Lecture 5 - psychological intervention in PC

• Start conversation by asking How do you feel? How long have you been in hospital?

• Wait for patient´s topics (its an offer, not neccary to talk, also offer the presence without talking a lot)

• Do not judge patients if they ask for death

• Assess depresivity/suicidal ideation

- Inclusion of all the domains (in PC work as a psychologist not only in psychologist manners, also physical expl. Fatigue etc)

• Spiritual : meaning based therapy, existential therapy etc

• Pain —> mindfulnesss/breathing exercise to release pain

• Distinguish between death anxiety and dying anxiety (more common is second)

• Social support, work with the system itself not only the patient (family therapy, intervention)

• 3 parts of dignitiy

• 
  

• level of independence

• symptoms

• seriousness of illness, how independent a person can be? (v.a. for physicans can help here, not really psychologists domain)

1) dignitiy conserving practices :things related to the practice atm, how staff talks/interacts with patients, how does family talks with patients?

2) dignity conserving perspective: what do I want for the future? When im not longer living/myself? —> the most use of psychologists is in the conserving practice and perspective!What do you wish for the future? How do I behave towards the patients?

• social support

• burden to others

• aftermath concerns

• social support of staff/family/friends, thoughts about afterlife (what happens with my body etc) (psychologist can support here a little)

-          One of the first therapy forms invented for Palliative care

-          Helps especially with spiritual and psychological domains

-          “Everyone has a story, sometimes they are incredible life experiences, sometimes sad, sometimes happy. But each of them is unique, it can only be told by that particular person.The given and specific person“

Very similar to psychotherapy – he created the set of questions for leading the conversation

• Existencial anxiety, distress

• Conversation is recorded —> based on the record / conversation: the legacy document is written (it differs a lot from patient to patient in length etc)

• Legacy document —>document is often given to family/friends so they know about their wishes

• Most of patients perceived as meaningful(86 %)

• Less depresivity, increase in meaning sense

• Possibility to influence the future after death

• Keeping continuity of myself

• Keeping my roles (even when theyre not theirselves anymore) • Hope (hope not for cure, but for my family to be better/ not that hard after I die)

• Fears related to future

Identification process – patient should be stable enough

Explanation of process – record, written document etc… explain why

Realization of meeting (in the best case in privacy room etc)

Legacy document

Revision with patients – write down what you think you learned from the meeting, revise with the patient (maybe patient forgot sth or the psychologist got sth wrong)

Final version to patient/family

• We do not do write verbatim trancript

– what is the most important of the meeting?

• Last paragraph is important

– wish for family members

• Keep the way how people talk

– e.g. put in (laugh) etc, to explain the emotions/atmosphere

• More journalist work:-)

• “What do I need to know about you as a person to give you the best care possible?”

—> right now, what can we do, what do you need (mini intervention)

• Using photos in care

– meaningful conversation, increase in dignity, for healthcare providers

– for staff: more joy at work, strengthening empathy (Mendelson et al., 2023)

• “Tell me a little about your life history, particularly the parts that you either remember most, or think are the most important. When did you feel most alive?” (What would you life look like in pictures? Which pictures would I see?)

• “What are the most important roles you have played in life (family roles, vocational roles, community service roles, etc.)? Why were they so important to you, and what do you think you accomplished in those roles?” —> difficult if patient “Lost” the role, expl. Job/career/separation so no longer husband/wife)

• “What are your hopes and dreams for your loved ones?” —> “push” people to think more about the time when they already died, confront with the topic

• “Are there words or perhaps even instructions you would like to offer your family to help prepare them for the future?” —> about aftermath concerns (do this with my money, don’t sell xyz, I want to be buried in xyz) (often patients know what they want f.e. with their bodies, but are afrid of sharing with their families, so the legacy document helps here)