depression and anxiety in late life: current issues in ... · kissane et al. handbook of psychiatry...
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Kissane et al. Handbook of Psychiatry in Palliative Medicine 2009, p. 325
Kissane et al. Handbook of Psychiatry in Palliative Medicine 2009, p. 325
Kissane et al. Handbook of Psychiatry in Palliative Medicine 2009, p. 325
Kissane et al. Handbook of Psychiatry in Palliative Medicine 2009, p. 325
sufferingdistress
desire forhastened death
demoralization
despair
depression
Compassion & Wisdom
vs.Disgust & Disdain
Authors Year Measures
Chochinov et al 1995 Will to liveDesire for hastened death
Bayes et al 1997 How long did yesterday (this morning, afternoon, evening, night) seem to you?
Steinhauser et al. 2006 Are you at peace?
Edmonton Classification System for Cancer Pain
• Mechanism of pain
• Incident pain
• Psychological distress
• Addictive behavior
• Cognitive function
(Fainsinger et al, 2010; Nekolaichuk et al, 2005)
Fig 2. Relationship of psychological distress with related concepts
psychologicaldistress
Pain
Fig 2. Relationship of psychological distress with related concepts
psychologicaldistress
Pain
physical emotional
social
spiritual
practical
coping
Fig 2. Relationship of psychological distress with related concepts
psychologicaldistress
Pain
physical emotional
social
spiritual
practical
The Edmonton Symptom Assessment System –What Do Patients Think?
• Pain• Tiredness• Nausea• Depression• Anxiety• Drowsiness• Appetite• Wellbeing• Shortness of breath
(Watanabe, Nekolaichuk & Beaumont, 2009)
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Total painRefractory suffering
Health Care Provider Patient
Vicarious Trauma
PTSD
Total painRefractory suffering
Health Care Provider Patient
accumulative
transformation
(McCann & Pearlman, 1990; Pearlman & Saakvitne, 1995; Swetenham et al, 2011)
Vicarious Trauma
PTSD
Iatrogenic suffering
Total painRefractory suffering
Health Care Provider Patient
accumulative
transformation
impaired
communication
Vicarious Trauma
PTSD
Iatrogenic suffering
Total painRefractory suffering
Health Care Provider Patient
accumulative
transformation
impaired
communication
transformation
Team dynamicsBoundary issues
Vicarious Trauma
PTSD
Iatrogenic suffering
Total painRefractory suffering
Health Care Provider Patient
compassionfatigue
moral distress
burnout
accumulative
transformation
impaired
communication
burnout
transformation
Team dynamicsBoundary issues
grief
Change
Loss
Griefangerrage
sadness fatigue isolation
fear
Change
Loss
Griefangerrage
sadness fatigue isolation
fear
Where is your grief?
hope
meaning
suffering
dignity
spirituality
will to live
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Non-Specific Therapeutic Factors
“Helping the Whole Person”
“Achieving a Sense of Healing”
Therapist Patient
Nekolaichuk et al (2013). Qualitative Health Research, 23:592-604.45
Nekolaichuk et al (2013). Qualitative Health Research.
Holding On“wanting to live”
Letting Go“wanting to die”
Hope
(Nekolaichuk, 2010)
HopeHopeful
Orientation
How might thingschange over time?
What might be a hopeful sign?
What might be possible…yet?(Nekolaichuk, 2010)
Dichotomies at End-of-Life
Certain
Uncertain
Meaningful
MeaninglessIsolated
Holding On“wanting to live”
Letting Go “wanting to die”
Hope
Connected
(Nekolaichuk, 2010)
(G. B. Mukherji, Landscape and Life, 2002)