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There are always challenges to the initiation of new programmes in healthcare, especially given the propensity for politics to dominate decision-making in the healthcare system. Consequently, programmes that may intuitively be in the best interest of patients, even those supported by good science, often have to wait. Clearly then, we must learn to effectively communicate who we are, what we do, and how we can improve healthcare outcomes in a biopsychosocial world. In psychosocial oncology these communication issues are ubiquitous. This chapter discusses the impact of the psychosocial aspects of cancer and why psychosocial programme development should be considered as a key piece of the armamentarium in the fight against cancer. It also looks at communication strategies that might prove helpful for the development of psychosocial oncology programmes. A number of large studies exist that identify emotional distress as a significant challenge to cancer patients. This chapter examines the role of psychosocial oncology in comprehensive cancer care and the business aspects of psychosocial care.

This chapter discusses psychosocial care, a collective responsibility of everyone working with those affected by ALS. Psychosocial care includes the giving of bad news, respecting and developing coping strategies, and acknowledging fears and maintaining hope. Psychosocial care is the core component of good palliative care; it plays an important role in determining how patients and families respond to the impact of the illness and aids in the coping with the experiences of loss and change as well as in expanding the sense of what is possible.

This chapter examines the concept of psychosocial care in the context of palliative care. According to the 2002 revised definition of the World Health Organisation (WHO), palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness and it is considered to be part of the so-called supportive care. The British National Council for Palliative Care (NCPC) defined psychosocial care as being concerned with the psychological and emotional well being of the patient and their family/carers, including issues of self-esteem, insight into an adaptation to the illness and its consequences, communication, social functioning, and relationships.

This chapter examines the provision of psychosocial care in the palliative care setting in Great Britain. It analyses the facts behind the increasing understanding that while a level of psychological distress is understandably associated with the diagnosis of cancer there is also a high level of psychiatric morbidity that, if treated, leads to an improvement in a person's state of mind and their quality of life. It suggests that palliative care should address the high incidence of psychological morbidity by providing screening methods and tool that may be used for the detection and management of psychological disorders.

This chapter recommends the adoption of the so-called family-centred care approach to provide psychosocial care for the marginalized. It explains that family-centred care offers an approach to the planning, delivery, and evaluation of healthcare that is governed by mutually beneficial partnerships between healthcare providers, patients, and families. It applies to patients of all ages and may be practised in any healthcare setting. The chapter also explores specific care groups where a growing body of evidence indicates that palliative care has been highlighted as a significant issue and describes the psychosocial dilemmas faced by this group of patients.

This chapter discusses the spiritual and psychosocial aspects of end-of-life care. It mentions the observation that far more suffering in patients with advanced illness results from psychic rather than from physical distress. The categories of psychic distress include depression, anxiety, and delirium. The chapter discusses the recommended drug and non-pharmacologic interventions for different types of spiritual and psychosocial aspects.

This chapter discusses the important role played by psychology and clinical psychologists in providing good palliative and psychosocial care for ALS patients as well as their respective families. Clinical psychologists play different roles within the team caring for someone with ALS. They can either be diagnostician, researcher, external consultant, psychosocial therapist, or team facilitator depending on the requirement of the team and the patient. Regardless of the role played by clinical psychologists, they are often depended on addressing psychological issues such as the psychological impact of the disease on the patient, patient neuropsychology and reactions to the symptoms, coping strategies of the family, individual coping mechanisms, and the social support network. They are often placed in the team to provide support and to aid in the coordination of care.

This chapter discusses issues of consent to care, communication, assessment of psychosocial and spiritual status and needs, and decisions regarding interventions. It provides a comprehensive framework that is familiar and easily understood by those providing other aspects of palliative care, stressing that this discussion relates to the morality of the process of care, and is not intended to be a description of the care itself. Psychosocial and spiritual care must be subjected to moral scrutiny in the same way as physical care; consent must be sought and the potential harms and risks of care must be balanced against potential benefits. The discussion also considers counselling and counselling skills.

Psychosocial care is the responsibility of everyone working with those affected by ALS. It includes the giving of bad news, respecting and developing coping strategies, acknowledging fears, and maintaining hope. The assessment and continuing review of psychosocial concerns must recognize the particular issues faced by carers and children living with ALS. Good psychosocial care also recognizes the challenges for the professionals involved. ALS impacts on the patient’s roles and relationships with family and friends. For all concerned the experience is not just physical; the ‘total pain’ concept, which encompasses physical, emotional, social, and spiritual elements, acknowledges the link between symptoms and psychological distress. A patient’s experience of illness is a direct product of the interaction between all aspects of their life. Competent psychosocial care can improve the quality of life of the patient and the family caregivers significantly.

There are many reasons why people entitled to use health and social-work services do not use them. Service design may preclude even those with the most complex and greatest needs. Some may be excluded because services are not acceptable, adequate, or appropriate. Others may place themselves out of the reach of services, for instance because of the stigma attached to their illness. This chapter shows how social work can be a prime mover in reviewing and reshaping health and social-work service delivery. Section 12.1 describes an action research project conducted in Glasgow, Scotland, with black and minority ethnic populations whose reluctance to use mental-health services has been compounded by their ongoing experience of racism and isolation. It addresses mental-health inequalities through community conversation. Section 12.2 describes an oncology social-work service of a large metropolitan hospital in Melbourne, Australia, with the goal of improving psychosocial care for cancer patients.

This chapter examines pain and symptom management for infants and children with a variety of life-limiting conditions. It explains that caring for infants and children with terminal illness is a complex challenge that requires a coordinated interdisciplinary effort across the continuum of care and that it is necessary for health professionals to work closely with the child and the family to meet this challenge. The chapter recommends a multimodal approach to treatment that includes integrating pharmacological and psychosocial care with intentional consideration of the child's physical, cognitive, emotional, and spiritual levels of development.

This chapter considers to what extent palliative care meets the needs of specific groups of people in society who may consider themselves to be vulnerable and marginalized. For most people in society, the experience of being excluded is transient and relatively short-lived. Despite the international call for palliative care to be recognized as a human right, there are challenges to that position and a case here is made to adopt a social justice framework, based on the principles of affective equality in palliative care. Using care studies around these specific groups, the reality of inequity and its impact on the psychosocial dilemmas faced by this group of patients and their families will be discussed.