RESUMO
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.
Assuntos
Transtornos do Humor/diagnóstico , Cuidados Paliativos/métodos , Psicometria/métodos , Adaptação Psicológica , Atitude Frente a Morte , Cuidados Paliativos na Terminalidade da Vida/métodos , Cuidados Paliativos na Terminalidade da Vida/psicologia , Humanos , Transtornos do Humor/psicologia , Dor/psicologia , Manejo da Dor , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Inventário de Personalidade , Relações Profissional-Paciente , Perfil de Impacto da Doença , Inquéritos e Questionários , Reino UnidoRESUMO
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.
