Therapy by Telephone

Can therapy for depression work when done by telephone?  The short answer is yes.  This type of therapy may be slightly less effective than face-to-face meetings, but patients are less likely to drop out of phone therapy. 

These were the findings of David Mohr and colleagues at the Northwestern University Feinberg School of Medicine published in the Journal of the American Medical Association in June of this year.  Mohr said, “One of the things we’ve found over the years is that it’s very difficult for people with depression to access psychotherapy.”  The authors speculated that reducing time commitments, transportation problems and cost may play a role in the lower drop-out rate for phone therapy.

Around 25% of all primary care visits are with patients who have clinically significant depression, according to the authors.  Cognitive behavioral therapy is an effective treatment for depression, but the drop-out rate is high.

Researchers in the randomized study had 325 people diagnosed with depression undergo 18 weeks of therapy, half by phone and half in person.  The quality of the telephone therapy was calculated to be equivalent to in-person treatment. By the end of the period 53 participants had dropped out of face-to-face therapy compared with 34 in the phone therapy group.

Patients in both groups felt decreased levels of their depression, however six months later patients who met with their therapists in person tended to feel less depressed than those who had phone sessions, but the difference was very small.

“At this point these findings do suggest that psychotherapy for depression can be administered both safely and effectively over the phone. Providers can be comfortable doing that and insurers and payers should feel comfortable” reimbursing for it, Mohr said.  Cognitive behavioral therapy by phone, “can overcome barriers to adhering to face-to-face treatment.” 

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Most Cancer Docs Reach Out to Bereaved

Seventy percent of cancer physicians contact bereaved family members and caregivers of their patients who die.  But of the 162 physicians surveyed, more than two thirds do not feel adequately trained to do this sort of reaching out.  These were the results of a study presented at the 53rd Annual Meeting of the American Society for Radiation Oncology (ASTRO).

Most of those surveyed sent condolence letters, and some called or attended funeral services.  One perceived barrier to bereavement follow-up is lack of time.  Another factor was uncertainty about which family member was the most appropriate person to contract.

“This study highlights the need to more clearly define the physicians’ role in bereavement activities and address bereavement activities in providers’ postgraduate training as we work to improve the multidisciplinary treatment of cancer patients and their families,” said lead author Aaron S. Kusano, MD, a radiation oncology resident at the University of Washington School of Medicine in Seattle. 

Source:  www.medicexchange.com/ASTRO-2011/most-cancer-physicians-reach-out-to-bereaved-family-caregivers-astro-2011.html.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Grief: A Process

Feeling a Loss

Grief is the emotional suffering caused by a loss. It often begins before the loss, like the sadness upon learning that a resident or a loved one does not have long to live.  Spouses and others grieve for the companionship they will lose and dreams that won’t happen, that life will be changed forever.

Natural Process

Grief is a natural part of life. People express it in their own ways.  There is no timetable for grief and there is no right or wrong way to grieve.  It can come and go. 

Grief takes different forms at different times.  At first, the bereaved person may feel disbelief and expect to see their loved one even though they know the person is gone. 

They may also feel anger at being “abandoned” by the loved one.  Or they may feel guilt—for the anger, for still being here, or for things they may have said or done (or didn’t say or do).  These feelings are all normal.

When to Get Help

But there are times when grief is so intense or so prolonged that the health of the bereaved person is at risk.  There are some signs that let us know a person may need help in coping with their grief.

Although deep sadness is a natural part of bereavement, in some individuals death triggers a lasting depression that may cause withdrawal from friends and family, thoughts of suicide and lack of energy.   This is one of the times when outside help is needed.

Mild weight loss, fatigue, insomnia and anxiety may be expected early on.  But it may be time for the grieving person to see their doctor or a mental health professional if after three months or so you see:

• Intense feelings are not starting to lighten.
• Excessive weight gain or weight loss.
• More than 12 or less than 4 hours sleep a night.
• Constant crying.

For more information about grief support services available at no cost from Pathways, visit us online at www.pathwayshealth.org or call 1.888.755.7855.

Should I Tell My Patient Death Is Imminent?

Does Not Increase Anxiety

When your patient with cancer is terminally ill and you have a good sense of the short prognosis, should you tell him?  It is a well-established practice for American physicians to be forthcoming about prognosis, but not so well established when death is just around the corner.

A study recently published online suggests that keeping the patient fully informed in the final days means that they are more likely to have their preferences met and to die in their preferred place.  Their family members are also more likely to be prepared for the death and to be offered bereavement support.

Researchers in Sweden looked at more than 1,000 cases in which patients were informed of their imminent death and compared this with a similar number who were not informed.  Results showed no differences with regard to pain control, nausea, anxiety, confusion, respiratory tract secretions and other end-of-life symptoms.

“People vary about the extent they want to know the truth, if they want to know at all, and in their understanding of what constitutes telling the truth,” the authors wrote.  But, they concluded, “being informed about imminent death does not lead to more unrelieved pain and anxiety during the last week of life.”

The study concludes that, “providing information of imminent death to a patient with cancer at the end of life does not seem to increase pain or anxiety, but it does seem to be associated with improved care and to increase the likelihood of fulfilling the principles of a good death.”  

The study appears in the Journal of Clinical Oncology, July 2011.

Grief and the Holidays

Remembering

With the holidays come reminders of their loss for those who are grieving.  Others are savoring a time of joy, sharing memories, and coming together in love. For those who are grieving, the holidays are a vivid reminder of who is NOT there.

Many grieving people find this the most difficult time of the year.  They cannot forget and cannot bury the pain.  Their hearts, minds and bodies are grieving and not functioning in their full capacities, as though part of them is missing.  These are natural feelings—they are all a part of the process—they can share them, accept them, and feel them.

Ways of Coping

 
As the holidays approach, it may help for those who are grieving to start with a blank slate. Accept that they may not have the energy or desire to accomplish all the things that people have come to expect during the holidays.

Rather than do things automatically, they can discuss and think about what they really want to do, what they don’t want to do, and what will be difficult but they want to try anyway.  Grief experts encourage people not to be afraid to change traditions or start new ones.

Equally important is to acknowledge how one feels.  Many recently bereaved worry they will spoil the holidays for others.  According to families Pathways has counseled, the most painful thing is when they try to keep their feelings inside. 

If friends or family members take the initiative to talk about the person who has died, it relieves the tension and creates an opportunity for sharing. 

Managing Grief

 
While there are no universal methods for healing and coping, there are some concrete things a person can do that may make the holidays easier and provide an opportunity to honor loved ones who have died.  

Grieving families can:

• Acknowledge the grief; accept whatever mood occurs.
• Remember they are not alone.  Attend a remembrance event or grief support group.
• Give themselves permission to let go of certain traditions—it’s okay to make changes.
• Share plans with others; let them know how they can help.
• Reserve time to honor the loved one quietly, alone or with others—light a candle, place a photograph on the table, share memories, or make a memorial donation.

And finally, grieving family members should remember to care for themselves at this time.

Grateful to Give Back: An Interview with Pathways Volunteer, Bill Jennings

Pathways Home Health & Hospice recognized Bill Jennings of Milpitas, California for outstanding volunteer service by honoring him with the Kennedy Award. Bill has been a volunteer at Pathways Home Health & Hospice since 2006, and is an active member of both bereavement and patient care teams.

A retired trainer with Sony Electronics, Bill has found many opportunities to adapt his professional skills to his volunteer work at Pathways. He uses his interpersonal skills when visiting patients and their families, where he provides companionship, and comfort. He uses his technical skills by creating and maintaining two databases for tracking the non-profits’ bereavement library and Integrative Therapies practices.

We recently sat down with Bill to ask him a few questions about his volunteer experiences at Pathways.

What does being a Pathways volunteer mean to me? 

• Self fulfillment, personal growth
• Appreciation from the patients and family you serve

What type of volunteer work do you do and which do you like the best?

• Hospice visits for companionship with patients and caregiver relief
• Bereavement calling to families who have lost a loved one
• Integrative therapies committee

What would you say to those who are considering volunteering at Pathways?

• So many opportunities to give back
• What skills do you have that you would like to share with others?

We appreciate you taking the time to talk with us today.  Thank you, Bill! 

Benefits of Volunteering

Volunteers often find that their greatest satisfaction comes from contributing to the wellbeing of others. They also have the opportunity to apply their talents in fields different from their usual work. For some, volunteering may even lead to a new career. Their gifts of time, energy, and skills fill a unique role that only they can provide. Many volunteers tell us that they learn from working with other dedicated professionals and volunteers.

Finding Your Niche at Pathways

To explore volunteer opportunities at Pathways, call the Manager of Volunteer Services in your area, or visit the “Apply to be a Volunteer” section of our website. After completing an application, you’ll meet with a representative from Volunteer Services to help you find your place at Pathways.

Contact Pathways

In Santa Clara County: 408.773.4219; in Alameda; Contra Costa Counties: 510.613.2017; and in San Francisco and San Mateo Counties: 650.808.4604.  Or visit us online at www.pathwayshealth.org.