The Place and Future of Social Work in Palliative Care Services in Turkey: State of the Art.

Palliative care, which is a special type of care including alleviation of physical and psychosocial symptoms of individuals with life-limiting serious diseases, has long been neglected in Turkey. This has also affected the activity of social work and social workers in the presentation of health services. In the present study, the present status of social work in palliative care services in Turkey was analyzed. It has also been attempted to explain the historical place of social work in palliative care services from 2002 on under the guidance of the World Health Organization and Ministry of Health. In the present study, an analysis is carried out of stages social work profession went through in social care services, its strong and weak aspects, and its future perspectives. It is thought that the experience gained and accumulation of knowledge in this process as it has occurred in Turkey may serve as guidance for other countries that have only recently started to implement palliative care services, which are evaluated in the context of human rights at present.

Coping with stress in patients with advanced cancer.

The incidence and mortality of cancer are increasing day to day. Advanced cancer is cancer that has grown beyond the organ where it first started. Often it has spread widely throughout the body. In advanced cancer when cure is impossible, symptoms should be the focus of attention. Having advanced cancer can bring anxiety and uncertainty to life of patients. Most people who have survived cancer and completed their treatment will say that they live with the underlying fear that their cancer will return. Some people with advanced cancer are living longer and with better quality of life (QOL). Each person with advanced cancer has unique experience. Advanced cancer is not the same for everyone; it behaves differently depending on what patients' primary cancer diagnosis have been. Symptoms then get worse and treatments are needed to help them to control. These symptoms can often be treated. Likewise, each person faced with recurrent cancer will cope differently too. Assessing and understanding the impact of cancer on patients is, therefore, very important for providing the appropriate care and for improving patients' QOL. Understanding the reasons why some individuals become depressed and faced with some problems in advanced cancer has become an increasingly important area in palliative care. By interest in end of life care, clinicans, nurses, social workers, psychologists, and researchers alike have begun to focus their attention on identifying factors that might facilitate coping with advanced cancer. The goals of this study was to examine cancer related stressors and how patients coping with them. For understanding cancer related stressors and coping patterns of patients with advanced cancer current literature has been examined. In this study the specific symptoms and concerns which are faced by advanced cancer patients has been assigned shortly on a priori basis in to the dimensions of physicial symptomps, psychological symptoms, social concerns and, existential issues. Coping with this stressors some useful coping strategies (problem focused and emotional focused approach) are suggested in this study. Framework which is developed by this study can be useful for understanding cancer related stressors, some interventions to assist cancer patients to manage symptoms (pain, fatigue) and coping strategies for health care staff who worked with advanced cancer patients. Health care staff who are aware of the common stressors in advanced cancer, palliative care and end of life care may identify more readily the need for support and assistance with coping strategies, thus improving the overall QOL of their patients. Providing psychological and social support requires interdisciplinary collaboration guided by a perspective of QOL in palliative care.

Psychological symptoms, illness-related concerns and characteristics of relatives of Turkish patients with cancer.

Being the relative of a patient with cancer is often very stressful, and there is a need for information, support, and help for carers. It is also important for the relative to know that the patient receives care of a good quality. This research investigated the relationships between sociodemographic characteristics, illness related concerns and psychological symptom scores of relatives of the patients with cancer in an inpatient oncology clinic of the GATA. A Questionnaire and Symptom Distress Check List (SCL-90-R) was administered to 106 relatives of in-patients and statistically significant relationships were found between the following characteristics and psychological symptom scores: sex, education level, duration of stay in hospital, having emotional problems and having financial problems. It was established that most problems of relatives were psychological and financial (p<0.05). Cancer is still a great source of fear and it is evident that offering psychosocial support at a professional level in addition to medical treatment will yield more favorable results for both patients and their relatives.

Neuropsychiatric involvement in juvenile systemic lupus erythematosus.

Neuropsychiatric involvement is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE) and it has been reported to occur in 22-95% of the childhood SLE patients. The aim of this study was to evaluate the neuropsychiatric involvement in our juvenile SLE patients. This was a cross-sectional assessment of patients to investigate the relationship between the involvement of the nervous system and the clinical factors, including autoantibodies, renal involvement and disease activity. We used Symptom Checklist-90-R (SCL-90-R), designed to measure the psychopathological symptoms. As controls, we used 20 healthy adolescents and 20 patients with chronic diseases without any neuropsychiatric manifestations. Overall, 55% (n= 11) of the patients displayed neurological symptoms and/or signs. However, central nervous system (CNS) imaging showed pathological findings only in four of these patients. Patients with headache only had normal CNS imaging. Nine patients had moderate to severe depression. When SLE patients were compared to healthy controls and to adolescents with chronic diseases, they were found to be significantly more depressed. In conclusion, pediatric rheumatologists should be aware of the frequency of neuropsychiatric disturbances in SLE. The neuropsychiatric disorders do not always correlate with disease activity and these children need professional psychological evaluation.

Quality of life and sociodemographic characteristics of patients with cancer in Turkey.

PURPOSE/OBJECTIVES: To determine whether a relationship exists between quality of life (QOL) and the sociodemographic characteristics of gender, age, marital status, educational level, occupation, and level of income in patients with cancer in Turkey. DESIGN: Exploratory study using a convenience sample. SETTING: Five hospitals in the capital city of Turkey. SAMPLE: 620 patients with cancer (44 inpatients and 576 outpatients). METHODS: The study was carried out using face-to-face interviews. A questionnaire was used as a tool for collecting data on the sociodemographic characteristics of patients, and the Rolls-Royce Quality-of-Life Scale was employed to measure QOL. MAIN RESEARCH VARIABLES: Gender, age, marital status, educational level, occupation, level of income, and QOL. FINDINGS: Men, older adults, widowed spouses, patients with lower levels of education, housewives, and those with lower income had lower QOL scores. CONCLUSIONS: Considering the results and giving the groups referred to in the study priority in the planning of patient care would be useful. IMPLICATIONS FOR NURSING: In the field of nursing in Turkey, a limited number of studies have examined the relationship between the sociodemographic characteristics of patients with cancer and QOL. The results will help nurses assess patient needs and engage in nursing interventions that are appropriate to the needs.

The status of alternative treatment in cancer patients in Turkey.

This study was designed to measure the frequency at which Turkish patients with cancer resort to complementary and alternative medicine (CAM). A total of 704 patients referred to the Gülhane Military Medical Academy and Ankara Numune Training Hospital between September 2002 and January 2003 were asked about the CAM therapies they used. Of these, 276 patients (39.2%) had used CAM. Gender, marital status, educational status, age, financial status, severity of pain, history of cancer in the family, and their own ideas concerning CAM therapies were found to be correlated with the frequency of resorting to CAM. Resorting to CAM may lead to delayed diagnosis and treatment, adverse drug interactions, treatment withdrawal, and disease progression. Therefore, it is very important to inform patients about these potential dangers. Further studies are needed to clarify the reasons that lead patients to resort to CAM.

Job stress and coping strategies in health care professionals working with cancer patients.

The aim of this study was to determine the factors influencing stress in health care professionals working with cancer patients and the strategies used to cope with stress. The data was collected by self-report questionnaires, the Job Stress Inventory and Ways of Coping Inventory. Overall 109 health care professionals (physicians n = 52, nurses = 57) employed in five Oncology Hospitals in Ankara, Turkey, between January 2001 and July 2001 were involved in the study. It was identified that the mean job stress score of health care professionals was 30.76 (physicians = 30.53, nurses = 31.00) (range = 0-50). This stress level indicated that there were signs of physical and psychological stress. It was determined that variables influencing stress scores were marital status, age, professional career, unfairness in promotion opportunities, imbalance between jobs and responsibilities, conflict with colleagues, lack of appreciation of efforts by superiors, responsibilities of role, long and tiring work hours, inadequacy of equipment, and problems experienced with patients and their relatives. It was also determined that health care professionals utilize similar strategies in order to cope with stress. The most common strategy used by physicians and nurses was a self-confident approach (x = 1.89 and 1.82 respectively), and the strategy least used was a submissive approach (respectively, x = 1.03 and 0.85). Programmes directed towards reducing job stress and enhancing motivation and job satisfaction were recently considered by health institutions. It is thought that the findings of the study could be taken into account in preparing programmes (coping with stress, training) for health care professionals working with cancer patients.