Clinical evaluation of theMood and Symptom Questionnaire (MSQ) in a day therapy unit in a palliative support centre in the United Kingdom.

OBJECTIVE: To evaluate the use of the Mood and Symptom Questionnaire (MSQ) within a program of structured psychosocial interventions in a Supportive and Palliative Care Center. Palliative care patients have a range of psychological symptoms as well as physical symptoms. Considerable expertise in controlling pain and fear of pain, other physical symptoms, and psychosocial distress has been built up in hospices and palliative care units. This expertise can be used even at late stages in the patient's illness to improve quality of life. METHOD: We evaluated the usefulness of the MSQ to record patient responses, as an aid to patient/staff discussions, and as a staff-training tool. The questionnaire consisted of visual analog scales completed by the patient with a staff member present. Using the tool increased the opportunities for staff and patients to discuss problematic psychosocial issues. Where possible, we obtained data at two time points and compared the responses. RESULTS: The MSQ was rapidly accepted as a clinical tool in the day therapy setting by staff and the patients. The process of completing the questionnaire encouraged patients to face and discuss difficult issues. Discussion of the issues raised on the questionnaire had a wider effect, influencing interactions and communications through the unit and facilitating wider discussion of other nonpain symptoms. The medical psychotherapist associated with the unit used the MSQ responses as a training tool to increase staff awareness and knowledge and understanding of psychological issues related to the patients' total pain experience by discussing the questionnaires with them. SIGNIFICANCE OF RESULTS: The use of this tool helped to identify some psychological issues that proved relatively straightforward to address once uncovered. Patients benefited from this opportunity when their remaining time was relatively short. Their quality of life at the end of their lives was improved.

Reflections on the experience of counseling supervision by a team of genetic counselors from the UK.

Despite it being generally acknowledged that counseling supervision is a vital part of the work for experienced genetic counselors and not just students, not all practising genetic counselors in the United Kingdom and Eire have access to this yet. This case study documents the supervision experience of our team of genetic counselors from Cambridge in the U.K. We document our retrospective thoughts on working practice before supervision was available in our department. We also give an overview of the individual and collective views of having one-to-one supervision only and then one year later, the impact of adding group supervision. Our 'supervision journey' is recorded using a practitioner-centred approach with a mixed method of data collection. Two focus group discussions and two written questionnaires were used, at different time points to gather attitudes. This paper captures experiences as our practice of supervision has evolved. This work is relevant to practising genetic counselors around the world who either do not yet have access to supervision, are planning its implementation or else are adding different types of supervision to their practice.

End of life care for adult cystic fibrosis patients: facilitating a good enough death.

BACKGROUND: There is little empirical research on end of life care for CF patients from qualitative, psychosocial perspectives or which examines how staff members manage specific issues raised by cystic fibrosis deaths. This study examined how a number of recent deaths have been handled in an adult CF centre in the UK. METHODS: Multi-perspective psychosocial interview study with patients, staff, and relatives of decedents. Team meetings were observed. Interviews were analysed using a qualitative methodology (Interpretative Phenomenological Analysis). Observational analyses were used to assess the team's interactions when dealing with end of life issues with patients. RESULTS: Analysis of interviews uncovered themes which addressed the team's questions on care and support of patients with end-stage CF as follows: talking about death and dying; the multidisciplinary team; difficulties for the staff and saying goodbye; active versus palliative care. As a result of psychological input with the multidisciplinary team, staff felt supported and developed the ability to talk openly and in good time to patients regarding their deaths and their wishes for treatment at the end of life. CONCLUSION: The team felt that they had reached a foundation upon which to propose a model of care at the end of life for adult cystic fibrosis patients.

Challenging the representations of cancer pain: experiences of a multidisciplinary pain management group in a palliative care unit.

OBJECTIVE: This article describes how a Multidisciplinary Pain Management Group was set up in a palliative care unit, and outlines the ways that the group works with different patients. We place these comments in the context of the wider representations of pain. METHODS: Our observations of patients seen by the multidisciplinary team. RESULTS: We tentatively propose that where the patient's pain has certain characteristics it may require a different approach. Patients who are older, with a lengthy treatment history, may require a different input than younger patients, who may have a number of factors that further complicate their experience of pain. We use our extensive experience with mesothelioma patients to draw a further important distinction between this patient group and other patients. SIGNIFICANCE OF RESEARCH: Our observations suggest the need to allow sufficient time for intensive psychological work to be done with mesothelioma patients in order for pharmacological interventions to be effective.