Psychosocial care

The article was written by Specialist Doctor I Nguyen Thi Phi Yen - Head of Palliative Care Unit, Radiation Oncology Center - Vinmec Times City International Hospital.

Suffering can be understood as an intensely personal, individual, subjective state of pain. Suffering comes from the notion that something is and will be threatening the integrity of the individual. Can be understood as a person's past, family life, socio-cultural roles, relationships or their own body has been, is and will be damaged or lost.

For many people, suffering is exacerbated by the realization that they are going to die. Suffering is a mixture of emotions: fear, sadness, grief, abandonment, and despair. In many cases, emotions are expressed over time, and perceptions of the future become intense, leaving them overwhelmed, fearful, and out of control.
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For individuals with serious illnesses, suffering is experienced at the highest emotional levels. For patients with terminal cancer, extreme suffering accounts for 25-55% of patients. Young patients the suffering is even more terrible. Suffering occurs often not only due to a serious illness but also as a result of treatment.

Suffering is often seen as inevitable and as a follow-up to illness, especially for serious illnesses. Facing death is one of the most terrifying and challenging things that exist in all aspects of human experience.
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Suffering emerges as a human experience, born of the physical, social, psychological and multi-faceted emotional stresses that exist.

The grief that accompanies an overwhelming loss such as loss of self, relationships, control, goals and values. This is not only a perceived loss in relation to relationships, but also a profound loss of one's role in society as a "healthy" person.

Often, distress is accompanied by pain. Pain in terminal cancer patients remains a highly influential issue, and pain control is an essential goal for alleviating suffering. However, pain improvement to reduce suffering is not always achieved for all patients.
Many studies confirm that patients with pain often report suffering when they lose control, when the pain becomes too much to bear, when it is unclear where the pain is coming from, when the pain becomes more intense. become more intense and when the pain becomes chronic.
This shows that it's not just physical pain that causes emotional pain, but also the way the patient perceives the pain. Physical pain is only one of the factors that contribute to the development of suffering. Many physical symptoms such as vomiting, difficulty breathing, loss of appetite, dry mouth and delirium also contribute to stress, feelings of worthlessness and loss of control.

Psychological fatigue comes from unattainable physical, psychological, social and spiritual needs, causing unnecessary suffering.
When such fatigue reaches its peak, the patient will find himself unable to continue living.

Depression and anxiety in the advanced stages of the disease make the person facing emotional turmoil and anxiety will often have thoughts of wanting to die due to suffering and feeling a loss of dignity.
Maybe the sick person doesn't ask to die, the suffering makes it impossible for the sick person to connect with the entity around him.
Accompanied by a terrible feeling of despair may arise. Despair is reported to be a prediction of the patient's desire to die. Such patients feel they have become a burden that has caused them to become excruciatingly psychologically distressed. Feelings of burden have been shown to be not necessarily related to truly demanding supports but to having to receive support from others.
Up to 96% of terminal cancer patients experience emotional pain during their lifetime.

Care providers can have both positive and negative influences.
The caregiver's presence, being around the patient and attending to their needs, has a direct impact on the patient's self-esteem, individuality, and suffering.
For many patients, the way they want to be noticed and appreciated is of special importance to themselves. Caregivers need to be aware that patients will seek validation, which is a reflection of the caregiver's gaze that will affirm their self-esteem and individuality.
How caregivers communicate with their patients has an important influence on what they go through. Receiving unnecessary information, feeling that their needs are not being met or inattentive, lack of commitment in the way they talk or respond with a non-irritating attitude, all create suffering in the world. patient.
Suffering develops by what the sick person goes through. Suffering must be accepted and heard, and denying what the patient has to say is also denying who the patient is and how they are going through the end of life.
The way caregivers present to the patient can help or worsen the patient's pain. Normalizing the patient's emotions or responding to them, recognizing and helping them find meaning in life, promoting the healing process between the patient and family are all steps needed. necessary to alleviate the nearness of death.

The diagnosis of a life-threatening illness has a huge impact on the entire family.
Although they do not find it difficult to support the sick person, the patient may feel that they are a burden to the family.
They still have to take care of other things for their family such as taking care of children, taking care of finances, kinship relationships.
Family members are faced with new circumstances such as a loved one's illness, which can be a physical, financial and psychological burden to lose a loved one that creates stress for everyone.
Many caregivers maintain good patience at this time, but they are also in a high risk group for mental illness, they go through bad times, have many regrets, and run the risk of getting confused higher psychosis. In most cases, family members also experience the same suffering as the patient.

Do not take the patient's pain lightly.
Always evaluate the cause of stress. Apply direct questions to the patient to clarify Cassell's stress:
Are you frightened by all that is happening? Are you in pain, but is stress worse than pain? Are there things you'd like to do but are finding it difficult to do right now? What can I do for u? The questions above can be used to find the source of health, meaning and purpose, and identify stress so that it can be treated.
Help the patient to move forward
Suffering often occurs over time, making the patient feel uncomfortable with the future in front of him and entangled in the past, which is essential to alleviating pain in the patient is to direct them to the present, and to help them maintain their abilities.
The patient's feelings about themselves have been altered and they are suffering from the fact that they can never be the same person again. There are several ways to help people stay optimistic and maybe they will find new emotional value such as:
Talk to colleagues Share personal thoughts on what to do Share with others loved ones about family situation, work, finances... Determining priorities for remaining time Although these simple things all follow the psychological cycle, it emphasizes the important tasks. that the patient needs to do while he is still alive.

ABCD Approach Model
A ttitude = Attitude B ehaviour = Behavior C ompassion = Empathy Dialogue = Exchange A. Attitude
The physician needs to clearly define attitudes, beliefs and assumptions what they think about the patient. This is a highly personal step that requires the physician to ask basic questions to understand the patient and whether the assumptions they make correspond to the patient's responses.
Asking yourself the following questions is an important step in ensuring that the physician fully understands how his or her presence affects each meeting with the patient and their family.
How would I feel if I were in their position? Is your attitude toward the patient based on personal experience, fear, anger, or even judgment? What prompted me to make these comments? Have I verified my statements yet? B. Behavior
Be aware that each patient is looking at medical staff with the desire to receive consideration and respect for them through their behavior.
Always make sure that their behavior shows "who they are" and not simply "what disease they have", so that there is empathy in the process of professional care.
C. Empathy
Protecting self-esteem is the awareness of something suffering and the desire to alleviate that suffering.
Empathy is felt, and often occurs naturally, but can also be enhanced by humanistic, cultural, artistic, or social science factors. There are many ways to gain empathy on both sides of the medical staff and the patient-family.
It can be through reading stories or articles about illness, watching movies or watching performing arts to give an impact to other people's world and an opportunity to test your own tolerance.
Or find empathy in real life experiences.
Each person must find a way to relate themselves to their own sensitivity, humanity and ability to respond to the patient's needs.
Empathy can be expressed in looks, touch or just a simple statement “I'm sorry, this must have been difficult for you”. Empathy indicates that every patient has a story that needs to be heard and understood.
D. Communicating
How we conduct the conversation to understand that the patient is more than just a sick person.
Be aware that the lines are more sensitive to the patient's feelings and feelings of suffering before death.
Recognizing the uniqueness of each patient, bringing different perspectives in the way of talking is an essential factor in alleviating suffering.
Always strengthen communication skills with patients and family members including mastering skills of listening, sensitivity and thinking clearly. Healthcare workers need to listen to both the spoken and the unspoken. This means that we allow some time to be quiet, observe the unspeakable, and understand that we cannot fix what the person feels or goes through.
The skilled doctor understands the difficult problems that are not always possible, and dedicated listening opens up opportunities for the patient to open up. Rigidity or silence only adds to the tension in communication.

Sometimes suffering cannot be alleviated or avoided, but forced the sick person to live and suffer. However, one of the preventions we can use is to be aware of suffering and being present with the sick person.
The presence of medical staff with listening brings peace of mind to the patient and family. When we ask if they are suffering, it doesn't mean that we care about them and respect them.
The presence of medical staff means we know your illness as well as your story.
Some more advanced measures to increase their sense of dignity, purpose and worth, to alleviate suffering and have a positive effect on both the patient and their family. These methods include assessment/reminiscence, heritage, core values ​​and dignity of life. The theory behind these methods is to give patients the opportunity to talk about issues they feel are important in their lives, thereby assessing their feelings about their goals and values.
For some patients, distress may be off-limits and sedation is required, as a last resort and should be closely controlled.
Vinmec General Hospital system was established with the goal of comprehensive health care of people. In which, mental health is always a big part. Therefore, the Psychology Clinic - Vinmec Times City Hospital was built with the function of examining, consulting and outpatient treatment of psychological and mental health problems, especially those with terminal cancer. .
With modern, well-invested equipment, along with a team of doctors who are lecturers of Psychiatry Department of Hanoi Medical University with many years of experience, seniority in the profession and internal medicine doctors. As a resident with solid expertise, the Psychology clinic - Vinmec Times City International General Hospital is capable of implementing psychological tests, intensive psychotherapy for general medical examination and treatment, cancer in particular.