Tetsuo Kashiwagi

Professionally perceived effectiveness of psychosocial interventions for existential suffering of terminally ill cancer patients

Background: Although integrated care for existential suffering is an essential part of palliative care, little is known about its concept and efficacy as perceived by professionals. A questionnaire survey was carried out to 1) explore the underlying structure of psychosocial interventions recommended by specialists, 2) identify the professionally perceived effectiveness of each intervention for specific existential distress, and 3) examine the effects of specialty on their recommendations. Methods: A questionnaire with three scenarios representing terminally ill cancer patients with uncertainty-related anxiety, guilt feelings, and dependency-related meaninglessness was mailed to 701 Japanese psychiatrists, 118 psychologists, and 372 palliative care nurses. Results: A total of 456 responses were obtained (response rate = 38%). Recommended psychosocial interventions were classified into six subcategories: ’a supportive-expressive approach,fl’providing comfortable environments,fl’meaning-centered approach,fl’being,fl’education and coping skills training,fland ’a religious approach.flA ’supportive-expressive approachflwas consistently recommended in all vignettes. On the other hand, ’providing comfortable environmentsflwas most recommended for patients with uncertainty-related anxiety, and a ’meaning-centered approachfland ’beingflwere most recommended for patients feeling dependency-related meaninglessness. Psychiatrists estimated the effectiveness of psychopharmacological treatment significantly higher than psychologists and nurses, while nurses evaluated efficacy of all other interventions significantly higher than psychiatrists and psychologists. Conclusions: Experts evaluated a variety of clinical interventions as effective in palliating existential suffering, although the perceived levels of efficacy of each intervention differed according to the nature of suffering and their specialties. To effectively alleviate existential suffering in terminally ill cancer patients, an integrated care by an interdisciplinary team is necessary.

Influence of Motoric Encoding on Forgetting Function of Memory for Action Sentences in Patients with Alzheimer's Disease

This study assessed whether verbal encoding and motoric encoding have different effects on the forgetting function for action sentences of patients with Alzheimers disease. Subjects were 13 healthy elderly adults and 10 patients diagnosed with Alzheimers disease. Three tasks were used: verbal tasks, subject-performed tasks, observed tasks. On the verbal tasks, subjects only heard the action sentences as read to them. On the subject-performed tasks, subjects heard, then performed each action sentence. On the observed tasks, subjects heard the action sentences read while observing the object mentioned in each action sentence. After presentation of each task, subjects conducted immediate and 30-min. delayed recall tests, and then a recognition test. Analysis indicated recall performance for subject-performed tasks was significantly better than that for verbal tasks and observed tasks at both immediate and delayed recall in each group. On the recognition test, carrying out the action had no effect, but for both groups recognition was enhanced by observing the object. Elderly adults performed significantly better than patients on all tasks of recall and recognition. However, the results indicate that patients with Alzheimers disease can use multimodal resources from motoric encoding even if time passes.

Psychosocial and spiritual issues in terminal care.

Abstract The author has been working as a psychiatrist over the past 30 years, engaging in clinical work and in research. During his career as a psychiatrist the author began to develop a special interest in terminal care. This led to additional study in a residency program in internal medicine and oncology, and culminated in the establishment of a hospice in 1984. Through this close association with hospice patients the author has experienced approximately 2000 deaths over the past 10 years. These experiences have reinforced in his mind the viewpoints that people die as a whole person.

Malignant intestinal obstruction

We conducted a prospective study of symptom prevalence in 206 terminally ill cancer patients and a retrospective study of the incidence and treatment of malignant intestinal obstruction in 110 patients (30 with gastric cancer, 30 with colon cancer, 30 with rectal cancer, and 20 with ovarian cancer). In the prospective study, pain was the most frequent symptom in patients surviving more than 1 month. The frequencies of general malaise, anorexia, constipation, and insomnia increased during the patient’s final month. The frequency of confusion increased during the final 2 weeks. The frequencies of agitation and death rattle increased during the final days. The incidence of intestinal obstruction was 16%. In the retrospective study, we defined malignant intestinal obstruction as a final obstruction continuing for more than 1 week and for which surgery was not indicated. Malignant intestinal obstruction developed in 63% of patients with gastric cancer, 45% with ovarian cancer, and 40% with colorectal cancer. Symptoms of malignant intestinal obstruction in many patients were successfully controlled with opioids (morphine, buprenorphine, fentanyl), anticholinergic agents (scopolamine butylbromide, scopolamine hydrobromide), a major tranquilizer (haloperidol), and a somatostatin analogue (octreotide). Nausea and vomiting due to malignant intestinal obstruction were effectively treated in 75% of patients by continuous subcutaneous infusion of octreotide, with a median dose of 300 μ g/day. However, a nasogastric tube was necessary in 33% of patients with ovarian cancer, 21% with gastric cancer, and 8% with colorectal cancer.