Objective: Palliative care of the terminally ill requires not only treatment of physical pain, but also care for a patient's spiritual and social needs. In Japan, where many customs correlate closely with the seasons of fall, winter, spring, and summer, seasonal events carry significance for patients who have reached a terminal stage of disease. This study determined how Japanese hospice patients evaluate a program that celebrates seasonal events and considers the modality and significance of season events at hospices.

Methods: A questionnaire survey was conducted for 1 year between August 2000 and July 2001 at a hospice located in the suburbs of Tokyo, Japan. Of the original 48 instruments, a total of 43 instruments were returned (response rate: 89.6%).

Results: Results showed that 72.1% of respondents participated in seasonal events, and the majority of participants positively evaluated their experiences of seasonal events. Positive aspects included being able to get a feeling for the seasons (74.2%) and being able to interact with staff and volunteers (51.6%). Negative aspects included that the events were too long (9.7%) and tiring (6.5%), and that the events made one feel sad (6.5%). Reasons for participating in seasonal events included seeming fun (71.0%), recreative (58.1%), and being entertaining (48.4%).

Significance of results: Overall findings suggest that there is significance in celebrating the seasons with a monthly event at hospices. Further research is needed on the modality and experiences of celebrating the seasons at hospices in other nations.

Objective: Little research has been undertaken regarding the psychological impact of cancer on those stricken during the young adult years. Specifically, research on the coping strategies of young adults with cancer is limited.

Method: In this qualitative, Grounded Theory study, we did not set out to examine coping; rather, it emerged as a major phenomenon in the analysis of interview data from 15 young adults with cancer.

Results: These young adults used various coping strategies to come to terms with the cancer diagnosis, management of the illness, its treatment, and treatment sequelae. The coping strategies varied considerably from person to person, depended on the stage(s) of the illness, and were rooted in their precancer lives. We were able to discern a pattern of coping strategies used by most participants. The prevailing goal for all participants was to achieve what they called “normalcy.” For some, this meant major changes in their lives; for others it meant to “pick up” where they had left off before the cancer diagnosis.

Significance of results: To aid the understanding of the issues that influence coping, we have developed a model to illustrate the bidirectional nature and the complexities of the coping strategies as they relate to the phases of the disease and the disease treatment. The model also affirms Folkman and Lazarus' coping theory.

Objective: Hypnosis is an adjunctive, noninvasive treatment with few side effects that can be useful in the management of chronic pain. However, it has fallen into disfavor in recent years and is often perceived by physicians as simple charlatanism. We evaluated the efficacy of this treatment as used clinically in a large, mostly rural, pain management center.

Methods: We conducted a chart review of 300 pain patients from the Pain Treatment Center of the Bluegrass who had undergone hypnosis for their pain concerns. A chart audit tool was developed consisting of basic demographics, pre- and posthypnosis pain ratings, a rating of relaxation achieved posthypnosis, and scores on the Beck Depression Inventory, Perceived Disability Scale, and the Pain Anxiety Symptom Scale.

Results: The sample consisted of 79 men (26.3%) and 221 women (73.7%) with a mean age of 46.3 years (SD = 9.9, range = 19–78). Pain levels recorded pre- and posthypnosis revealed significant improvement as a result of the intervention (mean difference = 2.5, t(1,298) = 25.9, p < .001). Patients reported an average of 49.8% improvement in relaxation level posthypnosis (SD = 24.2%) and had a mean score of 19.0 on the Beck Depression Inventory (SD = 9.9), indicating moderate levels of depression. Also, patients saw themselves as severely disabled regarding their ability to engage in physical (8.3/10) or job-related (7.7/10) activities. Attempts to identify predictors of hypnosis success were not fruitful with one exception. “Poor” responders to hypnosis reported greater levels of perceived dysfunction in their sexual functioning compared to the “good” responders, F(1,187) = 7.2, p < .01.

Significance of results: Hypnosis appears to be a viable adjunct for pain management patients, including those from rural and relatively disadvantaged backgrounds. Prospective trials are needed to examine the utility of this modality in end-of-life and palliative care patients.

Objective: This qualitative research study listens to the narratives of people experiencing the dying process who attended the Otago Community Hospice, Dunedin, New Zealand.

Methods: Ten people, aged between 51 and 65 years old, were approached; two declined and one died sooner than expected. All were women (although this was not part of the original design), and all had carcinoma. Data for the study were sought through qualitative research interviews, considering the development of each participant's illness in relation to her perception of her embodiment in the palliative care setting, and concluding with questions about what she wants the people who care for and about her to learn from her experience. Consistent with this phenomenological approach, the method of analysis was thematic and interpretive.

Results: The main theme was the uncertainty that all participants felt throughout the diagnostic process and during treatment. Uncertainty, too, was a factor in how they managed their day, whether they would be able to sustain an outing or an activity or not, and whether they would be pain free. None were afraid of dying but hoped that when they did die, they would do so comfortably. The relationship with their general practitioners varied. Where fatigue or the effects of medication were not an issue, they could think clearly, but their bodies were experienced as letting them down and limiting their activities. The ideal of “living until you die” was not able to be fulfilled. The increasing approach of social death as they withdrew from their employment and social responsibilities affected them.

Significance of results: Whether one has a “good death” or not is determined not only by the progression and management of the disease process by health professionals, but also by the way in which one is perceived, by self and others. There are no guidelines for the dying role; everybody dies differently and individually.

Objective: Crying is a common but seldom studied phenomenon in palliative care. The aim of this study was to explore the significance of patients crying in a palliative care context.

Methods: Tape-recorded interviews with 14 cancer patients in palliative home care were carried out. To gain deeper understanding, a hermeneutic analysis and interpretation was used.

Results: Crying was described in different dimensions: (1) intense and despondent crying as a way of ventilating urgent needs, (2) gentle, sorrowful crying as a conscious release of emotions, and (3) quiet, tearless crying as a protection strategy. Crying seems to be an expression for an inner emotional force, provoked by different factors, which cause changes in the present balance. To cry openly but also to cry on the inside meant being able to achieve or maintain balance. Crying may be something useful, which could create release and help reduce tension, but it may also have a negative impact as it consumes energy and creates feelings of shame.

Significance of results: Professionals need to understand the different levels of crying. In such situations sometimes comforting the patient may not be the best solution, as some may need privacy.

Objective: The study compared the qualitative aspects of the loneliness experience of the dying, their caregivers, and the general population.

Method: The patients were recruited in an oncological hospice in Israel, and, despite being on their deathbed, agreed to participate in the study. Thirty-seven cancer-stricken patients, 78 caregivers, and 128 participants from the general population volunteered to partake in the study. They answered, anonymously, a 30-item questionnaire and were asked to endorse those items that described their experience of loneliness.

Results: Results suggested that the three populations did, indeed, differ in their experience of loneliness. More specifically, dying patients and their caregivers had significantly higher subscale scores on the Growth and Discovery and the Self-alienation subscales than the general population did. It was also found that the number of hospitalization days was significantly negatively correlated to the Emotional Distress and Self-alienation subscales.

Significance of results: The present results indicate that loneliness is experienced differently in or out of the hospice and by the dying patient, his or her caregiver, and the general population. This may be the first study to examine the qualitative aspects of the loneliness experienced by the dying and by their caregivers. More research is needed to replicate the present study, using larger samples.

Objective: To examine the relationship between social support and emotional functioning and stress reactions. Our hypothesis is that patients who reported a high degree of social support will experience better emotional functioning and less serious stress reactions than patients with a low degree of social support.

Method: The sample was comprised of 434 patients at the Palliative Medicine Unit (PMU), University Hospital of Trondheim in Norway. The patients completed a questionnaire monthly including questions about social support from the MacAdam's Scale, subjective stress measured by the Impact of Event Scale (IES), and emotional functioning measured by the subscale in the EORTC QLQ-30.

Results: Although our hypothesis was not supported at the baseline assessment, it was supported at the second assessment, 2 months later. Patients with high social support reported better emotional functioning and less serious stress reactions, in terms of lower scores on the IES avoidance subscale, than patients with a low degree of social support.

Significance of the results: The mixed findings may indicate that social support has only small effects on emotional functioning and stress reactions. Our results on the second assessment indicate, however, that social support might work as a buffer against reactions toward external stressful events such as terminal cancer.

Objective: This study aims to clarify characteristics of the contents of life review in reminiscence therapies in cancer patients by age, gender, and stage of disease.

Methods: Sixteen patients who were terminally ill and were receiving anticancer treatments participated in life review therapy. Patients reviewed there lives according to their developmental stage, and they mainly reviewed impressive achievements. A clinical psychologist interviewed each patient four times and the total number of sessions was 64. The contents of each life review were transcribed, and a correspondence analysis and a significance test were conducted on these data to choose characteristic words or phrases.

Results: The main concern of 40-year-olds was “about children.” For 50-year-olds, it was “how to confront death” and for 60-year-olds, “death-related anxiety” and “new discoveries”. For 70-year-olds, “resignation about death” and “evaluative reminiscence of their lives” were most important, and for 80-year-olds the main concern was “relationships with others.” When analyzing the data according to disease stage and gender, “transcendence to children”, “reflection on their past behavior”, and “gratitude for my family” were characteristic words for males receiving treatment, “work,” “worries about children,” “side effects,” “homecare,” and “reflection on their past behavior” were characteristic words for females receiving treatment. “Physical condition”, “desire for death” and “how to confront death” were common phrase for males in the terminal stages of the disease process, while “resignation to life” was characteristic reaction for females.

Significance of results: There appear to be considerable differences in the focus of life review interviews by age, disease age, disease stage, and gender. Clinicians should consider these differences when using life-review therapy in order to tailor it to the individual.

Objectives: Opioid medications are frequently used in pain and palliative care patients with malignancy to manage symptoms such as pain and dyspnea. However, opiates are associated with various side effects. Constipation is a particularly problematic and common side effect of opioid pharmacology. Opioid antagonists have been studied in the management of opioid-induced constipation. Methylnaltrexone (MNTX) is a peripheral opioid antagonist currently under clinical investigation. It offers the potential to reverse undesirable side effects without reversing analgesia.

Methods: This article attempts to review existing clinical data, focusing on antagonism of opioid-induced adverse effects on the gastrointestinal system.

Results: MNTX seems to be well tolerated with limited or transient side effects. MNTX has been shown to improve oral-cecal transit times in opioid treated patients, induce laxation in chronic opioid users, and neither reverses the analgesic effects of morphine nor cause withdrawal symptoms.

Significance of results: Larger clinical trials of MNTX are still necessary to support its use as a standard for treatment of opioid-induced constipation.

“Chemobrain” is the phenomenon of cognitive decline some patients may experience after chemotherapy. Current research indicates the cognitive domains that may be most impacted by chemotherapeutic agents are visual and verbal memory, attention, and psychomotor functioning. These cognitive deficits can have an effect on a patient's ability to make informed treatment decisions, pursue occupational or academic pursuits, and his or her overall quality of life. The potential mechanisms that cause this disruption remain largely unknown, although contributing factors could be vascular injury and oxidative damage, inflammation, direct injury to neurons, autoimmune responses, chemotherapy-induced anemia, and the presence of the apolipoprotein E ε4 (APOE ε 4) gene. Interventions to help alleviate the symptoms of chemobrain could include nonpharmacologic treatment such as antioxidants and cognitive-behavioral therapy. In addition, patients may benefit from pharmacologic treatment such as recombinant human erythropoietin and psychostimulant drugs such as methylphenidate. It is important to note that the proposed therapeutics treat the symptoms of chemobrain based on the hypothesized mechanisms. Therefore, a detailed understanding of the mechanisms that cause chemobrain, as well as a comprehension of what specific cognitive domains are impacted, is crucial in developing more specific treatments to improve patients' cognitive functioning and overall quality of life.

We set out to discuss the psychological barriers that exist in the treatment of pain. Specifically, we argue that clinicians have several innate mechanisms at play that can hinder their judgment and lead to erroneous assumptions about their patients. Issues are discussed from social psychological and psychodynamic perspectives. A focus is placed on the issue of empathy and how this, too, can act as a barrier to rational judgment when evaluating patients. In the face of growing scrutiny on pain management in the United States, it is important to understand the barriers to providing care that already exist on an intrinsic level. Through the exploration of these barriers, clinicians might be better able to reflect on their own practice. Ultimately, we hope to push forward an agenda of rational therapy in pain management that utilizes safeguards against abuse and addiction while also preserving treatment modalities for patients in need of services.

Objective: When physicians confront a personal illness of a serious nature, they may discover that the transition to the sick role is challenging, and the inability to relinquish their stethoscope may cause undo anxiety. The physician–patient relationship is intrinsically asymmetrical, and the role of the physician is to regulate the amount of information patients need in order to become educated about their illness and to make informed decisions about their treatment plan. This article explores the challenges in the physician–patient relationship when the patient is also a physician.

Methods: This article is a literature review of publications involving the unique challenges physician–patients experience when suffering from serious personal illness.

Results: The medical knowledge physician–patients harbor has the potential to complicate their ability to cope with difficult or terminal diagnoses. Paradoxically, knowledge about a condition may fuel anxiety instead of alleviating the fear associated with the unknown. Medical knowledge therefore may entail a certain loss of innocence, and physicians are often unable to revert to being “mere” patients. Furthermore, managing this anxiety in physician–patients may prove to be challenging to the treating physician.

Significance of results: From a medical perspective, physician–patients need to be addressed like any other patient. Psychologically, however, these patients are unique, and the specific challenges their education and experience bring into the consultation room needs to be explicitly addressed.

Objective: Breathlessness is one of the core symptoms in many advanced conditions. The subjective nature of the symptom has been acknowledged in many definitions, emphasizing that it can only be fully perceived and interpreted by the patients themselves.

Aim: To review and assess the evidence on the psychosocial nature or experience of breathlessness.

Methods: Relevant literature was identified through electronic and hand searches. Studies with qualitative enquiry or mixed method designs were included. The methodological quality of studies was assessed with a standard grading scale.

Results: Twenty-two studies were identified, 12 from the United Kingdom, 4 from the United States, 3 from Canada, 1 from Sweden, 1 from Iceland, and 1 from Finland. The nature of the studies determined the themes in which the studies were subsumed. Studies on COPD (19) outnumbered “all other conditions” (3), one of which had COPD and cancer patients and so these were analyzed separately. Within the COPD category most studies (17) considered the experience of breathlessness from the perspective of the patient, 1 study from the informal carer, and 1 from the professional carer. Most of the papers sought to understand the meaning of the symptom in the patient's daily life. The other papers demarcated separate areas of the experience of acute exacerbations and the patient's view on care. The studies explored the subjective component of breathlessness, as part of human experience and social life. The papers showed the influence of the meaning the symptom has for those affected on their ability to cope and on their management.

Significance of results: Although the work in this area is still dominated by research on COPD, the totality of the evidence now shows breathlessness as an intractable symptom in other advanced conditions. Practice recommendations focused on the holistic approach as part of palliative and nursing care.

Adolescence and young adulthood is a time of enormous change. For many young people, the profound shift from dependence to autonomy that is the hallmark of this period is physically, emotionally, and spiritually demanding. On the other hand, this phase of life is generally marked by an exuberant optimism that is the envy of jaded adulthood. This optimism, when coupled with intelligence, lack of respect for established forms, and iconoclastic energy, may be the source of a lifetime's achievement.

The Rediscovery of the Human: Basic Texts of Viktor E. Frankl. Translated by Rabbi Dr. Shimon Cowen and Liesl Kosma. Monographs in Judaism and Civilization. Melbourne: Institute for Judaism and Civilization, 2006. ISBN 0-9585933-5-3, 74 pages.

Three seminal essays by Viktor Frankl highlight the deep spirituality that he believed to be at the heart of man's search for meaning and purpose in this world. Humanity returns consciously or unconsciously to this universal spirituality in its quest for a fulfilling existence.