Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-25T15:39:23.649Z Has data issue: false hasContentIssue false
  • English
  • Français

Dyadic psychological intervention for patients with cancer and caregivers in home-based specialized palliative care: The Domus model

Published online by Cambridge University Press:  30 March 2017

Annika B. von Heymann-Horan ,
Louise B. Puggaard ,
Kathrine G. Nissen ,
Kirstine Skov Benthien ,
Pernille Bidstrup ,
James Coyne ,
Christoffer Johansen ,
Jakob Kjellberg ,
Mie Nordly  and
Per Sjøgren
...Show all authors
Annika B. von Heymann-Horan*
Affiliation:
Danish Cancer Society Research Center, Copenhagen, Denmark
Louise B. Puggaard
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Kathrine G. Nissen
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Kirstine Skov Benthien
Affiliation:
Palliative Research Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Pernille Bidstrup
Affiliation:
Danish Cancer Society Research Center, Copenhagen, Denmark
James Coyne
Affiliation:
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA University Medical Centre Groningen, University of Groningen, The Netherlands
Christoffer Johansen
Affiliation:
Danish Cancer Society Research Center, Copenhagen, Denmark Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
Jakob Kjellberg
Affiliation:
KORA, The Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
Mie Nordly
Affiliation:
Palliative Research Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Per Sjøgren
Affiliation:
Palliative Research Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Helle Timm
Affiliation:
Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Copenhagen, Denmark
Hans von der Maase
Affiliation:
Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
Mai-Britt Guldin
Affiliation:
Research Unit for General Practice, Aarhus University, Aarhus, Denmark
*
Address correspondence and reprint requests to: Annika B. von Heymann-Horan, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 København Ø, Copenhagen, Denmark. E-mail: heymann@cancer.dk.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Patients with incurable cancer and their informal caregivers have numerous psychological and psychosocial needs. Many of these patients wish to receive their care and die at home. Few home-based specialized palliative care (SPC) interventions systematically integrate psychological support. We present a psychological intervention for patient–caregiver dyads developed for an ongoing randomized controlled trial (RCT) of home-based SPC, known as Domus, as well as the results of an assessment of its acceptability and feasibility.

Method:

The Domus model of SPC for patients with incurable cancer and their caregivers offered systematic psychological assessment and dyadic intervention as part of interdisciplinary care. Through accelerated transition to SPC, the aim of the model was to enhance patients' chances of receiving care and dying at home. Integration of psychological support sought to facilitate this goal by alleviating distress in patients and caregivers. Psychologists provided needs-based sessions based on existential-phenomenological therapy. Feasibility and acceptability were investigated by examining enrollment, nonparticipation, and completion of psychological sessions.

Results:

Enrollment in the RCT and uptake of the psychological intervention indicated that it was feasible and acceptable to patients and caregivers. The strengths of the intervention included its focus on dyads, psychological distress, and existential concerns, as well as interdisciplinary collaboration and psychological interventions offered according to need. Its main limitation was a lack of an intervention for other family members.

Significance of Results:

Our results show that psychological intervention can be systematically integrated into SPC and that it appears feasible to provide dyadic needs-based sessions with an existential therapeutic approach. The Domus RCT will provide evidence of the efficacy of a novel model of multidisciplinary SPC.

Keywords

Psychological interventionPalliative careExistential therapyFamily caregiverCancer
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 2 , April 2018 , pp. 189 - 197
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aabom, B.M., Obling, N.J., Rasmussen, H., et al. (2000). Unplanned emergency admission of dying patients: Causes elucidated by focus group interviews with general practitioners [in Danish]. Ugeskrift for Laeger, 162(43), 5768–5771.Google Scholar
Applebaum, A.J., Kulikowski, J.R. & Breitbart, W. (2015). Meaning-centered psychotherapy for cancer caregivers (MCP–C): Rationale and overview. Palliative & Supportive Care, 13(6), 1631–1641. Epub ahead of print May 22. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084443/pdf/nihms824425.pdf.CrossRefGoogle ScholarPubMed
Aranda, S. & Milne, D. (2000). Guidelines for the Assessment of Bereavement Risk in Family Members of People Receiving Palliative Care. Melbourne: Centre for Palliative Care. Available from http://prc.coh.org/BereavGuidelines.pdf.Google Scholar
Bakitas, M., Lyons, K.D., Hegel, M.T., et al. (2009 a). The project ENABLE II randomized controlled trial to improve palliative care for rural patients with advanced cancer: Baseline findings, methodological challenges, and solutions. Palliative & Supportive Care, 7(1), 75–86. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685415/,Google Scholar
Bakitas, M., Lyons, K.D., Hegel, M.T., et al. (2009 b). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. The Journal of the American Medical Association, 302(7), 741–749. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657724/.CrossRefGoogle Scholar
Benthien, K.S., Nordly, M., Videbæk, K., et al. (2015). Classification of a palliative care population in a comprehensive cancer centre. Supportive Care in Cancer, 24(4), 1865–1873. Epub ahead of print Oct 13.Google Scholar
Berg, C.A. & Upchurch, R. (2007). A developmental-contextual model of couples coping with chronic illness across the adult life span. Psychological Bulletin, 133(6), 920–954.CrossRefGoogle ScholarPubMed
Boston, P., Bruce, A. & Schreiber, R. (2011). Existential suffering in the palliative care setting: An integrated literature review. Journal of Pain and Symptom Management, 41(3), 604–618. Epub ahead of print Dec 8, 2010. Available from http://www.jpsmjournal.com/article/S0885-3924(10)00685-8/pdf.Google Scholar
Breitbart, W., Poppito, S., Rosenfeld, B., et al. (2012). Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of Clinical Oncology, 30(12), 1304–1309. Epub ahead of print Feb 27. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646315/.Google Scholar
Chochinov, H.M., Kristjanson, L.J., Breitbart, W., et al. (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. The Lancet. Oncology, 12(8), 753–762. Epub ahead of print Jul 6. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185066/.Google Scholar
Cohen, J., Houttekier, D., Onwuteaka-Philipsen, B., et al. (2010). Which patients with cancer die at home? A study of six European countries using death certificate data. Journal of Clinical Oncology, 28(13), 2267–2273. Epub ahead of print Mar 29. Available from http://ascopubs.org/doi/10.1200/JCO.2009.23.2850.Google Scholar
Gomes, B., Calanzani, N., Curiale, V., et al. (2013 a). Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. The Cochrane Database of Systematic Reviews, 6, CD007760. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473359/.Google Scholar
Gomes, B., Calanzani, N., Gysels, M., et al. (2013 b). Heterogeneity and changes in preferences for dying at home: A systematic review. BMC Palliative Care, 12(1), 7–19. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623898/.Google Scholar
Götze, H., Brähler, E., Gansera, L., et al. (2014). Psychological distress and quality of life of palliative cancer patients and their caring relatives during home care. Supportive Care in Cancer, 22(10), 2775–2782. Epub ahead of print May 9.CrossRefGoogle ScholarPubMed
Grande, G. & Ewing, G. (2008). Death at home unlikely if informal carers prefer otherwise: Implications for policy. Palliative Medicine, 22(8), 971–972. Epub ahead of print Oct 24.Google Scholar
Hagedoorn, M., Sanderman, R., Bolks, H.N., et al. (2008). Distress in couples coping with cancer: A meta-analysis and critical review of role and gender effects. Psychological Bulletin, 134(1), 1–30.Google Scholar
Hansen, M.B., Adsersen, M. & Grønvold, M. (2015). Dansk Palliativ Database Årsrapport 2014 [in Danish]. København: DMCG–PAL. Available from http://www.dmcgpal.dk/files/aarsrapport2014_endelig2.pdf.Google Scholar
Harding, R., Higginson, I.J., Leam, C., et al. (2004). Evaluation of a short-term group intervention for informal carers of patients attending a home palliative care service. Journal of Pain and Symptom Management, 27(5), 396–408.CrossRefGoogle ScholarPubMed
Higginson, I.J. & Sen-Gupta, G.J. (2000). Place of care in advanced cancer: A qualitative systematic literature review of patient preferences. Journal of Palliative Medicine, 3(3), 287–300.CrossRefGoogle Scholar
Hjermstad, M.J., Kolflaath, J., Løkken, A.O., et al. (2013). Are emergency admissions in palliative cancer care always necessary? Results from a descriptive study. BMJ Open, 3(5), e002515. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669727/pdf/bmjopen-2012-002515.pdf.Google Scholar
Hudson, P.L., Aranda, S. & Hayman-White, K. (2005). A psychoeducational intervention for family caregivers of patients receiving palliative care: A randomized controlled trial. Journal of Pain and Symptom Management, 30(4), 329–341. Available from http://www.jpsmjournal.com/article/S0885-3924(05)00389-1/pdf.Google Scholar
Jarlbæk, L. (2015). Dødssted og Dødsårsager i Danmark 2007–2011 [in Danish]. København: Videncenter for Rehabilitering og Palliation. Available from http://pavi.dk/Files/Udgivelser%20PAVI/D%C3%B8dssted%20og%20d%C3%B8ds%C3%A5rsager%20i%20Danmark%202007-2011.pdf.Google Scholar
Kissane, D.W. & Zaider, T. (2009). Bereavement. In Oxford Textbook of Palliative Medicine, 4th ed. Hanks, G. et al. (eds.), pp. 1483–1501. Oxford: Oxford University Press.Google Scholar
Kissane, D.W., McKenzie, M., Bloch, S., et al. (2006). Family-focused grief therapy: A randomized, controlled trial in palliative care and bereavement. The American Journal of Psychiatry, 163(7), 1208–1218. Available from http://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.2006.163.7.1208.CrossRefGoogle ScholarPubMed
Kissane, D.W., Zaider, T.I., Li, Y., et al. (2016). Randomized controlled trial of family therapy in advanced cancer continued into bereavement. Journal of Clinical Oncology, 34(16), 1921–1927. Epub ahead of print Apr 11.Google Scholar
Lo, C., Hales, S., Jung, J., et al. (2014). Managing Cancer And Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer. Palliative Medicine, 28(3), 234–242. Epub ahead of print Oct 29, 2013.Google Scholar
McMillan, S.C., Small, B.J., Weitzner, M., et al. (2006). Impact of coping skills intervention with family caregivers of hospice patients with cancer: A randomized clinical trial. Cancer, 106(1), 214–222. Available from http://onlinelibrary.wiley.com/doi/10.1002/cncr.21567/full.Google Scholar
Mitchell, A.J., Chan, M., Bhatti, H., et al. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies. The Lancet. Oncology, 12(2), 160–174. Epub ahead of print Jan 19.Google Scholar
National Comprehensive Cancer Network (2014). Distress Management: NCCN Clinical Practice Guidelines in Oncology. Fort Washington, PA: National Comprehensive Cancer Network. Available from https://www.nccn.org/professionals/physician_gls/f_guidelines.aspGoogle Scholar
Nordly, M., Benthien, K., Von Der Maase, H., et al. (2014). The DOMUS study protocol: A randomized clinical trial of accelerated transition from oncological treatment to specialized palliative care at home. BMC Palliative Care, 13(1), 44. Available from http://bmcpalliatcare.biomedcentral.com/articles/10.1186/1472-684X-13-44.CrossRefGoogle ScholarPubMed
Pitceathly, C. & Maguire, P. (2003). The psychological impact of cancer on patients' partners and other key relatives. European Journal of Cancer, 39(11), 1517–1524.Google Scholar
Schulz, R., Boerner, K. & Hebert, R.S. (2007). Caregiving and bereavement. In Handbook of Bereavement Research and Practice: Advances in Theory and Intervention. Stroebe, M.S. et al. (eds.), pp. 265–285. Washington, DC: American Psychological Association.Google Scholar
Sepulveda, C., Marlin, A., Yoshida, T., et al. (2002). Palliative care: The World Health Organization's global perspective. Journal of Pain and Symptom Management, 24(2), 91–96.Google Scholar
Spinelli, E. (2007). Practicing Existential Psychotherapy: The Relational World. London: Sage Publications.Google Scholar
van Deurzen, E. (2010). Everyday Mysteries: A Handbook of Existential Psychotherapy, 2nd ed. London: Routledge.Google Scholar
van Deurzen, E. & Adams, M. (2011). Skills in Existential Counselling & Psychotherapy. London: Sage Publications.Google Scholar
Walsh, K., Jones, L., Tookman, A., et al. (2007). Reducing emotional distress in people caring for patients receiving specialist palliative care: Randomised trial. The British Journal of Psychiatry, 190(2), 142–147. Available from http://bjp.rcpsych.org/content/190/2/142.long.Google Scholar
Supplementary material: File

von Heymann-Horan supplementary material

von Heymann-Horan supplementary material 1

Download von Heymann-Horan supplementary material(File)
File 30.2 KB