Psychological Distress in Oncology

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Psychological Distress in Oncology
Darius Razavi University of Brussels Institut
jules Bordet
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BIOLOGICAL AND PSYCHOSOCIAL STRESSORS
HEALTH CARE PROFESSIONALS
PATIENTS
Psychological Distress
Relational problems Diagnostic
problems Treatment choices Monitoring treatment
effects
Satisfaction with care Wish for
treatment Compliance with treatment Quality and
duration of life
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SIDE EFFECTS pain nausea and
vomiting fatigue
PSYCHOLOGICAL STATE anxiety depression satis
faction with care
SOCIAL STATE family work social relations
QOL
FUNCTIONAL STATE mobility autonomy fatigue
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Assessment of Psychological Distress
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Psychological Distress
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Modification of norms used to judge a given
situation
Psychological distress
QOL
Discomfort, side effects, handicaps,...
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ADJUSTMENT IN ONCOLOGY Diversities
Adjustment Disorder
Adjustment Difficulty
?
?
Adjustment
?
Stress II
Stress I
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Breakdown in adjustment
Loss of control
Adjustment disorder
Fatigue
Adjustment difficulty
Tension
Adjustment
Stress I
Stress II
Stress III
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DIAGNOSTIC AND THERAPEUTIC PROCEDURES IN
ONCOLOGY Consequences
Anticipatory anxiety Phobia Conditioned
Symptoms Compliance Problems Sleep
Disorders Adjustment Disorders Psychiatric
Disorders
Anticipatory Stress
Reinforcement
Discomfort Side Effects
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STRESS, ADJUSTMENT AND DEPRESSION ETC.
Adjustment Disorders
Depression
Adjustment Difficulties
Crisis
Anxiety
Stress
Adjustment
Phobia ...
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DETECTION

• C O M M U N I C A T I O N

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Process of Detecting Distress?
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Blocking behaviour Premature and excessive
information (example)

Dr What do you fear ? Pt Well to know that
it is cancer Dr But one does not die of
breast cancer. One dies of complications
of breast cancer. Do you fear that ? Of
course it is going to be a heavy treatment. But
I think that the first step is to get surgery. Do
you also fear to loose one of your breast? Pt
Well, at the moment no euh what I fear now is
mainly surgery .
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Blocking behaviour
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Weakly Emotional-SRPS

Utterances
Moderately Emotional-SRPS
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Highly Emotional-SRPS
60
50
40
30
20
10
0
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Results of a Micro-analyis of Consultations
Detection skills
Detection of Distress
Knowledge about Distress
Intention to identify cues of distress
Consolidation Workshops
Basic Training
Merckaert et al, Cancer 2006
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Assessment skillspromoting disclosure of
concerns(examples)

• How are you?
• How are you feeling?
• Tell me
• What do you think about it?
• What do you feel exactly?
• What is your understanding of your situation?
• Can you tell me more about the way you feel?

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Conclusions
Screening of Distress
Specific Distress Detection Module
Basic Training and Consolidation Workshops
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Improvement of assessment of distressImpact of
basic training and workshops
At baseline
After training
DISTRESS VAS
DISTRESS VAS
R20.40
R20.24
R20.08
R20.03
HADS
HADS
? Workshops Waiting list
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PREVENTION OF ADJUSTMENT DISORDERS
ILLUSTRATION
Adjustment Disorders
No disorder
Stress
Razavi et al, JCO 1993