.
        • Taylor F.
        A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer.
        Palliat Med. 2004; 18: 558-563
        • Stiefel R.
        • Die T.M.
        • Berney A.
        • Olarte J.M.
        • Razavi A.
        Depression in palliative care: a pragmatic report from the Expert Working Group of the European Association for Palliative Care.
        Support Care Cancer. 2001; 9: 477-488
        • Osse B.H.
        • Vernooij-Dassen M.J.
        • et al.
        The problems experienced by patients with cancer and their needs for palliative care.
        Support Care Cancer. 2005; 13: 722-732
        • Elkington H.
        • White P.
        • et al.
        The healthcare needs of chronic obstructive pulmonary disease patients in the last year of life.
        Palliat Med. 2005; 19: 485-491
      1. Agency for Healthcare Research and Quality. End-of-Life Care and Outcomes, Evidence report/Technology Assessment. US Department of Health and Humans Services. AHRQ Publication, 2004.

        • Callahan E.
        • Jaen C.
        • Crabtree
        • Zyzanski S.
        • Goodwin M.
        • Strange K.
        The impact of recent emotional distress and diagnosis of depression or anxiety on the physician–patient encounter in Family Practice.
        J Fam Pract. 1998; 46: 410-418
        • Frostholm L.
        • Fink P.
        • Christensen K.
        • et al.
        The patients’ illness perceptions and the use of primary health care.
        Psychosom Med. 2005; 67: 997-1005
        • Soothill K.
        • Morris S.M.
        • et al.
        The significant unmet needs of cancer patients: probing psychosocial concerns.
        Support Care Cancer. 2001; 9: 597-605
        • Fitzsimons D.
        • Mullan D.
        • et al.
        The challenge of patients’ unmet palliative care needs in the final stages of chronic illness.
        Palliat Med. 2007; 21: 313-322
        • Goodwin F.K.
        • Ghaemi S.N.
        An introduction to and historical review of mood disorders.
        in: New oxford textbook of psychiatry. vol. 1. Oxford University Press, Oxford2000: 677-682
      2. National Institute of Clinical Excellence. Improving supportive and palliative care for adults with cancer. 2004. <http://www.nice.org.uk/nicemedia/pdf/csgspexecsummary.pdf> (last accessed 15.01.2008).

        • Payne S.
        Depression in palliative care patients: a literature review.
        Int J Palliat Nurs. 1998; 4: 184-191
        • Bowers L.
        • Boyle D.A.
        Depression in patients with advanced cancer.
        Clin J Oncol Nurs. 2003; 7: 281-288
        • Wilson K.
        • Chochinov H.M.
        • de Faye B.J.
        • Breitbart W.
        Diagnosis and management of depression in palliative care.
        in: Chochinov H.M. Breitbart W. Handbook of psychiatry in palliative care. Oxford University Press, Oxford2000: 25-49
        • Potash M.
        • Breitbart W.
        Affective disorders in advanced cancer.
        Hematol Oncol Clin North Am. 2002; 16: 671-700
        • Hotopf M.
        • Chidgey J.
        • Addington-Hall J.
        • Ly K.L.
        Depression in advanced disease: a systematic review Part 1. Prevalence and case finding.
        Palliat Med. 2002; 16: 81-97
        • Ayuso-Mateos J.
        • Vazquez-Barquero C.
        • Dowrick C.
        • et al.
        Depressive disorders in Europe: prevalence figures from the ODIN study.
        Br J Psychiat. 2001; 179: 308-316
        • Werth Jr., J.L.
        • Gordon J.R.
        • Johnson Jr., R.R.
        Psychosocial issues near the end of life.
        Aging Ment Health. 2002; 6: 402-412
        • Chochinov H.M.
        Psychiatry and terminal illness.
        Can J Psychiat. 2000; 45: 143-150
        • Alexander P.J.
        • Dinesh N.
        • Vidyasagar M.S.
        Psychiatric morbidity among cancer patients and its relationship with awareness of illness and expectations about treatment outcome.
        Acta Oncol. 1993; 32: 623-626
        • Lloyd-Williams M.
        Diagnosis and treatment of depression in palliative care.
        Eur J Palliat Care. 2002; 9: 186-188
        • Lloyd-Williams M.
        • Payne S.
        A qualitative study of clinical nurse specialists’ views on depression in palliative care patients.
        Palliat Med. 2003; 17: 334-338
      3. Lloyd-Williams M, Sheils C. Taylor F, Dennis M. Depression an independent risk factor for early mortality in patients with advanced cancer, J Affect Disord (in press).

        • Maguire P.
        The use of antidepressants in patients with advanced cancer.
        Support Care Cancer. 2000; 8: 265-267
        • Ly K.L.
        • Chidgey J.
        • Addington-Hall J.
        • Hotopf M.
        Depression in palliative care: a systematic review. Part 2. Treatment.
        Palliat Med. 2002; 16: 279-284
        • Golden R.N.
        • McCartney C.F.
        • Haggerty J.J.
        • et al.
        The detection of depression by patient self-report in women with gynaecologic cancer.
        Int J Psychiatry Med. 1991; 21: 17-27
        • Lloyd-Williams M.
        Screening for depression in palliative care.
        in: Lloyd-Williams M. Psychosocial issues in palliative care. Oxford University Press, Oxford2003
        • Kendell R.
        • Jablensky A.
        Distinguishing between the validity and the utility of psychiatric diagnoses.
        Am J Psychiat. 2003; 160: 4-12
        • Lloyd-Williams M.
        • Friedman T.
        • Rudd N.
        The criterion validation of the EPDS for the assessment of depression in patients with advanced metastatic disease.
        J Pain Sympt Manage. 2000; 20: 259-265
        • Lloyd-Williams M.
        • Friedman T.
        • Rudd N.
        The validation of the Hospital Anxiety and Depression scale in terminally ill patients.
        J Pain Sympt Manage. 2001; 22: 990-996
        • Lloyd–Williams M.
        Should we screen for depression in palliative care patients?.
        Am J Hosp Palliat Care. 2002; 19: 112-114
        • Lloyd-Williams M.
        • Shiels C.
        • Dowrick C.
        The development of the Brief Edinburgh Depression Scale (BEDS) to screen for depression in patients with advanced cancer.
        J Affect Disord. 2007; 99: 259-264
        • Wing J.
        Reasoning about madness.
        Oxford University Press, Oxford1978
        • Andrews G.
        • Slade T.
        • Peters L.
        Classification in psychiatry: ICD-10 versus DSM-IV.
        Br J Psychiat. 1999; 174: 3-5
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders, DSM-IV.
        American Psychiatric Association, Washington1995
        • World Health Organisation
        ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines.
        World Health Organisation, Geneve1992
        • Andrews G.
        • Slade T.
        • Peters L.
        Classification in psychiatry: ICD-10 versus DSM-IV.
        Br J Psychiat. 1999; 174: 3-5
        • Park C.L.
        • Folkman S.
        Meaning in the context of stress and coping.
        Rev Gen Psychol. 1997; 1: 115-144
        • Lethborg C.
        • Aranda S.
        • Bloch S.
        • Kissane D.W.
        The role of meaning in advanced cancer – integrating the constructs of assumptive world, sense of coherence and meaning-based coping.
        J Psychosoc Oncol. 2006; 24: 27-42
        • Folkman S.
        • Greer S.
        Promoting psychological well-being in the face of serious illness: when theory, research and practice inform each other.
        Psychooncology. 2000; 9: 11-19
        • Engel G.L.
        A psychological setting of somatic disease: the “giving up-given up complex”.
        Proc R Soc Med. 1967; 60: 553-555
        • Frank J.
        The role of hope in psychotherapy.
        Int J Psychiat. 1968; 5: 383-395
        • Frankl V.E.
        From death-camp to existentialism.
        Beacon Press, Boston1959
        • Kissane D.W.
        • Clarke D.M.
        • Street A.F.
        Demoralization syndrome: a relevant psychiatric diagnosis for palliative care.
        J Palliat Care. 2001; 17: 12-21
        • Clarke D.M.
        • Kissane D.W.
        Demoralization: its phenomenology and importance.
        Aust NZ J Psychiat. 2002; 36: 733-742
        • Beck A.T.
        • Kovacs M.
        • Weisman A.D.
        Hopelessness and suicidal behaviour.
        JAMA. 1975; 234: 1146-1149
        • Owen C.
        • Tennant C.
        • Levi J.
        • Jones M.
        Suicide and euthanasia: patient attitudes in the context of cancer.
        Psychooncology. 1992; 1: 79-88
        • Breitbart W.
        • Rosenfeld B.D.
        • Passik S.D.
        Interest in physician-assisted suicide among ambulatory HIV-infected patients.
        Am J Psychiat. 1996; 153: 238-242
        • Chochinov H.M.
        • Tataryn D.
        • Clinch J.J.
        • Dudgeon D.
        Will to live in the terminally ill.
        Lancet. 1999; 354: 816-819
        • Kissane D.W.
        The contribution of demoralization to end-of-life decision making.
        Hastings Center Report. 2004; 34: 21-31
        • Kissane D.W.
        Demoralisation: its impact on informed consent and medical care.
        Med J Aust. 2001; 175: 537-539
        • Kissane D.W.
        • Wein S.
        • Love A.
        • Lee X.Q.
        • Kee P.L.
        • Clarke D.M.
        The Demoralization Scale: a report of its development and preliminary validation.
        J Palliat Care. 2004; 20: 269-276
        • Mangelli L.
        • Fava G.A.
        • Grandi S.
        • et al.
        Assessing demorlaization and depression in the setting of medicla disease.
        J Clin Psychiat. 2005; 66: 391-394
        • Grassi L.
        • Rossi E.
        • Sabato S.
        • Cruciani G.
        • Zambelli M.
        Diagnostic criteria for psychosomatic reserach and psychosocial varaibles in breats cancer patients.
        Psychosom. 2004; 45: 483-491
        • Kelly B.
        • Burnett P.
        • Pelusi D.
        • Badger S.
        • Varghese F.
        • Robertson M.
        Terminally ill cancer patients’ wish to hasten death.
        Palliat Med. 2002; 16: 339-345
        • Griffith J.L.
        • Gaby L.
        Brief psychotherapy at the bedside: countering demoralization from medical illness.
        Psychosom. 2005; 46: 109-116
        • Wein S.
        Courage: the heart of the matter.
        Palliat Support Care. 2005; 3: 81082
        • Wein S.
        Is courage the counterpoint of demoralization?.
        J Palliat Care. 2007; 23: 40-43
        • Viederman M.
        The psychodynamic life narrative: a psychotherapeutic intervention useful in crisis situations.
        Psychiatry. 1983; 46: 236-246
        • Viederman M.
        Presence and enactment as a vehicle of psychotherapeutic change.
        J Psychother Pract Res. 1999; 8: 274-283
        • Weingarten K.
        Witnessing, wonder and hope.
        Fam Process. 2000; 39: 402
        • Kissane D.W.
        • Miach P.
        • Bloch S.
        • Seddon A.
        • Smith G.C.
        Cognitive-existential group therapy for patients with primary breast cancer.
        Psycho-Oncologogy. 1997; 6: 25-33
        • Griffith J.L.
        • Gaby L.
        Brief psychotherapy at the bedside: countering demoralization from medical illness.
        Psychosom. 2005; 46: 109-116
        • White M.
        • Epstein D.
        Narrative means to therapeutic ends.
        Norton, New York1990
        • Weissman M.M.
        • Markowitz J.C.
        • Klerman G.L.
        Comprehensive guide to interpersonal psychotherapy.
        Basic Books, New York2000
        • Chochinov H.M.
        Dignity conserving care – a new model for palliative care.
        JAMA. 2002; 287: 2253-2260
        • Greenstein M.
        • Breitbart W.
        Cancer and the experience of meaning: a group psychotherapy program for people with cancer.
        Am J Psychother. 2000; 54: 486-500
        • Breitbart W.
        • Gibson C.
        • Poppito S.
        • Berg A.
        Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality.
        Can J Psychiat. 2004; 49: 366-372
        • Greenhalgh T.
        • Hurwitz B.
        Narrative based medicine. Dialogue and discourse in clinical practice.
        BMJ Books, London1998
        • Romanoff B.D.
        • Thompson B.E.
        Meaning construction in palliative care: the use of narrative, ritual, and the expressive arts.
        Am J Hosp Palliat Med. 2006; 23: 309-316
        • Guyatt G.H.
        • Sackett D.L.
        • Sinclair J.C.
        • Haywood R.
        • Cook D.J.
        • Cook R.J.
        Users’ guide to the medical literature. IX. A method for grading health-care recommendations. Evidence-Based Medicine Working Group.
        JAMA. 1995; 274: 1800-1804
        • Royal College of General Practitioners working party
        The future general practitioner. Learning and teaching.
        British Medical Journal for the RCGP, London1972
        • Dowrick C.F.
        • Ring A.
        • Humphris G.M.
        • Slamon P.
        Normalisation of unexplained symptoms by general practitioners: a functional typology.
        Br J Gen Pract. 2004; 54: 165-170
        • Salmon P.
        • Ring A.
        • Dowrick C.F.
        • Humphris G.M.
        What do general practice patients want when they present medically unexplained symptoms, and why do their doctors feel pressurized?.
        J Psychosom Res. 2005; 59: 255-260
        • Morriss R.
        • Dowrick C.
        • Salmon P.
        • et al.
        Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms.
        B J Psychiat. 2007; 191: 536-542
        • Gallo J.
        Emotions and medicine.
        J Gen Intern Med. 1997; 12: 453-454