Palliative care and (psycho) dignity therapy

The concept of “palliative care”, despite the negative meaning that we are socially accustomed to attribute to it, is not to be considered “useless” or to be interpreted as a “placebo effect”.

The term palliative then, has its etymological root precisely in the Latin “pallium” = cloak and, in fact, the sense of covering, wrapping, protecting (as inside a cloak) is the one that comes closest to the meaning that is today he wants to attribute to the term palliative.

In Palliative Care, the control of pain, other symptoms and psychological, social and spiritual problems is of fundamental importance, as is also limiting bureaucratic procedures as much as possible.

They aim to improve the quality of life as much as possible for both patients and their families, in particular:

  • they affirm life and consider death as a natural event;
  • they do not accelerate or delay death, consequently they are against any form of therapeutic persistence and any form of euthanasia;
  • provide relief from pain and other symptoms;
  • integrate the psychological, social and spiritual aspects of care;
  • they offer a support system to help the family during illness and bereavement.

Palliative Care has been defined by the World Health Organization as “… an approach that improves the quality of life of patients and their families who are faced with the problems associated with incurable diseases, through the prevention and relief of suffering for means of early identification and optimal treatment of pain and other problems of a physical, psychophysical and spiritual nature. “

With this in mind, especially in recent decades, psychotherapy has assumed a central role in the panorama of palliative care for dying patients and their loved ones. Some research carried out in recent years has shown how psychotherapeutic work on a terminally ill patient, while not having the effect of reducing his physical pain or all the discomforts connected to it, can at least improve the experience and quality of the defined moment. “End-of-life”.

It is a brief individual psychotherapy, also known as “dignity therapy”, precisely because the patients who have benefited from it, have emphasized how the sessions have considerably and significantly increased their sense of dignity, often underestimated in people with diseases in a terminal state, and therefore improving their quality of life.

In this therapy, the therapist follows a protocol of questions and engages the dying patient in a conversation rather than a structured clinical interview about the important aspects of his life and what he would like to be remembered about after his death. The session is recorded and transcribed. The transcript is then given to the patient, who will decide if it should be shared with friends and family.

It now remains to understand the effect these transcripts may have on family members, particularly those with whom the patient had lost contact, or on children who lose a parent. “We need to find ways to measure these equally important aspects, to show that we are making a difference,” said one of the researchers.

One study in particular (Harvey Max Chochinov, University of Manitoba, Winnipeg), had the primary purpose of understanding whether psychotherapy was really able to reduce the patient’s stress in the last phase of his life: the answer obtained is that the therapy dignity does not achieve this, as the researchers write in The Lancet Oncology.

The researchers involved 441 patients with a life expectancy of six months (or less) who received palliative care in a hospital, hospice facility, or at home. Although, as already mentioned, the intervention had absolutely no influence on the level of stress experienced by patients, a subsequent study indicated that “dignity therapy” still has some advantages over standard palliative care or client-centered care. .

In fact, compared to the other two interventions, the patients who received the “dignity therapy” judged it “useful”, both for them and for their families, arguing that:

  • it has improved their quality of life;
  • it increased their sense of dignity;
  • changed the way family members relate to them.

The results show that “dignity therapy” was significantly better than client-centered therapy for improving emotional well-being, as well as compared to standard palliative care, for relieving the sadness or depression usually present in these patients. Compared to palliative care, a greater proportion of patients who underwent “dignity therapy” reported that the study group was satisfactory.

“Further research will need to be done to explore the beneficial effects of dignity therapy ,  concluded the researchers, “to unravel the psychological, spiritual and existential complexity that affects an individual in the face of death, and to understand what is the best way to support patients with advanced or terminal illness, as well as their families

 

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