Psychotherapy Targeting Depression and Anxiety for Use in Palliative Care: A Meta-Analysis

Fulton, Jessica J.; Newins, Amie R.; Porter, Laura S.; Ramos, Katherine

doi:10.1089/jpm.2017.0576

Cited by 51 publications

(39 citation statements)

References 61 publications

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“…With regard to clinical practice, meta-analytic evidence shows that psychologist-delivered psychotherapy improves mental health outcomes among patients with serious chronic illnesses. 2 However, only 11% of palliative care teams include psychologists, 3 and the discipline has not yet developed a palliative care specialty. Although social workers and psychiatrists may also provide psychotherapy, psychologists uniquely bring expertise in the normed assessment of mental health and psychosocial functioningdkey for treatment planning.…”

mentioning

confidence: 99%

Organizing Psychologists, Behavioral Scientists, and Allied Professionals: Formation of the Society of Behavioral Medicine's Palliative Care Special Interest Group

Hoerger

Ramos

Ellington

et al. 2019

Journal of Pain and Symptom Management

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mentioning

confidence: 99%

Organizing Psychologists, Behavioral Scientists, and Allied Professionals: Formation of the Society of Behavioral Medicine's Palliative Care Special Interest Group

Hoerger

Ramos

Ellington

et al. 2019

Journal of Pain and Symptom Management

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“…In recent meta-analyses, meaning therapies ( n = 6 studies) showed moderate effects on positive meaning in life immediately post-intervention (0.65) and at follow-up (0.57) (Fulton et al, 2018). They had more moderate effects on psychological distress (0.47) (i.e., anxiety and depression and self-efficacy (0.48) at post-intervention).…”

Section: Discussionmentioning

confidence: 99%

Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial

et al. 2020

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Objective Compare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness. Method Primary trial analysis (n = 135) included patients with advanced cancer, congestive heart failure, or end-stage renal disease; Arm 1 received the Outlook intervention, addressing issues of life completion and preparation, and Arm 2 received relaxation meditation (RM). Primary outcomes at five weeks (primary endpoint) and seven weeks (secondary): completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACIT-Sp) subscales of faith, meaning, and peace. Results Average age was 62; 56% were post-high school-educated, 54% were married, 52% white, 44% female, and 70% had a cancer diagnosis. At baseline, participants demonstrated low levels of anxiety (<5 on POMS subscale) and depression (<10 on CESD) relative to population norms. Results of the primary analysis revealed no significant differences in mean Preparation by treatment arm at five weeks (14.4 Outlook vs. 14.8 RM; between-group difference −0.4 [95% CI, −1.6, 0.8], p = 0.49) or seven weeks (15.2 vs.15.4; between-group difference −0.2 [95% CI, −1.5, 1.0], p = 0.73). There were also no significant differences in mean Life Completion by treatment arm between five weeks (26.6 Outlook vs. 26.3 RM; between-group difference 0.2 [95% CI, −1.2, 1.7], p = 0.76) or seven weeks (26.5 vs. 27.5; between-group difference −1.0 [95% CI, −2.7, 0.7], p = 0.23). Compared to RM, Outlook participants did not have significant differences over time in the secondary outcomes of overall quality of life, anxiety, depression, FACT-G subscales, and FACIT-Sp subscales. Discussion In early-stage life-limiting illness, Outlook did not demonstrate a significant difference in primary or secondary outcomes relative to RM. Results underscore the importance of pre-screening for distress. Qualitatively, Outlook participants were able to express suppressed emotions, place illness context, reflect on adaptations, and strengthen identity. Screening for distress and identifying specified measures of distress, beyond anxiety and depression, is essential in our ability to adequately assess the multi-dimensional mechanisms that decrease existential suffering.

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“…A recent meta-analysis of psychotherapeutic interventions for depression and anxiety in palliative care found that psychotherapeutic interventions offered improvement in depression, anxiety and quality of life. But, notably, a moderator of the effect included the provider type, with greater improvement when therapy was delivered by a mental health clinician as opposed to another member of the team 11. Furthermore, proper use of valid and reliable psychological assessments to properly differentiate and diagnose depression, DHD, suicidal ideation and anxiety is critical 8…”

Section: Mental Health Issues In Palliative Carementioning

confidence: 99%

Mental healthcare and palliative care: barriers

O'Malley

Blakley

Ramos

et al. 2020

BMJ Support Palliat Care

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ContextPsychological symptoms are common among palliative care patients with advanced illness, and their effect on quality of life can be as significant as physical illness. The demand to address these issues in palliative care is evident, yet barriers exist to adequately meet patients’ psychological needs.ObjectivesThis article provides an overview of mental health issues encountered in palliative care, highlights the ways psychologists and psychiatrists care for these issues, describes current approaches to mental health services in palliative care, and reviews barriers and facilitators to psychology and psychiatry services in palliative care, along with recommendations to overcome barriers.ResultsPatients in palliative care can present with specific mental health concerns that may exceed palliative care teams’ available resources. Palliative care teams in the USA typically do not include psychologists or psychiatrists, but in palliative care teams where psychologists and psychiatrists are core members of the treatment team, patient well-being is improved.ConclusionPsychologists and psychiatrists can help meet the complex mental health needs of palliative care patients, reduce demands on treatment teams to meet these needs and are interested in doing so; however, barriers to providing this care exist. The focus on integrated care teams, changing attitudes about mental health, and increasing interest and training opportunities for psychologists and psychiatrists to be involved in palliative care, may help facilitate the integration of psychology and psychiatry into palliative care teams.

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Psychotherapy Targeting Depression and Anxiety for Use in Palliative Care: A Meta-Analysis

Cited by 51 publications

References 61 publications

Organizing Psychologists, Behavioral Scientists, and Allied Professionals: Formation of the Society of Behavioral Medicine's Palliative Care Special Interest Group

Organizing Psychologists, Behavioral Scientists, and Allied Professionals: Formation of the Society of Behavioral Medicine's Palliative Care Special Interest Group

Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial

Mental healthcare and palliative care: barriers

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