Biomedical subjects
A Stedeford
Publications and source records attributed to A Stedeford.
Care of the patient with advanced cancer: a course for clinical medical students at Oxford.
The objectives and content of a five-day course for final-year medical students at a palliative care unit in Oxford are described. The principal tutors comprise a physician, a psychiatrist, and a senior nurse. A philosopher, two chaplains, a bereavement officer, and a family practitioner also take part. Topics include pain and symptom management, psychosocial care, teamwork, and ethics. The sessions vary in structure from didactic lecture to group work. In addition to the acquisition of new knowledge, the course gives the students an opportunity to examine their own feelings in relation to cancer and the care of the dying. Although this is stressful, the course is highly regarded.
Psychological aspects of the management of terminal cancer.
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Couples facing death. II--Unsatisfactory communication.
Forty-one couples facing the prospect of separation by death were interviewed about how the nature and prognosis of their illness had been discussed with them by their general practitioner hospital staff, and the staff of the continuing care unit to which they were admitted. Communication between husband and wife and how they coped with telling their parents and their children was also assessed. Treatment was given when they were anxious or dissatisfied about the quality of communication in any of these areas. The couples found hospital doctors least successful at communication. Almost all who were dissatisfied wanted more information, not less. The wish to protect dependent relatives conflicted with the wish to be open, making decisions very difficult. Considerable suffering is caused by poor communication, and much of this is avoidable.
Couples facing death. I-Psychosocial aspects.
Forty-one couples facing the prospect of separation by death were followed up from the time of admission to a continuing care unit through death of the patient to an interview with the bereaved spouse. Half the patients were found to have anxiety or depression or both, usually as a result of failure to cope with specific difficulties. These fell into four groups: unsatisfactory communication, direct effects of illness and treatment, failure to adjust lifestyles to changing circumstances, and pre-existing marital and family problems. This paper examines in detail the problems in the second and third groups. Support was offered to the patient and family in an attempt to help them to adjust and make the best use of their resources. The responses obtained suggest that some of the suffering of terminal illness can be relieved when psychosocial problems are recognised and appropriated help is given.
Domiciliary and out-patient treatment of self-poisoning patients by medical and non-medical staff.
In a study of domiciliary and out-patient treatment of self-poisoning patients, using a brief problem-orientated approach, it was found that domiciliary treatment resulted in much higher attendance rates but no difference in outcome. Patients who completed out-patient treatment had a better outcome than those who failed to attend treatment sessions. Completion of out-patient treatment was more frequent among higher social class patients. Domiciliary treatment may be more appropriate in some cases for married patients and for those of lower social class. Medical and non-medical staff proved to be equally effective therapists. Future research should be concerned with evaluation of alternative methods of provision of help and further identification of patients who are most likely to benefit from treatment.
The psychiatrist in the terminal care unit.
The types of problems of 49 patients referred to a psychiatrist in a terminal care unit are reported and their management reviewed. The findings suggest that a psychiatrist can play a useful role in such a unit, particularly in supervising medical and nursing staff in the psychological care of patients and in helping more directly in the management of psychiatrically complicated cases.
Psychotherapy of the dying patient.
The psychotherapeutic aspects of the care of the 49 terminally ill patients described in the preceeding paper are discussed. Their differing ways of coping with the stress of dying and the range of psychotherapeutic strategies used in treatment are described. The work suggests that the therapist's use of psychological insights can improve his understanding of the emotional pain of terminal illness, and well-aimed psychotherapy can contribute to its relief.
Understanding confusional states.
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