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Biomedical subjects

F Stiefel

Publications and source records attributed to F Stiefel.

At least 19 recordsLinked to original sources
PubMed2006

[Major depression in the general hospital: adaptation and implementation of guidelines].

Major depression IMD) is highly prevalent in the general hospital and adds a considerable burden to affected patients, but remains under detected and under treated. In an attempt to improve this situation, existing guidelines on MD were retrieved, systematically evaluated with the instrument AGREE (Appraisal of guidelines for research and evaluation), and adapted to the needs of the general hospital. These guidelines were made available on intranet, and actively implemented in two wards, where their impact on clinical practice was evaluated.

Algorithms↗
PubMed2006

[Improving communication skills is possible: "clinical" experience and scientific assessment].

While the importance of individualized and comprehensive care, taking into account the bio-psychosocial characteristics of the patient, has been demonstrated, this remains a considerable challenge in daily clinical practise. The Swiss Cancer League promotes since many years so called Communication Skills Training (CST). Different studies have demonstrated a positive impact of CST, illustrating that communicational competence is not only a consequence of a personal and professional development, but can be modified by an intensive and interactive training. A new scientific approach aims to elucidate the underlying mechanisms of communicational improvements, based on the hypothesis that CTS modify participants' defence mechanisms.

Communication↗
PubMed2006

Communication skills training in oncology: it works!

While the previous chapter by L. Fallowfield and V. Jenkins focuses on different communication skills training (CST) concepts currently being utilized, this chapter reviews and comments the scientific evidence of the impact of CST on improving communication skills. The aim of this chapter is not to provide a complete review of the evidence-this has already been done in systematic reviews-but to discuss the scientific evidence and reflect on the available results and relevant topics for further investigations.

Communication↗
PubMed2006

Informing about diagnosis, relapse and progression of disease--communication with the terminally III cancer patient.

This chapter focuses on four crucial situations representing important challenges for physician-patient communication: diagnosis, relapse, progression of disease and terminal illness. The psychological aspects of each situation are discussed and a framework for communication is provided. The aim of the chapter is to invite the oncology clinician to think about these different stages of disease and to support him or her in the communication with the patient. Communication with cancer patients is a difficult task in clinical practice and it is especially challenging when informing about diagnosis and prognosis, when relapse occurs or when the disease is progressing. Physician-patient communication has undergone considerable changes and has become-compared to decades before, when medicine was based on a more paternalistic model of care--a central duty and challenge of the oncology clinician. The following chapter aims to discuss key elements of communication in the above-mentioned specific situations; it is based on our clinical experience as psycho-oncologists and teachers of communication skills training (Razavi and Stiefel 1994; Stiefel and Razavi 1994; Razavi et al. 2003; Berney and Stiefel 2004; Delvaux et al. 2005; Voelter et al. 2005; Bragard et al. 2006).

Communication↗
PubMed2006

Attitudes toward euthanasia and physician assisted suicide: a survey among medical students, oncology clinicians, and palliative care specialists.

OBJECTIVE: The aim of this study was to compare the results of surveys about attitudes toward euthanasia and related issues that was conducted among palliative care specialists, health care professionals of a cancer center, and first- and second-year medical students. METHODS: By means of an anonymous questionnaire with different hypothetical scenarios concerning physician assisted suicide (PAS) and related issues, 726 members of the Swiss Association for Palliative Care (SAPC), 148 health care professionals of the Institute of Oncology of Italian speaking Switzerland (IOSI), and 140 medical students of the University of Fribourg, Switzerland, were surveyed. RESULTS: Among palliative care specialists a decreasing number supported PAS, direct active euthanasia (DAE), DAE for psychiatric patients, DAE in incompetent patients, and life terminating acts without explicit request (LAWER). Professionals of the cancer center were more in favor of DAE and PAS than palliative care specialists, but less in favor than medical students. SIGNIFICANCE OF RESULTS: Significant variations among different professionals exist in attitudes toward euthanasia. The hypothesis that familiarity with the care of severely ill and dying patients is an important underlying factor explaining variance has been confirmed by these surveys.

Adult↗
PubMed2005

[Diagnosis and treatment of depression in patients with cancer].

Thirty percent of cancer patients experience depression during the course of their illness. Depression may occur at several key-moments: after diagnosis, a relapse, in the context of treatment failure. Depression is correlated with biological factors due to illness itself and its treatments, but also with inappropriate coping strategies. Diagnosis of depression is not straightforward in cancer patients. Its phenomenology is specific. Moreover, patients as well as clinicians may be reluctant to address the problem of psychological well-being. The treatment of depression has proven to increase quality of life as well as satisfaction with treatments and compliance. Antidepressants are the first line treatment. Psychotherapy and several psychological interventions are considered to be a valid alternative. In most severe cases a combined treatment is mandatory.

Antidepressive Agents↗
PubMed2001

"Euthanasia": a survey by the Swiss Association for Palliative Care.

Since the Swiss Association for Palliative Care (SAPC) considers itself an important partner in the national debate on euthanasia, the Board decided to conduct a survey among its members. An anonymous questionnaire was sent to the 726 members of the SAPC, consisting of multiple choice questions on positions that might be adopted in different hypothetical scenarios and one open question about the rationale for the answers. The response rate achieved with one mailing was 55.6%. The proportions of the respondents who were opposed to different forms of euthanasia were, in ascending order: 56% opposed to physician-assisted suicide (PAS); 69% to direct active euthanasia (DAE); 75% to DAE for psychiatric patients; 84% to delegation of DAE in the case of incompetent patients; and 90% to life-terminating acts without explicit requests (LAWER). Almost 10% of the members reported personal experiences with PAS and different forms of DAE. The main decisional bases drawn on for the answers were ethical values and the clinical or personal experience of the respondents; however, the same categories of arguments were used both by those opposing and by those favouring DAE. There are important variations among the members of the SAPC in the debate on euthanasia. Individual autonomy seems to be an important underlying concept for the different positions; the categories of arguments cited by opponents and supporters of DAE did not differ.

Adult↗
PubMed2001

Identification of case complexity and increased health care utilization in patients with rheumatoid arthritis.

OBJECTIVES: To document biopsychosocial profiles of patients with rheumatoid arthritis (RA) by means of the INTERMED and to correlate the results with conventional methods of disease assessment and health care utilization. METHODS: Patients with RA (n = 75) were evaluated with the INTERMED, an instrument for assessing case complexity and care needs. Based on their INTERMED scores, patients were compared with regard to severity of illness, functional status, and health care utilization. RESULTS: In cluster analysis, a 2-cluster solution emerged, with about half of the patients characterized as complex. Complex patients scoring especially high in the psychosocial domain of the INTERMED were disabled significantly more often and took more psychotropic drugs. Although the 2 patient groups did not differ in severity of illness and functional status, complex patients rated their illness as more severe on subjective measures and on most items of the Medical Outcomes Study Short Form 36. Complex patients showed increased health care utilization despite a similar biologic profile. CONCLUSIONS: The INTERMED identified complex patients with increased health care utilization, provided meaningful and comprehensive patient information, and proved to be easy to implement and advantageous compared with conventional methods of disease assessment. Intervention studies will have to demonstrate whether management strategies based on INTERMED profiles can improve treatment response and outcome of complex patients.

Adult↗
PubMed2001

Psychopharmacology in supportive care of cancer: a review for the clinician. IV. Other psychotropic agents.

Besides benzodiazepine, antidepressant and neuroleptic agents, all of which have established roles in supportive care, other psychotropic drugs deserve consideration in selected conditions affecting patients with advanced cancer. This article briefly reviews relevant aspects of miscellaneous psychotropics available for secondline treatment, including nonbenzodiazepine sedative, hypnotic and anxiolytic drugs, anaesthetic agents, stimulants, and analgesic adjuvants acting on the central nervous system. The proper use of such subsidiary psychotropic agents requires that both their specificities and the particular characteristics of palliative care patients are taken into account.

Anti-Anxiety Agents↗
PubMed2001

Depression in palliative care: a pragmatic report from the Expert Working Group of the European Association for Palliative Care.

Our objective in this study was to summarize the relevant knowledge on depression in palliative care and to provide a framework for clinical, scientific and educational efforts at improving its management. The Research Steering Committee (RSC) of the European Association of Palliative Care (EAPC) established an Expert Working Group (EWG) to address the issue of depression in palliative care. Each invited expert was allocated a specific topic and was asked to review the literature. These reviews were presented during the Sixth Congress of the EAPC in 1999 and then discussed in a closed meeting with members of the RSC. Based on these reviews, and the discussions that followed their presentation, a first draft of the paper was produced and circulated among the invited experts and members of the RSC who had been present at the meetings. After some debate the manuscript was revised, and a second draft was circulated, this time also to RSC members who had not attended the meetings. All persons consulted have agreed on this final version of the report. The EWG concluded that the current level of evidence did not lend itself to the development of clinical guidelines and decided to publish the results of their work as a pragmatic report. The report is divided into four sections, focusing on detection, training and nonpharmacological and pharmacological treatment of depression in palliative care. For each of these sections, general considerations are addressed on the basis of the literature review and of clinical experience and a short description of unresolved issues and recommendations is provided. Underdetection and undertreatment of depression is a serious problem in palliative care. Training of the nonpsychiatric staff should therefore have the highest priority. A proactive, flexible and comprehensive strategy embracing clinical, scientific, and educational aspects is advocated.

Depression↗
PubMed2001

Communication with terminal cancer patients in palliative care: are there differences between nurses and physicians?

The aim of this study was to find whether there were interprofessional differences in specific elements of communication with terminal cancer patients and decision-making processes that concern such patients. Given that interdisciplinary team work is one of the basic values in palliative care, if there are conflicting views between professions on such important issues it is most important to know about these and to understand them. A questionnaire utilized in an earlier survey of palliative care physicians and addressing their attitudes to and beliefs about specific elements of communication and decision making was sent to a sample of palliative care nurses working in the same regions, i.e. the French-speaking parts of Switzerland, Belgium and France. After a second mailing (reminder), 135 of the 163 questionnaires (83%) were returned. There was general agreement between nurses and physicians on questions dealing with perceptions of patients' knowledge of their diagnosis and stage of disease, patients' need for information, "do not resuscitate" orders and ethical principles in decision-making processes. Statistically significant, but small, differences between professional groups were only observed for a minority of the questions. Interprofessional differences in specific elements of communication with terminal cancer patients and decision-making processes affecting these patients were not so marked that they could be called "conflicting interprofessional views."

Adult↗
PubMed2001

[The health professional's approach to chronic lumbago: clinical experience at the Spinal Cord Unit at the orthopedic hospital].

The treatment of back pain patients refers to the biopsychosocial model of care. This model includes illness in patient's personal and relational life. In this context, it is not only the physical symptom of the patient which is focused but also his psychological distress often hidden by algic complain. Clinical interviews conducted with back pain patients have highlighted psychosocial aspects able to influence the relationship between health care user and provider. Taking account of psychosocial aspects implies an interdisciplinary approach that identify and assesses patients' needs through adequate tools. As a result, the different health care providers implied with back pain patients have to collaborate in a structured network.

Chronic Disease↗
PubMed2000

Psychopharmacology in supportive care of cancer: a review for the clinician. III. Antidepressants.

This review covers pharmacokinetics, adverse effects and drug interactions of antidepressants and the indications for them, with the aim of assisting the clinician working in palliative and supportive care in the prescription of such drugs. Practical considerations and decision trees to be used prior to the prescription of an antidepressant are also part of this review. Special emphasis is put on the management of depression, which is frequent in patients with advanced cancer and often remains underdetected and undertreated, or is treated at a stage when there is little time for medication to have an effect.

Antidepressive Agents↗
PubMed2000

Psychopharmacology in supportive care of cancer: a review for the clinician: II. Neuroleptics.

Neuroleptics are frequently used in patients with advanced cancer. Most relevant and practical aspects of their use in supportive cancer care are reviewed, to assist the clinical oncologist and palliative care specialist when prescribing these drugs. This article reviews pharmacological properties, indications, such as delirium, nausea and vomiting, pain, anxiety and other symptoms, adverse effects, and drug interactions of neuroleptics and compares the profiles of different compounds. Special emphasis is put on the role of neuroleptics in the management of delirium.

Antipsychotic Agents↗