Distress and identity crisis at end of life

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Distress and identity crisis at end of life

A. van Lander, Raymond Hermet, Bruno Pereira, Céline Deveuve-Murol, Wadih Rhondali, Jacques Gaucher

To cite this version:

A. van Lander, Raymond Hermet, Bruno Pereira, Céline Deveuve-Murol, Wadih Rhondali, et al.. Distress and identity crisis at end of life: A prospective observational study. 7th World Research Congress of the European Association for Palliative Care, 2012, Trondheim, Norway. �hal-03119282�

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1. Distress

Distress>4/10:

53% patients, 42 % interviews

No correlation with age, gender

or social support.

At home more important.

Evolution :

improvement

!

GEOGRAPHICAL SCOPE

DISTRESS

AND

_AND

IDENTITY

_IDENTITY

CRISIS

_CRISIS

AT

_AT

END

_END

OF

_OF

LIFE

_LIFE

**A PROSPECTIVE OBSERVATIONAL STUDY*.**

1.

1. Creation of a form and a booklet

_{Creation of a form and a booklet}

It is a grid of concepts to collect representations : of the psychologist patient's mental

proc-esses ;its own cons

esses ;its own cons

-

transfer ; maintenance functions.

The psychologist open a booklet and then filled out a form after each patient interview. It does

not change their practices.

l Impression (CGI-3) to evaluate the therapeutic effect,

l

-

Free notes.

The patient’s psychic functioning :

- Intensity of the loss caused by illness

- Distress thermometer (DT)

- Rupture identity

3

or new component

- Defense mechanisms

PUBLICATIONS

Van Lander Axelle

1-2-3

, Hermet Raymond

2

, Pereira Bruno

4

, Deveuve-Murol Céline

5

, Wadih Rhondali

6

, Gaucher Jacques

1

.

1_{Laboratory EAM-SIS 4129, University Lumiere, F-69500 Bron, France ;}2_{CHU Clermont-Ferrand, Center of palliative care, F-63003 Clermont-Ferrand, France ;} 3_{Reseau Palliadom, 63000 Clermont-Ferrand, France ;}4_{CHU Clermont-Ferrand, DRCI, F-63003 Clermont-Ferrand, France;}5_{Hospital, F-63220 Riom ;}

6_{CHU Lyon, Center of palliative Care F-69000 Lyon, France.}

*from the research work by Van Lander A for a phD in psychology.

Contact: avanlander@chu-clermontferrand.fr

52 % women

Middle age Middle age

: 68

±13.2 [25±13.2 [25--95]95]

22 % at home

Workers 21 %

Managers 10 %

801 forms

236 patients, 14 psychologists of teams at home (4)

and Hospital (8)

Duration of psychological follow : 30 days

Md:13 [1Md:13 [1--416]416]

41 days before deaths.

Usually 3 interviews per patient.

His own transfer-cons

The interview functions

3. Correlations

Distress and regression

p<0.0001p<0.0001

Distress and identity breaks

p<0.0001p<0.0001

Distress of patients and powerless

psycholo-gists

gists

p<0.0001 p<0.0001

Therapeutic efficacy on distress and identity

cri-sis : dream on identity

sis : dream on identity

p<0.001p<0.001

in transitional inter-

in transitional

inter-views

views

p<0.0001 p<0.0001

(Winnicott W.R.).

PROSPECTS

METHODOLOGY

ORIGINALITY

Using perception psychologists

of interviews: this three-way

in-teraction where the protagonist

is the lethal disease.

MAIN

OBJECTIVE

_OBJECTIVE

Verify the link to the distress of patients

in palliatif care (PC) with an identity crisis.

Distress is related to the importance of break of identity.

Brief psychological therapy is efficient. Distress is not a fatality.

2. Identity Crisis

Break feelings of identity:

77% patients, 56 % interviews

New feelings of identity in 28%

Major break :



Continuity



Sense of being realized by ac-

Sense of being realized by

ac-tions

tions



Sense of unity

Evolution : improvement !

Demographic profile of Auvergne, the same as 88 European regions :

Burgundy, 2 Spanish regions, Asturias and Extremadura, 2 Portuguese regions Centro and Alentejo, the vast majority of German, Romanian, Bulgarian and Baltic regions and a handful of Scandinavian regions.

This bookletThis booklet This booklet

is a manualis a manual is a manual

of instructionof instruction of instruction

and definitionsand definitions and definitions of differentof different of different psychologicalpsychological psychological ConceptsConcepts Concepts NecessaryNecessary Necessary to analyzeto analyze to analyze intersubjectiveintersubjective intersubjective relationship.relationship. relationship. F2 F1

All psychologists

of palliative care, in one

French region, Auvergne,

took part in this research in 2010.

4.716 patients followed up in PC.

Van Lander A, Van Lander A,

Van Lander A,

Gaucher J, Pereira B, Deveuve

-

Murol C, Valour C, Begert A, Hermet R (2012

) L’identité à l’épreuve de la maladie létale, un formulaire d’analyse des entretiens psychologiques. ) L’identité à l’épreuve de la maladie létale, un formulaire d’analyse des entretiens psychologiques. ) L’identité à l’épreuve de la maladie létale, un formulaire d’analyse des entretiens psychologiques. PsychoPsychoPsycho---OncologieOncologie, Oncologie, , sous pressesous presse.sous presse..

Van Lander A, Gaucher J, Pereira B, GodardVan Lander A, Gaucher J, Pereira B, Godard

Van Lander A, Gaucher J, Pereira B, Godard---Auray I, MurolAuray I, MurolAuray I, Murol---Deveuve C, Hermet R (2012) Détresse et identité en fin de vie, représeDeveuve C, Hermet R (2012) Détresse et identité en fin de vie, représeDeveuve C, Hermet R (2012) Détresse et identité en fin de vie, représentation des psychologues. ntation des psychologues. ntation des psychologues. Revue JALMAVRevue JALMAV Revue JALMAV 108, 34108, 34108, 34---41.41.41.

Van Lander A (2011) A booklet for Psychologist in Palliative Care to evaluating Distress and Identity Crisis. Van Lander A (2011) A booklet for Psychologist in Palliative Care to evaluating Distress and Identity Crisis.

Van Lander A (2011) A booklet for Psychologist in Palliative Care to evaluating Distress and Identity Crisis. 12e Congress of the european association for palliative care12e Congress of the european association for palliative care12e Congress of the european association for palliative care Lisbon: European Journal of Palliative Care, 152Lisbon: European Journal of Palliative Care, 152Lisbon: European Journal of Palliative Care, 152---3. 3. 3.

Van Lander A (2011) Un livret crée pour des psychologues intervenant en soins palliatifs. Van Lander A (2011) Un livret crée pour des psychologues intervenant en soins palliatifs.

Van Lander A (2011) Un livret crée pour des psychologues intervenant en soins palliatifs. 1e congrès francophone d'accompagnement et de soins palliatifs.1e congrès francophone d'accompagnement et de soins palliatifs. 1e congrès francophone d'accompagnement et de soins palliatifs. Lyon: Revue internationale de Soins Palliatifs (26), 228Lyon: Revue internationale de Soins Palliatifs (26), 228Lyon: Revue internationale de Soins Palliatifs (26), 228---9.9.9.

Van Lander A, DeveuveVan Lander A, Deveuve

Van Lander A, Deveuve---Murol C, Pereira B, Valour C, Rutowicz C, Guastella V, et al. (2011) Entretiens psychologiques en soins paMurol C, Pereira B, Valour C, Rutowicz C, Guastella V, et al. (2011) Entretiens psychologiques en soins paMurol C, Pereira B, Valour C, Rutowicz C, Guastella V, et al. (2011) Entretiens psychologiques en soins palliatifs, caractéristiques des patients, spécificités des suivis. lliatifs, caractéristiques des patients, spécificités des suivis. lliatifs, caractéristiques des patients, spécificités des suivis. Revue internationale en soins palliatifs Revue internationale en soins palliatifsRevue internationale en soins palliatifs , 26, 26, 26 (3), 269(3), 269(3), 269--

-275.275.

275.

Van Lander A, Guastella V, Dalle N (2010) PsychoVan Lander A, Guastella V, Dalle N (2010) Psycho

Van Lander A, Guastella V, Dalle N (2010) Psycho---oncologie et culture du mourir à domicile : l'appel à la pluridisciplinarité deoncologie et culture du mourir à domicile : l'appel à la pluridisciplinarité deoncologie et culture du mourir à domicile : l'appel à la pluridisciplinarité des médecins généralistes. s médecins généralistes. s médecins généralistes. PsychoPsychoPsycho---oncologieoncologie oncologie , 4, 4, 4 (2), 135(2), 135(2), 135---9.9.9.

Distress Identity crisis Losses caused by disease Wellbeing of patients News identity Regression Therapeutic fonctions Defens mechanism Dream

2. Items and principal measuring tools



35 items of psychology concepts on distress and crisis of identity in palliative care.



A qualitative ordinal board for losses

caused by illness



Visual analog scales (VAS) for 23 concepts



A qualitative categorical board for breaks identity



CGI (item3)

Patients with distress>4/10

Patients distress≤4/10 B re ak identit y

RESULTS

-2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 1 2 3 4 5 6 7 8 9 10

IDENTITY CRISIS BREAK FEELINGS NEW FEELINGS

-2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 1 2 3 4 5 6 7 8 9 10