Art Therapy in Patients with Terminal Cancer and Their Families: A Multiple Case Study

Research background. The causes of fibromyalgia (FM) are unclear and diagnosing FM is complicated, which limits treatment options, and no treatment to date has proven fully effective in alleviating its symptoms. In current studies, where art therapy has been applied in the case of FM, art therapy has been part of a multidisciplinary intervention. The authors were unable to find any published data on the effects of art therapy on FM. The aim of the research was to determine the effect of group art therapy on pain, emotional state, and feeling of health and comfort of FM patients. Research methods. Intervention included ten structured art therapy sessions. The participants were 20 women between the ages of 39–64 years. In order to assess the results of therapy, a self-rate questionnaire was used. Therapy session changes were registered using pain and fatigue NRS and semantic differential scales of feeling of health and comfort. The outcome of group art therapy was assessed with a pain and fatigue NRS, and an Emotional State Questionnaire (EST-Q2). An open question was used to study the expectations of participants at the beginning of therapy and the main result of the therapy upon its conclusion. Research results. During the group art therapy session, pain and fatigue decreased and the feeling of health and comfort improved. This was confirmed by the content analysis of open questions. Following therapy, a significant decrease had taken place in the subscales of the Emotional State Questionnaire in depression, anxiety, and agoraphobia-panic; a substantial decrease in pain and fatigue took place in patients with heightened baseline measures. Conclusion. The changes following the therapy session confirm the results of earlier studies on the positive effects of psychotherapy and art therapy sessions on pain. The pilot study provided promising results for the application of structured short-term group art therapy with FM patients. Keywords: group art therapy, fibromyalgia, pain, fatigue, emotional state.Keywords: group art therapy, fbromyalgia, pain, fatigue, emotional state.

It is difficult to manage terminal cancer patients with major depressive disorder in hospice palliative care. There have been still few literatures about clinical studies among terminal cancer patients with major depressive disorder. Understanding existential issues of those patients may be contributed for clinical practice. According to Heidegger's dasein hermeneutics, the texts from psychotherapies which included four terminal cancer inpatients with major depressive disorder after signing letters of informed consent were analyzed to find the existential issues. There were twenty two valid texts of all four patients. The existential issues of terminal cancer patients with major depressive disorder are death, self-awareness, dignity, meaning and meaninglessness, autonomy and choice, and relations. The results will contribute to understand and deal with terminal cancer patients with major depressive disorder.

To analyze the controversies surrounding therapeutic decision-making and the withholding of life- sustaining treatments, values held concerning therapeutic interventions of terminal cancer patients are compared between physicians and family members. 42 advanced or terminal stage cancer patients were enrolled for the study. The questionnaires were administered to the duty doctor and the family of the patients. Questions included whether to use new agents with a 15% partial efficacy and whether to use opioid analgesics, intravenous nutrition, a feeding tube, antibiotics, and hemodialysis. Additionally, we asked about the administration of CPR, ventilator application, and euthanasia. If the family permitted, the same questionnaires were given to the patients. Of the 42 cases, 5 families refused to answer the questionnaire. Of the available 37 families, only 5 families permitted access to the patients. Of the 5 patients, 2 patients refused the questionnaire. Only 67.6% and 8.1% of families and the patients clearly understood the stage of cancer. The use of a new agent was accepted by 45.2% of the physicians and 45.9% of the families. The rankings of the acceptance of treatment in the physicians and in the families were similar. The concordance rate between the physicians and the families was lowest on ventilator application and CPR. 31% of the physicians and 43.2% of the families agreed on the issue of euthanasia. Values held on issues like therapeutic decision-making and the withholding of life-sustaining treatments in terminal cancer patients are discordant between physicians and family members. In order to resolve controversies on the role of physicians in end-of-life decisions, the values of physicians as well as patients and their family members should be considered in the final decision-making process.

In addition to modern medicinal therapy, many cancer patients in Taiwan are treated regularly with herbal medicines or prescribed a traditional herbal diet. In this paper, the effect of a Taiwanese traditional herbal diet (TTHD) on pain in terminal cancer patients was investigated. A total of 2,466 patients diagnosed with a variety of cancers were included. The most common patient-reported symptoms included troublesome pain (79.2%), weakness (69.0%), anorexia (46.4%), fever (36.5%), dyspnea (31.1%), and leg edema (30.9%). The 2,466 terminal cancer patients included in the study were randomly divided into three groups. The TTHD group (n=1044; 42.3%) were given the TTHD consisting of analgesic herbs (paeony root: licorice root=1:1) and a Taiwanese tonic vegetable soup (Lilii bulbus, Nelumbo seed, and Jujube fruit). The remaining patients were divided into a reference group, given the regular hospital diet, (n=909, 36.9%) and a control group, given the Taiwanese tonic vegetable soup without analgesic herbs, (n=513, 20.8%). All patients maintained their assigned diets for one week. A verbal numerical scale was used to assess pain. Results revealed that the patients given TTHD reported enhanced pain relief (p<0.05) compared to the reference and control groups. We found that TTHD could alleviate the pain among terminal cancer patients thereby supporting the supposition that Eastern and Western medicines can be effectively co-administered to enhance terminal patient's quality of life. Further research is warranted.

Hyponatremia is a common and associated with poor clinical outcome in cancer patients. But little is known regarding hyponatremia in terminal cancer patients. The purpose of this study is to investigate the prognostic role of the hyponatremia in terminal cancer patients. A retrospective observational study was conducted between January 2010 and December 2012 in a tertiary hospital palliative care unit. Medical records were collected from hospitalized patients who were eligible for obtaining serum sodium level. Hyponatremia was defined as serum sodium <136 mEq/L. And we classified patients into three groups; eunatremia (sodium 136-145 mEq/L), mild to moderate hyponatremia (sodium 126-135 mEq/L), and severe hyponatremia (sodium ≤125 mEq/L). Univariate and multivariate Cox regression analyses were performed to determine factors affecting survival time. Of the 576 patients, hyponatremia was present in 367 individuals (63.7 %). In the univariate analysis, serum CRP, PPS, and sodium ≤125 mEq/L were associated with survival time (HR = 1.22; p < 0.001, HR = 0.69; p < 0.001, HR = 1.91; p < 0.001). In the multivariate analysis, serum CRP, PPS, sodium 126-135 mEq/L, and sodium ≤125 mEq/L were associated with survival time (HR = 1.16; p < 0.001, HR = 0.70; p < 0.001, HR = 1.19; p = 0.048, HR = 1.75; p < 0.001). Hyponatremia is an independent prognostic factor in terminal cancer patients and careful clinical concern is needed. In the future, large prospective study is warranted in terminal cancer patients.

BackgroundCancer patients who have reached the terminal stage despite attempts at treatment are likely to experience various problems, particularly as they encounter increasing difficulty in doing what they were able to do easily, and their physical symptoms increase as the disease advances. The purpose of this study is to explore how terminal cancer patients who have not clearly expressed a depressed mood or intense grief manage their feelings associated with anxiety and depression.MethodsEleven terminally ill patients with cancer who were receiving symptom-relieving treatment at home or in palliative care units were interviewed. Interviews were generally conducted weekly, two to five times for each participant. In total, 33 interviews were conducted, and the overall interview time was 2027 min. Data were analyzed via qualitative methods.ResultsThe following five themes were extracted regarding the experience of managing feelings associated with anxiety and depression when facing death: “I have to accept that I have developed cancer,” “I have to accept the undeniable approach of my own death,” “I have to accept my need for assistance,” “I have to accept this unsatisfactory circumstance” and “I have to accept this as my destiny and an outcome of my life.”ConclusionThe present study revealed key themes related to how patients come to terms with their impending death. Nurses are required to comprehend the patients’ complicated mental patterns that are expressed in their daily languages. Furthermore, the findings clarify the necessity for nurses to help patients understand the acceptance of a terminal disease state during a patient’s final days.

This paper investigates art therapy techniques. The author describes and clarifies a selective sample of art therapy techniques: art therapy with children, family art therapy, art therapy with geriatric clients, and multipurpose techniques. As a field of study, art therapy was divided by the author into three general classifications: (1) art psychotherapy, (2) structural or rehabilitative art therapy, and (3) psychoeducational or functional art therapy. The reference source for all published works used in this study was Grant and Schmal (1974 ) . No art therapy books were consulted, nor were journal articles that dealt only in theory. The specific journal articles used were those that provided information about art therapy techniques.

BackgroundTen percent of non-sudden deaths in the Netherlands occur in inpatient hospice facilities. To investigate differences between patients who are admitted to inpatient hospice care or not following application, how diagnoses compare to the national population, characteristics of application, and associations with being admitted to inpatient hospice care or not.MethodsData from a database representing over 25 % of inpatient hospice facilities in the Netherlands were analysed. The study period spanned the years 2007–2012. Multivariate regression analyses were performed to study associations between demographic and application characteristics, and admittance.ResultsTen thousand two hundred fifty-four patients were included. 84.1 % of patients applying for inpatient hospice care had cancer compared to 37.0 % of deaths nationally. 52.4 % of applicants resided in hospital at the time of admission. Most frequent reasons for application were the wish to die in an inpatient hospice facility (70.5 %), needing intensive care or support (52.2 %), relieving caregivers (41.4 %) and needing pain/symptom control (39.9 %). Living alone (OR 1.68, 95 % CI 1.46–1.94), having cancer (OR 1.40, 95 % CI 1.11–1.76), relieving caregivers (OR 1.18, 95 % CI 1.01–1.38), needing pain/symptom control (OR1.72, 95 % CI 1.46–2.03) wanting inpatient hospice care until death (vs respite care) (OR 3.59, 95 % CI 2.11–6.10), wanting to be admitted as soon as possible (OR 1.64, 95 % CI 1.42–1.88), and being referred by a primary care professional (OR 1.36, 95 % CI 1.17–1.59) were positively associated with being admitted. Wishing to die in an inpatient hospice facility was negatively associated with being admitted (OR 0.85, 95 % CI 0.72–1.00).ConclusionsThis study suggests that when applying for inpatient hospice care, patients who seem most urgently in need of inpatient hospice care are more frequently admitted. However, non-cancer patients seem to be an under-represented population. Staff should consider application based on need for palliation, irrespective of diagnosis.

Background: Disruptions in activity‐rest rhythms are common in terminal cancer patients, yet continuous monitoring of these changes is challenging. The effects of opioids and psychotropic drugs on sleep quality remain inadequately understood. Objectives: (i) To objectively evaluate temporal changes in diurnal (8:00 a.m.–8:00 p.m.) and nocturnal (8:00 p.m.–8:00 a.m.) activity‐rest rhythms over the final 2 weeks of life in terminal cancer patients using a nonwearable actigraph and (ii) to assess the adjusted impact of opioid and psychotropic drug use on these rhythms. Design: A longitudinal study. Settings/Participants: Twenty‐six terminal cancer patients in a Japanese palliative care unit. Measurements: A nonwearable actigraph was placed under the mattress to continuously monitor activity‐rest rhythms. Measured parameters included time in bed (TIB: minutes), total sleep time (TST), wake after sleep onset (WASO), sleep efficiency (SE: 0%–100%), activity score (0–960 counts/min; higher values indicate greater activity), and movement index (MI: percentage of time moving in bed; higher values suggest restlessness). Results: As death approached, diurnal TIB and SE increased, indicating reduced daytime activity. Nocturnal sleep metrics fluctuated irregularly, with an increase in MI, suggesting deteriorating sleep quality. Opioid users exhibited a higher MI and lower SE both day and night compared to nonusers. Psychotropic drug users showed a decreased nocturnal MI and improved SE. Conclusion: Terminal cancer patients experience decreased daytime activity and unstable nocturnal sleep as death nears. Opioid use correlates with inadequate rest, while psychotropic drugs may enhance nocturnal sleep quality. Continuous nonwearable monitoring offers valuable insights for optimizing end‐of‐life care.

The terminal cancer patients increase needs for hospice care day by day. A new hospice consulting system has been developed in Taiwan to provide options for terminal cancer patients in choosing a suitable post-acute hospice care while a combined hospice care system is also given by the consulting team in the acute wards. Hereinafter is our report. From March 2005 to January 2006, 313 terminal cancer patients were analysed. These patients had signed consent forms for palliative treatment and had received consultations from the new hospice consulting system. Multivariate analysis showed that the home care patients had better performance status (P = 0.012), less shortness of breath (P = 0.006), less limbs swelling (P = 0.043), less flatulency (P = 0.000) and less constipation (P = 0.018). Among the 162 patients with regular follow-up, the symptoms/signs were significantly improved after intervention of consulting team in pain (P = 0.000), shortness of breath (P = 0.000), difficulty in sleeping (P = 0.002), nausea (P = 0.004), constipation (P = 0.008), changes in skin (P = 0.024) and adoption (P = 0.000). This new system had significant improvement in the terminal cancer patients' symptoms/signs control in acute wards and could contribute to the care quality of home care patients.

Purpose: This study was conducted to evaluate the effects of integrated palliative care intervention on quality of life in terminally ill patients. Methods: A comprehensive literature search was performed via PubMed, Cochrane Library CENTRAL, LWW (Ovid), CINAHL and several Korean database s. The main search strategy was to combine terms indicating palliative care intervention, presence of terminal illness and study design. Methodological quality was assessed using Cochrane’s Risk of Bias for randomized studies and Risk of Bias Assessment tool for non-randomized studies. Data were analyzed by the Stata 10 program. Results: Eight clinical trials met the inclusion criteria with a total of 356 participants. Integrated palliative care interventions were administered for a mean of 6.5 weeks, 5.6 sessions and an average of 47.8 minutes per session. Effect sizes were heterogeneous, and subgroup analysis was done. Integrated palliative care interventions had a significant effect on quality of life (ES=1.83, P=0.018, l 2 =92%), spiritual well-being (ES=0.78, P=0.040, l 2 =0), depression (ES=0.86, P＜0.001, l 2 =32) and anxiety (ES=0.69, P=0.041, l 2 =71.1). But integrated palliative care interventions had no significant effect on pain (ES=0.365, P=0.230, l 2 =69.8). Conclusion: Results support findings that integrated palliative care interventions were helpful in lessening depression and anx iety and improving quality of life and spiritual well-being, however, the interventions did not assist pain management in terminal cancer patients. These findings suggest that various integrated palliative care interventions can assist terminal cancer patients with better quality of life in the socio-psycho-spiritual dimension.

Background: Previous studies on hospice/palliative care indicated that patients’ socio-demographic factors, disease status, and availability of health-care resources were associated with hospice/palliative care utilization. However, the impact of family caregivers on hospice/palliative care utilization has not been thoroughly investigated. Aim: To evaluate the association between attitudes toward hospice/palliative care of both patients with terminal cancer (defined as progressive, advanced cancer in which the patient will die within months) and their family caregivers and utilization of inpatient hospice/palliative care facilities. Design: A prospective observational cohort study was performed in 12 hospitals in South Korea. Attitude toward hospice/palliative care was assessed immediately after terminal cancer diagnosis. After the patient’s death, caregivers were interviewed whether they utilized hospice/palliative care facilities. Participants: A total of 359 patient–caregiver dyads completed baseline questionnaires. After the patients’ death, 257 caregivers were interviewed. Results: At the baseline questionnaire, 137/359 (38.2%) patients and 185/359 (51.5%) of caregivers preferred hospice/palliative care. Preference for hospice/palliative care was associated with awareness of terminal status among both patients (adjusted odds ratio: 1.87, 95% confidence interval: 1.16–3.03) and caregivers (adjusted odds ratio: 2.14, 95% confidence interval: 1.20–3.81). Religion, metastasis, and poor performance status were also independently associated with patient preference for hospice/palliative care. At the post-bereavement interview, 104/257 (40.5%) caregivers responded that they utilized hospice/palliative care facilities. Caregiver’s preferences for hospice/palliative care were significantly associated with actual utilization (adjusted odds ratio: 2.67, 95% confidence interval: 1.53–4.67). No patient-related factors were associated with hospice/palliative care utilization. Conclusion: Promoting awareness of prognosis and to improve communication between doctors and families is important for facilitating the use of hospice/palliative care.

Interactive media-based dance and art therapies as interventions for treating posttraumatic symptoms among school children with abduction experience

One of the main goals of end-of-life care is to achieve the best quality of life (QOL) for patients and their families. Quality of life, therefore, represents a significant outcome indicator to evaluate end-of-life care interventions. However, nonresponse bias and nonrandom missing data in QOL research at the end-of-life limits the generalizability and threatens the internal validity of the study findings. The use of family proxy of patients' QOL has been suggested as a solution. Demonstration of satisfactory levels of agreement between proxies and patients is warranted before family caregivers' or other proxies' assessments can be employed when patients cannot provide their own information. Contrary to the conclusion made by Sprangers and Aaronson [The Role of Health Care Providers and Significant Others in Evaluating the Quality of Life of Patients with Chronic Disease: A Review. J. Clin. Epidemiol. 1992, 45, 743–760], it is suggested from this review of literature that terminal cancer patients and their family caregivers agreed at least moderately well on the patients' QOL. The bias introduced by the use of family informants is generally of a modest magnitude. When discrepancies existed, without exception, family caregivers held a more negative view of patients' QOL than did patients. When using family proxies, this is important to remember. The degree of agreement between terminal cancer patients' and their family caregivers' assessments varies as a function of the dimensions of QOL being measured and the patient's health status. However, the accuracy of family caregivers' assessments can be improved by assessing both patients and family caregivers concurrently over time. Several suggestions for future research are provided to better understand the influencing factors of agreement between patient and family assessments and to enhance the quality of statistical analyses on this topic.

The development of cancer therapies is a long and arduous process. Because it can take several years for a cancer agent to pass clinical testing and be approved for use,...