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Bucarest 23 Novembre 2011 Dott. Marco Romeo
Presidente Semper Onlus Società Italiana di Psico-Oncologia Regione Marche
Italia email :[email protected]
Psycho-Oncology
Psycho-Oncology Macro Areas
Assistance /Care
Research
Prevention
Learning
Screening in Psycho-Oncology
Screening of the psychological desease is the first step and the most important one
The second step is the Therapeutical Continuity
The third step is palliative care or rehabilitation
The expressed needs
The theoretical five-factors model tested of Needs Evaluation Questionairre
Informative Needs
Needs related to assistence/care
Relational Needs
Needs for a Psycho-Emotional Support
Material Needs
Need Evaluation by U.O. of Oncology, Urbino,
Marches, Italy V.Lai, M.Romeo, F.Graziano, V.Belbusti, U.O. of Oncology , Urbino, Italy
Need Evaluation Questionairre (NEQ), has been administered to 70 patients subjected to chemotherapy
The results show high request for Psychosocial assistance, while other needs had a lower score.
The results seem strictly related to the phase of therapy.
Item n°2 “ I need to get more information about future conditions”, showed the highest percentage, 57%, followed by the need of meeting people who lived the same illness experience
Half of the patients expressed the need of social assistance, that is more insurance and economical information
45 % of patients under chemotherapy would like to feel more useful in their family
36 % expressed the need of the psychologist
The percentage of those who ask a higher control over their troubles seems amazingly low (26%), if we consider that almost 40 % needs more help to carry out his daily activity.
If compared to the research carried out in Milan (1997-2001), these results show more satisfaction about nurse and medical assistance in all items.
Moreover, people show a great desire of being informed about the disease (88%).
Uncertainty about the future and reassurance remain the main need, even because the questionnaire was administred in Urbino mostly to people in advanced stage of illness.
As a consequence, the percentages related to diagnosis role in therapeutic choices and dialogue with medical équipe appear more satisfying than in Milan.
The increment of Psychosocial and spiritual assistance is amazing while the percentage of social information is the same as in Milan.
The Psychological Distress Psychological Distress Inventory – PDI
PURPOSE
The questionnaire is aimed at assessing general emotional liability of cancer patients and more specifically disorders tied to adjustment.
POPULATION
Cancer patients in different stages of disease (including the terminal phase of illness).
Psychological Distress Inventory DESCRIPTION AND ADMINISTRATION OF THE PDI
The questionnaire measure the general emotional liability of cancer patients and more specifically disorders tied to adjustment, as discussed in the W.H.O. Classification of Mental and Behavioural Disorders (ICD 10). More specifically:
•Reactive anxiety to cancer and its therapies, such as inner tension and worry;
•Reactive depression such as sorrow, decreased energy, loss of self-confidence and loss of interests;
•Emotional reactions to changes in the body image and disturbances in the interpersonal and sexual behaviours
Psychological Distress Inventory APPLICATION
The questionnaire was developed for use as a screening instrument (to identify psychopathological disorders in cancer patients) and for research purposes (as an outcome measure of psychological distress).
During the last week : 1)Do you think that your motivation in talking with another person decreased? Not at all A little Reasonably A lot Very much 2)Did you feel calm? Not at all A little Reasonably A lot Very much 3)Did you have anxious or tensed moments? Not at all A little Reasonably A lot Very much 4)Did you feel tired or without energy? Not at all A little Reasonably A lot Very much
5)Did you feel lonely? Not at all A little Reasonably A lot Very much 6)Did you feel fine? Not at all A little Reasonably A lot Very much 7)Did you have moments of disconfort or depression? Not at all A little Reasonably A lot Very much 8)Did you think that your illness may have negativelly affected your physical image, which were not
present before it? Not at all A little Reasonably A lot Very much
9)Did you feel yourself without value? Not at all A little Reasonably A lot Very much
10)Did you feel yourself lacking will? Not at all A little Reasonably A lot Very much 11)Did the interest in the people you know decrease? Not at all A little Reasonably A lot Very much 12)Did your interest in sexual activities decrease? Not at all A little Reasonably A lot Very much 13)Did your illness affect your relationships with the others you know? Not at all A little Reasonably A lot Very much
The CBI Caregiver Burden Inventory
The 24 questions measure the impact of caregiving on the caregiver’s:
•Flexibility with time
• Physical health
•Social relationships
•Emotional well-being, and
•Life in general
For each item circle a number in the columns to the right that represent how often the statement describes your feelings.
Burden Scale
For each item circle a number in the columns to the right that represent how often the statement describes your feelings.
0 = never; 1= rarely; 2 =sometimes; 3= quite frequently; 4 =nearly always
1)He/she needs my help to perform many daily tasks.
2)He/she is dependent on me.
3)I have to watch him/her constantly.
4)I have to help him/her with many basic functions.
5)I don’t have a minute’s break from his/her chores.
6) I feel that I am missing out on life.
7)I wish I could escape from this situation.
8)My social life has suffered.
9)I feel emotionally drained due to caring for him/her.
10)I expected that things would be different at this point in
my life.
11)I’m not getting enough sleep.
12) My health has suffered.
13)Caregiving has made me physically sick.
14)I’m physically tired.
15)I don’t get along with other family members as well as I used to.
16)My caregiving efforts aren’t appreciated by others in my family.
17)I’ve had problems with my marriage (or other significant relationship).
18)I don’t get along as well as I used to with others.
19)I feel resentful of other relatives who could but do not help.
20)I feel embarrassed over his/her behavior.
21)I feel ashamed of him/her.
22)I resent him/her.
23)I feel uncomfortable when I have friends over.
24)I feel angry about my interactions with him/her.
Psychological support during chemotherapy Marco Romeo1, Vittorio Lai2, Valentina Belbusti3 1Psycho-Oncology Unit, Department of Medical Oncology, Urbino Hospital, ZT2 ,Italy 2Department of Medical Oncology Director, Urbino Hospital, ZT2, Italy 3Psychologist, SIPO Member, Italy
The psycho-oncologist is more and more present into the oncology department, as all the medical and nurse operators have become aware of the psychological uneasiness, involving all the patients both at the moment of diagnosis communication and during the therapies but especially in the advanced phase of illness. The presence of a psycho-oncologist can also be useful for the staff working into oncology departments, which are in danger from a psychological point of view because of the heavy emotional charge that may lead to the burn -out syndrome. An experience of this kind, including a psychological assistance in the day-hospital chemotherapy and sometimes during the home-care assistance, has been taking place all over the Urbino territorial zone for some years. From September 2006 to March 2007, 160 interventions of reception and psychological support involving at least 60 patients, 48 of which had never met a psycho-oncologist before, have been carried out. A total addition of home care and outpatients\' department interventions is of 283 presences with 58 new patients.
Results Results: The positive effects of the possibility of carrying out support during
chemotherapy have consisted of : 1) More punctuality and efficacy in the charging of the patient 2) Possibility of preventing symptoms related to psychological distress 3) Possibility of several meetings in a shorter time ( and more alliance with several people) 4) A better exam of the mood of the patient and of his family 5) A better acknowledgement of caregivers and relatives before starting home care assistance 6) Probable diminishing of the burn out risk for the operators The possible negative effects are resumed as follows : 7) A lot of energy is spent for the effort to respect everyone\'s privacy with a possible consequent lack of satisfaction of all the expectations during the interviews ( as there are two beds in every chemotherapy room) 8) It may be difficult for the actors of the process to single out the best methodological course in order to face the psychological problems together with the psychologist
Conclusions Conclusions : The support has revealed itself as a success as it has increased the number
of meetings and it has reduced other kinds of interventions ; The patients have often expressed satisfaction for the psychological support during chemotherapy, they experienced in a different way at an individual level. The postulate that to offer psychological assistance is already to carry out Psychological assistance has appeared clear, and also the possibility of giving a containing to psychic pain. The presence of the psychologist reassures the people who are starting a therapy and also the ones already experiencing the psychological uneasiness brought about by chemotherapy. During the next months meetings with the equ
ipe will take place, aimed at reducing increasingly the negative effects outlined, taking into account that a possible psychological intervention during chemotherapy will bring about important advantages from the psychological assistance point of view.
Follow up of volunteers activity in urban and rural areas of Ancona district, Marches,Italy.
Giordano Galeazzi¹, Marco Romeo¹,Marco Nocchi¹,Simonetta Rossini¹
Palliative Care Unit,Oncology Institute of Marches for Supportive Care (I.O.M.), Ancona, Italy
Background: From 1997 to 2002, 75 volunteers have been trained to join IOM Palliative Care Unit, in both home care and in-hospital activity. A 15 volunteers education module was helded each year. Age , sex, education, previous volunteer experiences, neoplastic disease in relatives and motivation were recorded at registration. By the end of 2004 reason of withdrawal was investigated.
Result: Overall attendants: sex F 80% (60 vs 15), mean age 42 (range 15 – 65), preavious volunteer exp 51%, neoplastic disease in relatives 64%, university education 28%( 53% high school, 19% primary). Solidarity is motivational category more rapresented (49%) out of five. 55 volunteers withdrawed (75%) with 13 never started, 20 are still working.. Study/work, lack of motivation, family reasons rapresent 25%, 20%,25% of withrawal reasons respectively . Withrawal rate (w.r.) from Home care and in-hospital activity is 75% and 50% respectively. W.r. for age <35, 35-50,50-65 is 95%, 64% and 40%. W.r for primary, high school, university education is 46%, 84%,70% .
Conclusion: under 35 attendants are more likely to withdraw,as well as home care volunteers and highly educated ones. Selection, specific training and psychological supervision should be reconsidered..
Euthanasia as an escape from palliative care culture
Recent political and propagandistic opinion polls underlined in Europe an increasing trend which is in favour of euthanasia for people in an advanced stage of illness.
There is an opinion trend which does not trust in what can be defined as palliative care culture .
As a matter of fact in Italy the term palliative in often considered as a synonym of useless.
On the contrary, in our reality there have been no requests in these direction and during the years 2005-2006 no trial of suicide took place.
It is worrying that the possibility, the idea of a quick and painless alternative can justify the escape from what instead of culture is perceived as nonsense suffering.
As a consequence we risk an increment of refusal of palliative care and of the choice of illicit ways of care, as an alternative to euthanasia.
Therefore palliative care risk not to be taken into account.
Admitting this situation brings about a simplistic authorized escape in a psychological chaos, because far from the culture there are no rules.
In fact from a Psychological point of view it doesn’t matter if the publicity won’t become law: as a matter of fact palliative cares are already discredited.
CONCLUSION
The executive efficacy of palliative care is strictly related to the trust that ill people-but not only ill- put in them.
The quality of assistance and moreover patient’s quality of life mostly depends on the alliance between the families and the équipe. During the year 2007 an encounter about this theme should be proposed in Ancona.
Institute of therapeutical continuity M.Romeo, G.Galeazzi, M.Nocchi, V.Belbusti Istituto Oncologico Marchigiano, Ancona, Italy
The institute of therapeutical continuity represents for the city of Ancona a cue intervention involving the Hospital and the Istituto Oncologico Marchigiano (IOM) .
A psychologist and a palliative care consultant are present at the moment of recovering and evaluate with the family the possibility of facing home care and of staying in a Hospice.
Thanks to this project the admission to hospital by callings to emergency or because of perceived needs and deaths in hospital are diminished .
The psychologist evaluates the family composition, the awareness of illness by the patients and by the caregiver, their motivation to home care and then their compliance towards IOM.
The most frequent problems are related to the lack of adults at home, to the presence of children, to the lack of awareness about the illness to the feeling of loneliness and abandon
The relatives which do not accept the advancing of illness tend to bring the patients to hospital, as they deceive themselves that there will be further possible cares
Some relatives just prefer home care to hospice, but they refuse to see the patients die at home, so they call the emergency when the patient is not conscious any more
A substitute of caregiver (week-end caregiver) often brings about problems whit compliance and a following confusion in the assistance
Conclusion The analysis of family composition, but also of
awareness, of motivation and resources can provide some elements to help the family to live more easily the advanced stage of illness, with the comprehension of the patient’s and of the caregiver’s coping styles.
Palliative Care Titolo : Analisi dei dati sulla somministrazione di una scheda di accoglienza per i pazienti in Assistenza
Domiciliare Oncologica presso l’ASUR n° 7 di Ancona
Autori : Marco Romeo(1) , Giordano Galeazzi (1)
Unità di Cure Palliative, Istituto Oncologico Marchigiano, Ancona
Parole Chiave : Composizione familiare, Referente Familiare, Grado di consapevolezza della situazione
Soggetti e Metodologia: Pazienti in assistenza domiciliare oncologica; intervista semistrutturata (scheda di accoglienza)
Dal Novembre 2003 al Marzo 2005, è stata somministrata una scheda durante l’accoglienza domiciliare e sono state analizzate le seguenti variabili : Età, sesso, grado di parentela e sesso del referente familiare, composizione familiare presso il domicilio dell’assistito, presenza di minori a domicilio o accessi di minori, accessi di altri parenti, richiesta di assistenza Psicologica, richiesta di un Volontario, grado di consapevolezza della situazione (malattia) da parte del paziente.
Risultati : Lo studio è stato effettuato su 102 assistiti, 51 Maschi e 51 Femmine di età compresa tra 41
e 95 anni; il 27% di età inferiore a 65 anni, il 28 % di età compresa tra 65 e 75 anni, il restante 45 % superiore ai 75 anni. (il 50% tra i 65 e gli 80 anni).
Il referente familiare si identifica nella maggioranza delle situazioni nei figli , 43 % o nel coniuge 37% ; nel restante 20 % sono le nuore ed i generi i più presenti .
Ciò che caratterizza tuttavia il referente familiare è il netto sbilanciamento verso la figura femminile che ha una marcata prevalenza ; il 78 % dei referenti familiari sono da ricercare tra figlie, mogli, nuore e sorelle.
La grande maggioranza delle persone assistite (88%) affronta l’assistenza nel proprio domicilio, dove nel 60 % dei casi, risiede anche il referente familiare (meno di frequente c’è il trasferimento continuato del referente).
Assodato che il 40 % dei referenti ( in prevalenza figli) risiedono comunque altrove, si è calcolato il numero di adulti che risiedono con la persona malata. Il 65 % degli assistiti non vivono con più di una persona , nel 38 % di queste situazioni inoltre essa non è il referente e quindi spesso si tratta di un coniuge anziano. Un dato da sottolineare è che nessuno degli assistiti che appartiene al 12 % che si è trasferito condivide l’abitazione con meno di una persona.
Verificando gli accessi di altri familiari, riscontriamo che il 70 % degli assistiti dichiara di ricevere visite; le famiglie che vivono un forte disagio per mancanza di familiari sono quindi un numero abbastanza limitato che pur nelle peggiori considerazioni non dovrebbero superare il 10 %.
La presenza di minori riveste un notevole interesse; se sommiamo i minori che abitano con la persona malata (9%) e coloro che si recano frequentemente al domicilio dell’assistito otteniamo un rilevante 20 %.
Per quanto concerne la consapevolezza della situazione e dunque della malattia, ci sono due dati abbastanza discordanti: da un lato solo il 51 % degli assistiti ha una piena coscienza, dall’altro ben l’85 % ha maturato comunque una certa consapevolezza, dati che meriteranno un approfondimento.
Per quanto riguarda la presenza di assistenza Psicologica, nel 34 % dei casi sono stati svolti ulteriori incontri ; nel 32 % delle situazioni totali la persona ha inoltre usufruito dell’invio di un volontario.
Conclusioni Conclusioni : Lo studio pilota si pone come base per due diversi e
fondamentali utilizzi ;
la relazione tra le variabili psico- sociologiche rilevate, insieme ai dati sui ricoveri ospedalieri ed i luoghi del decesso sarà utilizzata per rinforzare la ricerca di un percorso sanitario di qualità del malato neoplastico.
In secondo luogo, questi dati saranno considerati anche in un’ottica di sviluppo dell’assistenza Psicologica: la consulenza ai minori coinvolti e la prevenzione e trattamento del lutto complicato, partendo dal grado di consapevolezza della malattia e dalla comunicazione all’interno del sistema familiare, sono tematiche oggetto di continuo approfondimento.
Elisabeth Kubler-Ross
Lilt
Guide Inspire IPOS
Bye
