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Biomedical subjects

P Salander

Publications and source records attributed to P Salander.

10 recordsLinked to original sources
PubMed2000

How was life after treatment of a malignant brain tumour?

The malignant glioma is a severe disease with an unfavourable prognosis. Aside from a few case studies, the knowledge of the victimised patients' lives from diagnosis to death is mainly restricted to studies assessing functional status and rating quality of life by means of questionnaires. From a clinician's perspective this knowledge is not sufficient. By introducing the concepts 'time of everyday life' and 'time of disease', the purpose of this paper is to supplement with descriptive knowledge of clinical value. Twenty-eight patients with malignant gliomas and their spouses were followed during the course of the disease by repeated interviews. The time after treatment was then judged as representing, 'time of everyday life' or 'time of disease'. Life after treatment turned out to be quite varied. To slightly more than a third of the patients', life-continuity was lost, experiencing only 'time of disease'. Among the others who were judged to experience 'time of everyday life' and who were of working age, nearly two-thirds were able to resume work or studies on a part-time basis. In the total sample, the mean 'time of everyday life' turned out to be nearly equal to 'time of disease', 6.1 and 5.4 months, respectively. The findings are illustrated by case descriptions and the conceptualisation of time into 'everyday life' and 'disease' is proposed as meriting further study.

Adult↗
PubMed1999

[Modified cost-benefit analysis takes equity into consideration. Treatment of brain tumors is more cost-effective than hip replacement].

As health care resources are held to be insufficient to permit free choice of available treatment options, prioritizing is necessary. A precondition of careful prioritizing is comprehensive knowledge of the consequences, both for the patient and the community, of adopting each of the available options in a given case. A tool used in setting priorities is cost-benefit analysis, based on the utilitarian principle of health maximisation. However, it is evident from findings in recent studies that equity is widely considered a factor which ought to be included in the analysis. The article presents a method for correcting the variable, quality-adjusted life years (QALY), by introducing an equity factor, yielding a new variable, equity-adjusted QALY (EQALY). Use of the method is illustrated by comparison of the cost-effectiveness of two procedures, hip replacement and the treatment of malignant glioma, and showing how priority ranking of the two procedures is reversed if the EQALY variable is used instead of QALY.

Adult↗
PubMed1999

[Surprising ability to handle bad news. A study of how cancer patients create hope].

The article discusses findings in a study where malignant glioma patients were serially interviewed to determine how they constructed new perceptions of reality when confronted with the diagnosis. Although most of the patients were aware that the tumour posed a grave threat, they were also able to find refuge and hope by using various cognitive strategies. The process, that draws on various resources (the body, supportive relationships, cognitive schemata, and information processing), is discussed in relation to adjacent psychoanalytic theory, and is regarded as an expression of the 'intermediate area' of mental life, which is proposed as theoretical point of reference in discussing How to tell cancer patients.

Adaptation, Psychological↗
PubMed1999

Pathways from symptoms to medical care: a descriptive study of symptom development and obstacles to early diagnosis in brain tumour patients.

BACKGROUND: The time between experiencing symptoms and treatment in cancer diseases is a time of insecurity and despair. Brain tumour disease is a severe disease with dramatic manifestations and it is important that this time be kept as short as possible. METHODS: A consecutive sample of 28 patients with malignant gliomas and their spouses were interviewed about symptom development, help-seeking and experiences of medical care. The cumulative development of their symptoms was described and factors acting as obstacles to medical care were identified. RESULTS: Most spouses witnessed months of global dysfunction preceding the symptom leading to physician consultation. The patient factors 'less alien symptoms', 'personality change' and 'avoidance'; the spouse factors 'spouse's passivity' and 'spouse's successive adaptation'; and the physician factors 'reasonable alternative diagnosis', 'physician's inflexibility' and 'physician's personal values' were identified as obstacles on the pathway to appropriate medical care. The importance of acknowledging the power of the spouse as a provider of substantial information from everyday life facilitating differential diagnosis is stressed.

Adult↗
PubMed1999

Does 'denial' really cover our everyday experiences in clinical oncology? A critical view from a psychoanalytic perspective on the use of 'denial'.

The concept of 'denial' emanates from psychoanalytic psychology. Within this framework it is regarded as a primitive defence mechanism related to personality disorder. The concept has been adopted by coping research but invested with quite other implications. Different researchers operationalize 'denial' in different ways which contributes to this confusion. This paper views 'denial' from the different perspectives of psychoanalysis and coping research and, based on a previous qualitative study, it proposes a reconceptualization which distinguishes between three different processes: 'avoidance', 'disavowal' and 'denial'. 'Disavowal', self-deception in the face of accurate perception, is, more than 'denial', regarded as the appropriate concept covering everyday experiences of patients dealing mentally with their strain.

Adaptation, Psychological↗
PubMed1996

The creation of protection and hope in patients with malignant brain tumours.

The malignant brain tumour disease condenses much of the anguish of cancer diseases. The brain is a vital and delicate organ, and the prognosis is generally unfavourable. The patient is exposed and has to rely on cognitive manoeuvres to manage the mental stress. The purpose of this study was to generate new insights into how the patient constructs a new sense of reality when confronted with the malignant brain tumour diagnosis. Within grounded theory methodology, 30 patients with malignant gliomas were interviewed twice, in direct connection with diagnosis, surgery and radiotherapy. In addition, their partners were interviewed, and quantitative instruments (SMMSE, RDCQ) were used as additional references for assessing the patients cognitively and emotionally. Eleven patients were excluded from the final analysis because of cognitive impairment of personality change. Most of the patients were aware of the fact that the brain tumour exposed them to grave danger, but they were also able to use various cognitive manoeuvres to create protection and hope. This process originated from different sources: the body; helpful relations; cognitive schemata; and the handling of information. The importance of the body to raise hope is emphasized. In the discussion we consider this process as an expression of how the patient brings together reality and hope, thus creating her/his own illusion. These findings are also related to adjacent psychoanalytic theory, proposing a theoretical reference with clinical implications when discussing "What to tell cancer patients."

Adaptation, Psychological↗
PubMed1995

Long-term memory deficits in patients with malignant gliomas.

Knowledge about the neuropsychological performance of adult patients with brain tumors, and especially with malignant gliomas, is limited. In this study 30 patients were consecutively included at time of diagnosis. Five months after completion of radiotherapy eleven of the patients showed no signs of focal neurology or tumor recurrence. These eleven patients, and their partners, were interviewed independently. Using each partner as control the patients were assessed neuropsychologically with special emphasis on memory abilities. The selective reminding technique was used with nouns of different visual imagery. A consistent pattern was found: there was no clear impairment in global intellectual abilities, but there was a pronounced deficit in long-term memory. However, the patients had a preserved capacity to use visual imagery to boost performance. It is important that medical staff acknowledge or confirm this problem. The sparing of imaginal coding makes it possible for the staff to assist with advice facilitating memory. Memory is a vital cognitive ability and the selective reminding technique was a sensitive method capable of detecting subtle impairments. The technique is recommended in future examinations of conditions and evaluations of treatments affecting the CNS.

Adult↗
PubMedDate not supplied

Using beliefs and magical thinking to fight cancer distress-a case study.

This case relates to the way in which a young patient developed serious difficulties in coping with her life in the years following a successful bone-marrow transplant. By means of an illustrative metaphor, she revealed her existential position and the way in which she attempted to deal with her anxiety. Being diseased implied that life's order was replaced by disorder and a loss of basic trust. She tried to re-establish order by establishing beliefs that attributed specific regularities to life, and to influence the risk of recurrence by living according to these beliefs. Unfortunately, this meant that she had to tread a very thin line over a course mined with anxiety and eventually, she became a prisoner of her own creation. The author claims that we can learn from this case, as it clearly illustrates psychological dimensions commonly seen in cancer patients: the way anxiety is related to disorder and the way patients try to regain control of their lives through constructing belief-systems. The case also features a discussion of how we, as clinicians, may be able to help these patients.

Adaptation, Psychological↗