Existenzielles Leiden und sinnbezogene Interventionen

Zusammenfassung

Die Befindlichkeit Schwerstkranker wird üblicherweise im Rahmen der multidimensionalen gesundheitsbezogenen Lebensqualität beschrieben. Diese erfasst jedoch nicht Aspekte existenziellen Leidens, wie sie z. B. Eric Cassell definierte. In den vergangenen Jahren entstand eine Vielzahl empirischer Arbeiten zum Erleben von und zur Intervention bei umfassendem Leiden. Mittlerweile konnte überzeugende Evidenz sowohl zur Konzeption von “Leiden” als auch zu dessen Linderung mithilfe psychotherapeutischer Interventionen vorgelegt werden. Sinnorientierte Therapieverfahren liegen sowohl als Einzelals auch als Gruppeninterventionen vor. Ein besonders vielversprechender Ansatz ist die einzeltherapeutische Kurzzeitintervention “Managing Cancer And Living Meaningfully CALM”, deren Prüfung zurzeit in mehreren internationalen RCTs erfolgt.

Summary

The state of terminally ill patients is commonly described in terms of Health related Quality of Life though these do not cover aspects of existential suffering, e.g. described by Eric Cassell. Recently, many empirical investigations on the experience of suffering and corresponding interventions were presented. Meanwhile we have thorough knowledge about the conceptualization and treatment of suffering in advanced cancer patients. Meaning-centred interventions are available in an individual as well as groupbased format. Particularly promising is the individual therapy “Managing Cancer And Living Meaningfully CALM” which is currently tested in several international RCTs.

Schlüsselwörter

Körperlich Schwerkranke - Psychoonkologie - existenzielles Leiden - sinnorientierte Interventionen

Keywords

Terminally ill - psycho-oncology - existential suffering - meaning-centred interventions

• Literatur

• 1 Aaronson NK, Ahmedzai S, Bergman B. et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Nat Cancer Inst 1993; 85: 365-76.
• 2 Barnicle M. et al. The functional assessment of cancer therapy (FACT) scale: Development and validation of the general measure. J Clinical Oncol 1993; 11 (03) 570-579.
• 3 Best M, Aldridge L, Butow P, Olver I, Webster F. Conceptual analysis of suffering in cancer: a systematic review. Psycho-Oncology 2015; 24: 977-986.
• 4 Bowlby J. Attachment. New York: Basic Books; 1982
• 5 Bozzaro C. Der Leidensbegriff im medizinischen Kontext. Ein Problemaufriss am Beispiel der tiefen palliativen Sedierung am Lebensende. Ethik in der Medizin 2015; 27: 93-106.
• 6 Bottomley A. The cancer patient and quality of life. The Oncologist 2002; 07 (02) 120-125.
• 7 Breitbart W, Poppito SR. Meaning-centered group psychotherapy for patients with advanced cancer. A treatment manual. New York: Oxford University Press; 2014
• 8 Breitbart W, Rosenfeld B, Pessin H, Applebaum A, Kulikowski J, Lichtenthal WG. Meaning-Centered Group Psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. J Clinical Oncol 2015; 33 (07) 749-54.
• 9 Cassell EJ. Diagnosing suffering: A perspective. Ann Intern Med 131: 531-534 1999;
• 10 Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med 1982; 306: 639-645.
• 11 Cella DF. et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 1993; 11 (03) 570-9.
• 12 Chochinov HM. Dying, dignity, and new horizons in palliative end-of-life care. CA Cancer J Clin 2006; 56 (02) 84-103.
• 13 Chochinov HM. 2012. Dignity therapy. Final words for final days. New York: Oxford University Press.;
• 14 Chochinov HM. et al. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clinical Oncol 2005; 23 (24) 5520-5525.
• 15 Chochinov HM. et al. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol 2011; 12: 753-762.
• 16 Colosimo K, Nissim R, Pos AE, Hales S, Zimmermann C, Rodin G. “Double awareness” in psychotherapy for patients living with advanced cancer. Journal of Psychotherapy Integration. 2017 http://dx.doi.org/10.1037/int0000078
• 17 Dees MK, Vernooij-Dassen MJ, Dekkers WJ, Vissers KC, Weel van C. ‘Unbearable suffering’: a qualitative study on the perspectives of patients who request assistance in dying. J Med Ethics 2011; 37 (12) 727-734.
• 18 Faller H, Schuler M, Richard M, Heckl U, Weis J, Kuffner R. Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol 2013; 31: 782-793.
• 19 Frank AW. Can we research suffering?. Qual Health Res 2001; 11: 353-362.
• 20 Frankl VE. Man’s Search for Meaning. Boston: Beacon Press; 2006
• 21 Harrington SE, Smith TJ. The role of chemotherapy at the end of life: “When is enough, enough?”. JAMA 2008; 299 (22) 2667-2678.
• 22 Hyphantis T, Papadimitriou I, Petrakis D, Fountzilas G, Repana D, Assimakopoulos K, Carvalho AF, Pavlidis N. Psychiatric manifestations, personality traits and healthrelated quality of life in cancer of unknown primary site. Psycho-Oncology 2013; 22: 2009-2015.
• 23 Koller M, Warncke S, Hjermstad MJ, Arraras J, Pompili C, Harle A, Johnson CD, Wei-Chu C, Schulz C, Zeman F, Van Meerbeeck J, Kulis D, Bottomley A. Use of the lung-cancer-specific quality of life questionnaire EORTC QLQ-LC13 in clinical trials: a systematic review of the literature 20 years after its development. Cancer 2015; 121 (24) 4300-4323.
• 24 Krikorian A, Limonero JT, Maté J. Suffering and distress at the end-of-life Psycho-Oncology. 2012; 21: 799-808.
• 25 Limonero JT. Evaluación de necesidades y preocupaciones en enfermos en situación terminal. Rev Psicología Salud 2001; 13 (02) 63-77.
• 26 Lo C, Hales S, Jung J, Chiu A, Panday T, Rydall A, Nissim R, Malfitano C, Petricone-Westwood D, Zimmermann C, Rodin G. Managing cancer and living meaningfully (CALM): phase 2 trial of a brief individual psychotherapy for patients with advanced cancer. Palliat Med 2004; 28: 234-242.
• 27 Mitchell SA. Relational concepts in psychoanalysis: an integration. Cambridge: Harvard University Press; 1988
• 28 Nissim R, Freeman E, Lo C, Zimmermann C, Gagliese L, Rydall A, Hales S, Rodin G. Managing cancer and living meaningfully (CALM): A qualitative study of a brief individual psychotherapy for individuals with advanced cancer. Palliat Med 2011; 26: 713-721.
• 29 Oechsle K. Palliativmedizinische Versorgung onkologischer Patienten. In: Mehnert A, Koch U. (Hrsg.) Handbuch Psychoonkologie. Göttingen: Hogrefe; 2016: 94-102.
• 30 Pasman HR, Rurup ML, Willems DL, Onwuteaka-Philipsen BD. Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians. BMJ 2009; 339: b4362.
• 31 Puchalski C, Ferrell B, Virani R. et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. J Palliat Med 2009; 12 (10) 885-904.
• 32 Reich M, Lesur A, Perdrizet-Chevallier C. Depression, quality of life and breast cancer: A review of the literature. Breast Cancer Res Treat 2008; 110: 9-17.
• 33 Reuter K, Spiegel D. Psychische Belastungen bei Krebserkrankungen – Gruppentherapie nach dem supportiv-expressiven Ansatz. Göttingen: Hogrefe; 2016
• 34 Rodin G, Zimmermann C. Psychoanalytic reflections on mortality: A reconsideration. J Am Acad Psychoanal Dyn Psychiatry 2008; 36: 181-196.
• 35 Rodin G, Lo C, Rydall A, Nissim R, Malfitano C, Shnall J, Zimmermann C, Hales S. Managing cancer and living meaningfully (CALM): A randomized controlled trial of a psychological intervention for patients with advanced cancer. J Clin Oncol 2017; 35 suppl; abstr LBA10001.
• 36 Saunders C. 1991. Leben mit dem Sterben. Betreuung und medizinische Behandlung todkranker Menschen. Bern: Huber.;
• 37 Sherman DW, Norman R, McSherry CB. A comparison of death anxiety and quality of life of patients with advanced cancer or AIDS and their family caregivers. J Assoc Nurses AIDS Care 2010; 21 (02) 99-112.
• 38 Scheffold K, Engelmann D, Schulz-Kindermann F, Rosenberger C, Krüger A, Rodin G, Härter M, Mehnert A. “Managing Cancer and Living Meaningfully”: Qualitative Pilotergebnisse einer sinnbasierten Kurzzeittherapie für fortgeschritten erkrankte Krebspatienten (CALM) Psychotherapeut. 2017; 62: 243-248.
• 39 Schulz-Kindermann F. Psychoonkologie – Grundlagen und Psychotherapeutische Praxis. Weinheim: Beltz; 2013
• 40 Schulz-Kindermann F, Ramm G, Weis J, Hasenbring M. Psychological problems and chances in intensive-care medicine as exemplified by bone marrow transplantation. PPmP – Psychotherapie · Psychosomatik Medizinische Psychologie 1998; 48 9-10 390-7.
• 41 Spiegel DI, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989; 02 8668 888-91.
• 42 Spiegel D, Classen C. Group therapy for cancer patients: a research based handbook of psychosocial care. New York: Basic Books; 2000
• 43 Vehling S. Sinnorientierte Interventionen. In: Mehnert A, Koch U. (Hrsg.) Handbuch Psychoonkologie. Göttingen: Hogrefe; 2016
• 44 Vos J, Craig M, Cooper M. Existential therapies: A meta-analysis of their effects on psychological outcomes. J Consult Clin Psychol 2015; 83: 115-128.
• 45 Wilson KG, Chochinov HM, McPherson CJ, LeMay K, Allard P, Chary S, Gagnon PR, Macmillan K, De Luca M, O’Shea F, Kuhl D, Fainsinger RL. Suffering with advanced cancer. J Clin Oncol 2017; 25: 1691-1697.
• 46 Yalom I, Greaves C. Group therapy with the terminally ill. American Journal of Psychiatry April 1977; 134 (04) 396-400.
• 47 Yalom ID. Existential Psychotherapy. New York: Basic Books; 1980