Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, SpainSpain
Psycho-Oncology Unit, Hospital Duran i Reynals, Institut Català d’Oncologia (ICO), L’Hospitalet de Llobregat, SpainSpain
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Diseases in general, and particularly those that threat the continuation of life, may affect the person in diverse manners causing suffering or emotional distress. At the end of life, suffering may be caused by different dimensions (physical, psychological, social & spiritual), and these dimensions can contribute separately or in an accumulative way to the experience of suffering.
Importance of Psychological Research in Opinion * *Corresponding author Palliative Care: Barriers in its Development Joaquín T. Limonero, PhD Stress and Health Research Group Faculty of Psychology 1* Joaquín T. Limonero and Francisco Gil-Moncayo Universitat Autònoma de Barcelona Campus Universitari s/n 08193 Bellaterra (Cerdanyola del Vallès) 1 Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Spain Barcelona, Spain Tel. +34 93 581 31 76 Fax: +34 93 581 33 29 2 Psycho-Oncology Unit, Hospital Duran i Reynals, Institut Català d’Oncologia (ICO), E-mail: joaquin.limonero@uab.cat L’Hospitalet de Llobregat, Spain Volume 1 : Issue 1 Article Ref. #: 1000PMHCOJ1101 Diseases in general, and particularly those that threat the continuation of life, may affect the person in diverse manners causing suffering or emotional distress. At the end of life, suffering may be caused by different dimensions (physical, psychological, social & spiritual), Article History and these dimensions can contribute separately or in an accumulative way to the experience of th Received: March 19th, 2014 suffering. Consequently, the problems related to one dimension can cause or increase others nd Accepted: April 22nd, 2014 leading to total suffering (in patients and their families).1 rd Published: April 23rd, 2014 In palliative care the unit of care is the whole person, both the patient and significant others, with the well-being as the goal. To get this aim a multidisciplinary palliative health care Citation team embraces the principles of holistic care with inclusion of psychosocial care as well as Limonero JT, Gil-Moncayo F. Im- physical care.2 portance of Psychological Re- search in Palliative Care: Barriers Taking in mind the interactive effects of the integrated dimensions of suffering, research in its Development. Palliat Med on the psychosocial aspects in palliative care (emotional reactions, interactive emotions, coping Hosp Care Open J. 2014; 1(1): 1-3.
strategies, spirituality...) is a basic task for later apply this knowledge in the care of the patient doi: 10.17140/PMHCOJ-1-101 and his family to provide comfort or diminish suffering.
The analysis of the psychosocial aspects in patients with advanced illness or at end of life has a number of characteristics that difficult the study. The barriers to psychological research are related to the following aspects: (1) psychological issues are subjective, variables or constructs are complex and difficult to operationalize, (2) psychological variables are difficult to measure, (3) the patients are fragile, their condition (both physical and psychological state) is mediated by the progress of the disease and the presence of impending death, (4) health professionals had limited time to conduct assessments or research, (5) and there was a lack of 3-6 validated clinical tools.3-6 In psychological research, in many cases, the complexity of construct to study has been conceptualized in various ways, aspect that difficult research. It is particularly important to provide as clear a definition as possible for what is assessed. For example, the complexity of the meaning of life construct or the well-being construct reflects a lack of consensus among 7-9 researchers as to what constitutes the essential dimensions of these constructs.7-9 One of the crucial aspects of psychological assessment is related to the instruments of assessment or screening used. In this sense, it is necessary to have adequate tools to assess emotional distress or suffering and the specific emotional reactions that occur in this difficult situation.10 Copyright ©2014 Limonero JT. This is an These inherent aspects at the end of life situation difficult in many case the assessment open access article distributed un- of psychological aspects and the effectiveness of psychological intervention. The causes of der the Creative Commons Attribu- tion 4.0 International License (CC emotional distress or suffering are multiple and changing in time and with the progress of BY 4.0), which permits unrestricted disease, which implies the need to assess the patient’s condition holistically and continuously.9 use, distribution, and reproduction These difficulties are evident, therefore, in the development of assessment instruments or in any medium, provided the origi- screening measure.
Bearing in mind the specific characteristic of patient at patients with cancer to live with sense, of a full way, keeping end of life, the ideal assessment tool should meet the following and expanding the sense of his life, living in peace and with criteria: 1) simplicity and ease of implementation; 2) language an aim in the life. These two models appointed the need to of questions adapted to patients; 3) avoid the iatrogenic with structure the intervention, giving the possibility to replicate a excessive number of items; 4) to assess relevant aspects for the same models in different contexts, and with different the patient in their situation; 5) short implementation time; therapists. Also, they guide us in the objectives, the process 6) that allows monitor the evolution of emotional patient’ and therapeutic techniques and the future results expected with condition over time; and 7) to facilitate their derivation, if our intervention.18 necessary, to a qualified professional for specific assessment 5,6,11 Despite the achievements of the previous and intervention.
psychological interventions, a recent review of psychological In addition to these characteristics, to facilitate intervention in cancer highlights the difficulty of comparing clinical implementation, the assessment tools should be easy different psychological therapies, since the elements that to use, without requiring extensive training.4 compose or the mechanisms underlying them are not specified in many cases. This lack of clarity is a potential obstacle to the Given the above comments, we find that there are provision of a coherent evidence base if we compare with drug few tools developed to analyze psychological reactions of treatment that is more concrete.
dying patient and his family, i.e, specific instruments to assess psychological aspects in palliative care.6 However, this The legacy of psychological research is not very big, should not be an obstacle, but an opportunity to research and but is a great help to better understand the emotional reactions develop specific and validated clinical tools. For example, in of dying people and help us to design the most effective the nineties we developed an easy screening tool to assess psychological interventions. But isn’t enough, the challenge suffering in patients at the end of life based on the subjective of psychological research in palliative care is enormous,20 patient perception of time. We asked the patients how long further research is needed, despite the difficulties, since the did yesterday (long, short or regular) and the reason of their psychological care is the cornerstone of palliative care.
answer. We obtained the subjective perception of time, as an