The International Journal of Whole Person Care
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No Talent Required: Using Drama Therapy in Support Groups for Cancer Patients
No full textObjectives: It is well known that a cancer diagnosis impacts a person’s mental, emotional and spiritual well-being as well as their body. Many patients and caregivers seek out support groups to bolster themselves in this challenging time. While talk and peer-based groups can provide validation and understanding, drama therapy can provide a beneficial approach for support groups.Methods: Drama therapy is a gentle form of creative therapy between a trained therapist and one or more clients with a specific therapeutic intention. It uses action methods (such as role play, storytelling, improvisation, writing, and projective tools) to facilitate creativity, imagination, learning, insight and growth. Drama therapy provides a creative-expressive basis for support groups within a humanistic framework.Results: Drama therapy-based support groups encompass the patient’s holistic experience and address all aspects of their cancer experience in order to provide meaning. In addition to validating participants’ perspectives, they help participants to come to terms with their experiences and emotions, to gain insight into their responses and to learn new ways of dealing with them. Drama therapy utilizes the concepts of distance, projection and witnessing to allow clients to explore challenging issues in a safe – and potentially playful – way. It is a flexible approach that can be adapted to the specific needs of participants and therefore is well equipped to serve a broad spectrum of issues and concerns in varying and supportive ways.Conclusions: This poster will highlight some of the theory behind drama therapy-based support groups to show the advantages these groups entail. It will also showcase various creative interventions that have been used with cancer patients
Group Art Therapy Program for Women Living with Breast Cancer
No full textBackground/Objective: A 9-week group art therapy program for women living with breast cancer is a new initiative to bring comprehensive cancer care to oncology patients and caregivers at our host institution, a major university health center. The development of this program was supported by a mixed-methods research study which explored the impact of art therapy on the psychosocial needs of women in treatment for breast cancer. Over 60 women were recruited for this study (control and intervention groups). The art therapy program offers tangible meaning-making opportunities through art-making in a therapeutic frame. Participants incorporated their artworks in group discussions and individual reflections of how they benefited from art-making.Methods: Sources of data include the artwork and group discussions, an upcoming exhibit, narrative-based interviews, and quantitative questionnaires. The data will be analyzed qualitatively to elicit the major themes that the participants addressed in their art-making and group experiences, and in their narratives about their journey with cancer as a whole.Results: The program’s 9 weekly topics will be presented and the qualitative results will be discussed. The topics include addressing a changing mind/body, processing challenging emotions / thoughts / relationships, highlighting one’s strengths and capabilities, building talismans and amulets (protection), and increasing one’s self-awareness of the realities of living with cancer. Some of the major themes from a preliminary data analysis include the development of one’s personal artistic language/symbolism; a place just for me; discovering and building connections; at a crossroads; and transformations.Conclusion: This study highlights the importance and benefit of complementary therapies such as art therapy. We propose that creative arts therapies should be considered as an important contributor to the provision of whole person care in oncology clinics and wellness centres. The implications of group art therapy will be discussed in light of its feasibility in routine cancer care
Exploring the Relationship Between Subjective Ratings of Mindfulness Practices and Outcomes in Patients Participating in an MBSR Program
No full textObjectives: The present study explored relationships between outcomes of the Mindfulness-Based Stress Reduction (MBSR) program and the importance attributed by patients to the mindfulness practices taught.Methods: Patients with chronic illnesses (46.8% breast cancer; N=126) completed questionnaires pertaining to medical symptoms, stress, and mindfulness, pre- and post-MBSR. At program completion, each patient rated the importance of the mindfulness practices employed. Stepwise linear regression analyses were run to investigate associations between changes in outcome variables and subjective ratings of practice importance.Results: Increases in mindfulness were associated with high ratings of importance for sitting meditation (p LT 0.02) and homework manual (p LT 0.02; Adjusted R2 = 0.10). Decreases in medical symptoms were associated with high ratings for the body scan (p LT 0.01) and small group exercises (p LT 0.01; Adjusted R2 = 0.13). High ratings for the body scan were moderately, albeit significantly, correlated with decreases in perceived stress (p LT 0.01, Adjusted R2 = 0.05). A cluster analysis performed on all 10 of the ratings of practice importance showed that greater importance was associated with better outcomes for all three dependent variables (p LT 0.01). A qualitative examination of patients’ answers to open-ended questions revealed that incorporating mindfulness practices in daily life was a central component of the lifestyle changes experienced during the course of the program.Conclusions: Understanding the mechanisms underlying MBSR’s effectiveness is important as this program becomes recognized as an empirically-supported intervention. These results suggest that specific types of practice (concentration vs. the body scan) are related to distinct outcomes (dispositional mindfulness vs. medical symptoms, respectively). Overall, awareness of the importance of practicing is connected to actual program outcomes
Using the Arts to Explore Whole Person Care
No full textThere has been an increase in the use of arts in Australian General Practice medical education in recent years. This workshop will aim to continue the Australian journey by exploring how the arts can teach about the whole person care. It will be facilitated by two medical educators experienced in these teaching techniques. Participants will be asked to contribute an example from the arts (film, writing, image, music etc) and be guided via skilled facilitation in how this could be used to explore whole person care. There will be discussion of how these pieces could be used in teaching and clinical practice. Potential benefits and pitfalls will be highlighted. At the conclusion, these resources will be collated for distribution and made freely available.Learning objectives include: (i) how to use the arts in teaching whole person care, (ii) to discuss different methodologies and the pros and cons of each one (iii) to allow participants an opportunity to experiment and participate with different mediums (iv) to collate a list of different examples used from the workshop to distribute to the group.Please note, if you attend this workshop you will need to bring a small contribution of art (film, writing, image, music etc) to share with the group. Electronic versions are welcome. It does not need to be original
Transforming Challenging Patients into Interesting People - Creative Writing as Burnout Prevention for Health Professionals
No full textAnd now for something completely different….. As health practitioners, we are involved in writing “stories” every day. The patient record is our interpretation of our patients’ stories (History) and a summary of our response to this (Examination and Management Plan).This record does not allow for much creativity on the part of the writer, and is very limited in its ability to assist the health practitioner in making sense of what has gone on for them at a personal level. To assist in remedying this problem, this workshop will use creative writing as a tool to assist in burnout prevention.The workshop will allow participants an opportunity to experience the use of stories and creative writing as a means of helping them to better manage some of the more challenging aspects of their working life, and to better make sense of what it means to be a health practitioner.Practical writing exercises across a range of styles will assist participants in reflecting on the effect their clinical practice has on their lives with the goal of increasing their enjoyment of work, and of life in general. These simple writing exercises will magically transform challenging patients into interesting people. No previous writing experience is required. Most of all, it will be an opportunity for some light hearted fun with colleagues.Learning Objectives: By the end of the workshop, participants will have had the opportunity to1. Learn knew skills in creative writing2. Reflect on what it means to be a health practitioner through the use of structured writing exercises3. Develop skills in using reflective writing as a way of personal debriefing about experiences at work4. Reignite previously lost passions for creativity5. Marvel at the brilliance of their colleagues6. Share some of their creative brilliance with colleagues, if they choose to
Is the Whole Greater Than the Sum of Its Parts? Self-Rated Health and Transdisciplinarity
No full textHow individuals rate their general health – self-rated health, SRH – predicts future morbidity and mortality. Evidence shows that this prospective association hold true across age groups, patient populations and ethnicities, and is independent of existing illness or biomedical conditions. The reason why such subjective self-perception of one’s health (the whole) is a valid and powerful predictor of health outcomes, beyond traditional disease biomarkers and risk factors (the parts), has remained unclear. One possibility is that the experience of Health transcends the biological domain, and that psychological, social, behavioral and spiritual factors are integrated in unique ways among each individual/patient to shape “true” health. Each domain bears different relative importance for different individuals. Thus, self-rated health, by virtue that it arises from a completely non-leading and non-directed question, may capture an emergent holistic experience that best represents health, and which translates more directly than other focused assessments into healthspan and lifespan. By reviewing epidemiological, clinical and qualitative research findings about self-rated health, this presentation will adopt a transdisciplinary stance to explore new knowledge that can be derived from the study of self-rated health, as well as its limitations. We will also discuss a practical approach to “profile” self-rated health as a means to identify therapeutic windows and orient person-centered care. Integrating individuals’ self perceptions of health into healthcare practice should enhance patient satisfaction with care, strengthen the therapeutic alliance, and promote empowerment and sustainable care
'BUT WHAT AM I GOING TO SAY?" Some advice to medical students about dealing with feelings of inadequacy
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Electronic Health Record (EHR) Training in Undergraduate Medical Education: Theory-Informed Development of a Longitudinal Curriculum for Empowering Patient- and Relationship-Centered Care in the Computerized Setting
No full textObjectives: While electronic health record (EHR) use is becoming state-of-the-art, formal teaching of Health Care Information Technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT but formal pedagogy is sparse. Fundamental challenges include preserving and fostering effective health care provider-patient communication skills in the computerized setting to preserve patient and relationship-centered care and facilitate reciprocity within whole person care. Thus, curriculum innovation with overarching goal of empowering undergraduate medical students’ patient- and relationship-centered interviewing skills, information mastery, electronic documentation skills, and HCIT-supported patient education is needed.Methods: The authors describe innovative, systematic curriculum development for EHR training within a series of clinical skills courses at their institution, informed by Kern et al.’s framework, narrative medicine, and reflective practice. Initially, a didactic and an observed standardized patient encounter were piloted in Year 3. Subsequent surveys of participating faculty both validated the session’s educational value and identified the need for additional practice opportunities.Results: In addition to the existing presentation and individualized practice, second iteration revisions include reflective readings and exercises, relevant “introductory” skills presented in grid format, and opportunities for direct observation of and by mentor physicians in clinical settings. The behavior grid was then expanded to include “advanced” Year 4 skills, i.e. patient participation for chart building, patient education/information sharing, shared decision-making, and sending information to the interprofessional health care team.Conclusions: Effective triangulation of physician-patient-computer may be optimized with medical education curriculum developing competencies of effective EHR use preserving patient-and relationship-centered care, reflection, and narrative medicine. Systematic, longitudinal monitoring of learners' skill development by faculty, standardized patient, self-assessment, and reflective writing will inform our innovative multi-faceted, longitudinal, transferable curriculum presented herein. Further research is needed on formal pedagogy for EHR use by learners
Enduring Witness - The Inner Journey of a Compassionate Doctor
No full text“Enduring witness” is a 30 minute DVD produced in Australia. It traces the fictional relationship between a family practitioner (Geoff) and one of his female patients (Lisa) as she make the transition from adolescence to adulthood, through snippets from consultations about contraception, marriage, pregnancy and caring for her young children. Lisa then develops breast cancer, and we watch how Geoff manages breaking the news, assisting her with treatment, remission, relapse and palliative care. Issues relating to after care for Lisa’s family are covered at the end.Some of Geoff’s “qualities” as a doctor (empathy, openness, patient-centredness) are the very same factors which put him at risk of burn out and compassion fatigue. The story is told primarily through the eyes of the doctor, and we gain access to some of his “hidden thoughts”.The primary goal of the DVD is to promote discussion about preventing burnout and compassion fatigue which can occur from managing emotionally draining situations in clinical practice. There is further opportunity to explore issues such as breaking bad new, support for colleagues, boundary issues and surviving the ups and downs of working with people at the end of their lives.The DVD will be shown at the start of the workshop. This will then be followed by a facilitated discussion between participants. Discussion will focus on both personal responses of participants to the DVD, and also on how as practitioners we can best deal with the emotional challenges that arise in clinical practice
Exercise-Never Too Late: The Meaning of Exercise for Advanced Palliative Care Patients
No full textObjective: Increasing evidence supports the role of exercise for palliative care patients through maximizing physical function, improving fatigue and overall quality of life in the face of advancing disease. The objective of this study was to explore the meaning of exercise for these patients and their carers and to increase the understanding and value of exercise for this population.Methods: An emergent qualitative study design was employed using semi structured interviews with patients attending a palliative care gym program and their carers. Thirteen patients and seven carers participated.Interviews were taped and transcribed verbatim and analyzed to identify common themes.Results: Patients and carers identified improvement in strength, confidence and mood that enabled greater participation in life. Access to an open flexible program that allowed patients control of their exercise was important. Exercise contributed to promoting self identity and as a consequence provided a source of inner strength. Benefit was also felt from the shared positive experience in a safe environment. Carers used the session as a form of respite or opportunity for interaction.Conclusions: Patients perceive exercise as important as it enables independence but it also provides significant psychosocial and spiritual support. Carers similarly identify the benefits beyond improved physical function. Exercise is a positive treatment regime that contributes to wholistic care