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| EDITORIAL |
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| Year : 2006 | Volume
: 12
| Issue : 1 | Page : 2-3 |
Psychosocial issues in palliative care
Jacob Alexander
Christian Medical College, Vellore, India
Correspondence Address:
Jacob Alexander
Christian Medical College, Vellore
India
DOI: 10.4103/0973-1075.25911
How to cite this article:
Alexander J. Psychosocial issues in palliative care. Indian J Palliat Care 2006;12:2-3 |
One in every third individual will develop cancer at some point in their lives and a third to even half of these will develop a clinically significant or diagnosable psychiatric disorder.[1] The prevention of secondary psychological complications arising from cancer has therefore become of vital concern.[2]
Advocates of the biomedical model could claim that psychosocial issues are outdated in the current climate of evidence based medicine. However, we must remember that palliative care was born with the hospice movement as a response to a medical service that seemed unable or unwilling to care adequately for dying people and their families. The concept of psychosocial issues is therefore integral to palliative care. However, practical concerns will dictate the extent to which psychosocial issues are integrated into day-to-day practice. MR Rajagopalan, former president of the Indian Association of Palliative Care physicians and currently chairman, Pallium India discusses these issues in the context of palliative care services in India. His article reinforces greatly the need for psychosocial issues to be taken more seriously in the development of services, as the actual provision seems to fall very short of what would be acceptable, let alone ideal.[3] Some of the efforts that have been directed in this direction are highlighted in the article by Chitra Venkateswaran,[4] which provides an overview of psycho-oncology initiatives in India, specifically the efforts at trying to impart appropriate communication skills to palliative care professionals and volunteers.
Other developments over the latter half of the last century have renewed the focus on psychosocial issues in palliative care. Treatment options in oncology have multiplied leading to openness in dialogue between doctors and patients and a discarding of traditional attitudes such as withholding the diagnosis from patients. This has fostered an increased interest in the psychological issues that affect cancer therapies, such as, individual reactions to illness and treatment; psychological and behavioural attributes that influence the course of disease and response to therapy.
Reactions to illness are dealt with in a novel way by Juliet Jacobsons' article on demoralization as a distinct syndrome in advanced cancer.[5] This article highlights the need for more effective tools to measure the symptoms and burden of illness in addition to an improved taxonomy to describe terminal illness.
Nandini Vallath's perspectives on psychoneuroi- mmunology strives to put into biochemical terms changes that are wrought by the emotional upheavals that accompany the subjective experience of being ill with cancer and proposes strategies to incorporate practices for a more holistic approach to cancer treatments.[6]
Other articles discuss the management of delirium in terminal illness,[7] the paucity of systematic reviews to inform psychosocial initiatives in palliative care[8] and the difficulties researchers face in conducting good quality studies in this sensitive arena.[9] Palliative care in its current form is a dynamic new speciality and in order to maintain its vitality and credibility we need to constantly evaluate the practices we engage in. It is hoped that this journal will provide just such a forum. Reviews of existing literature and original research on many different aspects such as communication skills, service provision, anxiety, depression, spiritual care, non-malignant disease, bereavement care, carers and staff, ethical issues in palliative care (research, patient autonomy, euthanasia) and the future of psychosocial care will be encouraged in future issues while trying to avoid philosophical interpretations and personal opinions.
We also take this opportunity to thank Dr Reena George who was editor from 2003 to 2005.
Under Dr. George's stewardship the journal has marked certain significant milestones. She introduced the concept of constructing each issue of this journal around a central theme in her last two issues. A tradition we choose to continue with this issue on psychosocial issues in oncology. Under her stewardship the Indian Journal of Palliative Care achieved a further milestone when it went online and can now be accessed at www.jpalliativecare.com. Her insistence on full and free access to this site reflects her concerns as a professional oncologist, clinical supervisor and cancer palliative care physician in a resource poor, developing country and her zeal in the dissemination of information. She has taken special care to enhance the interdisciplinary and academic content of the journal.
We are grateful to her for her immense contributions in time, effort and resources for the cause of this journal and we wish her well.
We also invite contributions for the next issue of the journal, which is themed around issues involved in respiratory, head and neck malignancies.
Palliative Care in India today needs to observe itself critically and try to avoid further departure from the definition the World Health Organization gave of palliative care in 1990: "Control of pain, of other symptoms and of psychological, social and spiritual problems."
It gives me great pleasure to bring you this issue of the Indian Journal of Palliative Care, my first since being entrusted with the august responsibility of editorship. I hope you enjoy perusing the contents of this issue as much as I have enjoyed putting this issue together.
| References | |  |
| 1. | Walker LG, Walker MB, Ogston K, Heys SD, Ah-See Ak, Miller ID, et al . Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. Brit J Cancer 1999;80:262-88.  |
| 2. | Cancer care at the interface of psycho-oncology and psychoneuroimmunology. Accessed at http://www.communicata.co.uk:81/maggies/files/psychology_paper.pdf on 06.05.2006 |
| 3. | Rajagopal MR. Pain and beyond. Indian J Palliat Care 2006; 12. |
| 4. | Venkateswaran C, Kumar TM. Psycho-oncology in India - emerging trends from Kerala. Indian J Palliat Care 2006; 12. |
| 5. | Jacobsen JC, Vanderwerker LC, Block SD, Friedlander RJ, Maciejewski PK, Prigerson HG.Depression and demoralisation as distinct syndromes: preliminary data from a cohort of advanced cancer patients. Indian J Palliat Care 2006; 12. |
| 6. | Vallath N. Perspectives on psycho-neuro-immunology in oncology. Indian J Palliat Care 2006; 12. |
| 7. | Macleod AD. The management of terminal delirium. Indian J Palliat Care 2006; 12. |
| 8. | Tharyan P, Jebaraj P. Systematic reviews of randomized controlled trials and evidence informed palliative care. Indian J Palliat Care 2006; 12. |
| 9. | Parkes CM. Guidleines for conducting ethical research in psychological issues in palliative care. Indian J Palliat Care 2006; 12. |
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