bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Assistance in Dying
Authors: Panjwani Aliza A. , Rodin Gary , Li Madeline 
Published: January 2023

Abstract
Medical assistance in dying (MAiD) is increasingly garnering global support, with 24 jurisdictions having legalized one or more forms of MAiD and several more considering legislation. In this chapter, the authors present a historical and global overview of MAiD; characteristics of individuals who pursue it; impacts of MAiD on family, health professionals, and medicine; and key practice challenges of MAiD with case illustrations. The majority of those who pursue MAiD receive palliative care services, and there has been little global evidence of MAiD being disproportionately provided to unwilling or vulnerable populations. The most common reason cited by individuals who receive MAiD is psychological distress, including loss of autonomy, dignity, and ability to participate in valued activities. Patients with significant depressive symptoms or death anxiety are often ambivalent about their MAiD requests. Paramount in ensuring that MAiD is delivered safely and ethically is differentiating the desire for death as an indicator of pathology from that as a rational choice undertaken by an autonomous individual. A common reason for psychiatric referral in MAiD is the determination of capacity. However, palliative psychiatry is also uniquely positioned to conduct psychodiagnostic assessment and deliver psychotherapeutic interventions to relieve existential suffering. Palliative psychiatry should play a significant role in developing frameworks and safeguards in jurisdictions considering expansion of MAiD to controversial areas such as mature minors, for psychiatric disorders, and as advance requests.
Communicating with Patients with Advanced Cancer
Authors: Parker Patricia A. , Epstein Andrew S. , Rosa William E. , Banerjee Smita C. 
Published: January 2023

Abstract
Effective communication between the patients, families, and the healthcare team is essential to providing quality patient care. This is true for patients at any point on the cancer trajectory, but especially important for patients with advanced cancer. This chapter describes many of the key communication needs and challenges of patients with advanced cancer and their caregivers and suggest strategies to communicate effectively about these complex issues. Some of the important communication tasks include discussions of prognosis, advanced care planning and end-of-life goals of care, palliative and supportive care, and hospice. When communicating with advanced cancer patients, it is essential to find ways to maintain hope. The authors also discuss important considerations when communicating with patients with advanced cancer from minoritized groups. Finally, the authors discuss communication strategies and programs that have been developed to communicate optimally with patients with cancer and their families. Enhancing the communication skills of members of the healthcare team is critical to providing patient-centered care for patients with cancer and their families.
Care for the Healthcare Provider
Authors: McFarland Daniel C. , Vachon Mary L. S. 
Published: January 2023

AbstractClinicians working with patients at the end of life face many distinct challenges that influence their well-being. Burnout and related conditions like moral distress and compassion fatigue are highly prevalent across medical specialties. However, the disciplines of palliative care and psychiatry have moderate levels of burnout despite mortality salience and significant interpersonal stressors in clinical palliative care. This chapter reviews the issues surrounding burnout and related conditions as they relate to palliative care specifically. It discusses key concepts related to burnout and the work environment as distinguished from other mental health maladies that are also prevalent in clinicians (e.g., depression, risk of suicide, substance use). These conditions have healthy, functional opposites such as compassion satisfaction, moral success, and engagement in work. Resilience is discussed as it relates to adapting, persevering, and coping. Attachment theory and its clinical implications for patients and clinicians is discussed. Last, several forms of burnout interventions are analyzed and presented. While data are limited, organizationally addressed burnout interventions appear to be most efficacious and durable along, with mindfulness-based stress reduction techniques. In general, greater attention is now given to burnout and its related conditions, which stands to significantly help clinicians working with patients at the end of life.
Ethical Issues in Palliative Care
Authors: Esbensen Kari L. , Sulmasy Daniel P. 
Published: January 2023

AbstractThe authors provide a historical-social context and philosophical framework to illuminate some of the major ethical issues crucial to palliative care. They argue that the terminally ill patient’s increased vulnerability, medicine’s moral obligation to serve the four-fold good of the patient, the telos of medicine as providing healing by restoring wholeness even when cure is no longer possible, and the many domains of suffering experienced by the terminally ill all converge to justify intensive comprehensive palliative care (ICPC) as the appropriate response to these realities. They then review some of the many ethical challenges ICPC faces in responding to the needs of the terminally ill, challenges that arise when addressing pain, other symptoms, and suffering; providing spiritual and existential care; telling the truth and conveying “bad news”; assessing decision-making capacity and ensuring informed consent; encouraging advance care planning and supporting surrogate decision-making; determining when to withhold or withdraw life-sustaining treatments; considering the appropriateness of artificial nutrition and hydration; responding to requests for futile or potentially inappropriate treatments; addressing requests for euthanasia or physician assisted suicide; and considering the use of sedating medications at the end of life. They offer arguments to support their views on each of these issues while acknowledging that some of these topics remain deeply controversial.
Cognitive Behavioral Therapy in Palliative Care
Authors: McDarby Meghan , Trevino Kelly , Kozlov Elissa 
Published: January 2023

AbstractCognitive behavioral therapy (CBT) examines relationships among cognitions, emotions, and behaviors to help patients address maladaptive patterns of thinking and behaving. Despite its robust evidence base for the treatment of psychopathology, questions remain about the feasibility, acceptability, and efficacy of CBT approaches in palliative care settings. However, meta-analytic evidence indicates that CBT is not only feasible and acceptable to patients with palliative care needs, but also that it is effective in the treatment of psychological distress among patients in palliative care and their care partners (e.g., spouses, adult children). Importantly, CBT can be incorporated into treatment for patients with a wide range of medical diagnoses (e.g., cancer, heart failure, kidney disease) and psychological and somatic concerns (e.g., anhedonia, death anxiety, fatigue, insomnia, and pain). CBT is also recommended by the National Institute of Health Care and Excellence guidelines for individuals nearing end of life who are in need of psychological support. This chapter summarizes the traditional CBT framework and applies this framework to the care of patients in palliative care settings. The authors also briefly describe the evidence base for CBT use in palliative care, enumerate special considerations for practicing CBT with patients receiving palliative care, and offer recommendations about how CBT might be applied across the palliative care trajectory.
Meaning-Centered Psychotherapy
Authors: Applebaum Allison J. , Lichtenthal Wendy G. , Pessin Hayley , Breitbart William 
Published: January 2023

AbstractExistential distress and suffering are common among patients with advanced cancer. For patients who are facing death, a sense of meaning is clinically and existentially important and central to providing holistic, high-quality end-of-life care. Two decades ago, the authors’ research group at Memorial Sloan Kettering Cancer Center began to understand that a meaning-centered approach to psychosocial care had the potential to alleviate existential distress that plagued many patients with advanced cancer. Based originally on the work of Viktor Frankl and principles of existential psychology and philosophy, the authors developed meaning-centered psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives in the face of the challenges and limitations they commonly face. This chapter provides an overview of MCP and its clinical applications. The authors summarize the growing body of research that has demonstrated the efficacy of MCP in improving meaning, quality of life, and spiritual well-being, and in reducing psychological distress and despair at the end of life among patients with advanced, life-limiting cancers. Adaptations of MCP for other purposes and populations, such as cancer survivors, cancer caregivers, and bereaved family members, are also discussed.
Psychiatry in Multidisciplinary Pediatric Palliative Care
Authors: Kearney Julia A. , Gilman Megan 
Published: January 2023

AbstractPediatric palliative care (PPC) is multidisciplinary, child- and family-centered, developmentally informed, holistic care for children, adolescents, and their families facing life-threatening illness. Child and adolescent psychiatrists in PPC contribute valuable skills in the assessment and management of emotional and behavioral symptoms, family dynamics, communication, and interventions. Symptom management with psychotropic medications is appropriate to provide comfort and relief from physical or emotional distress. A developmental understanding of children’s conceptualization of death can assist in providing tailored support for children and their caregivers. Communication with children and adolescents about their own death and dying should be done in conjunction with parent psychoeducation and support in the context of a therapeutic relationship and should be careful, individualized, and child-led. Adolescents and young adults should be increasingly included in goals-of-care discussions, as appropriate. Evidence-based therapeutic interventions and communication tools such as advance care planning guides and therapeutic games are invaluable tools at the bedside in PPC. Expertise in palliative communication is shown to be closely correlated with child quality of life outcomes and parent bereavement outcomes after the death of a child. Family support and bereavement care is in the scope of pediatric palliative care.
Looking beyond a biopsychosocial model of pain
Authors: Sullivan Mark D. , Ballantyne Jane C. 
Published: January 2023

Abstract
This chapter argues that the widely endorsed biopsychosocial (BPS) model is incomplete and was powerless to stop the opioid epidemic. The BPS model addresses a diverse set of psychological and social influences on chronic pain, but it doesn’t question the independence of the “objective biological event” of disease or pain. The BPS model focuses on biological causes of pain and psychosocial modifiers of that experience. Biological factors are allowed to stand on their own as causes of chronic pain, while psychological and social factors are not. Emotion is often conceived as a reaction to the pain sensation rather than a core component of pain. This means that the BPS model does not challenge the separation of mechanical pain from human suffering, including the idea of pain as passive suffering, which has supported the right to pain relief and the use of opioid painkillers.
Selling opioids as targeted painkillers
Authors: Sullivan Mark D. , Ballantyne Jane C. 
Published: January 2023

Abstract
This chapter describes how the discovery of an endogenous opioid system in humans in the mid-1970s radically changed our understanding of opioids. Whereas opioids had long been known as drugs that could produce pain relief or addiction, depending on circumstances, endogenous opioid systems revealed a role for opioids that extended far beyond simple pain relief or addiction. These systems, we now know, are critical in stress responses, and in learning protective actions and behaviors to allow the individual to function in a hostile world and in society. For humans, socialization is critical for survival. One of the greatest harms of opioid drugs, which commandeer endogenous opioid systems, is the attenuation of natural survival behaviors, including socialization. Here we describe how the discovery of an endogenous opioid system opened up a new understanding of pain itself, how the individual has power over pain, and how opioid drugs compromise the individual’s ability to self-manage pain.
From causal to moral models of pain, and the right to pain relief
Authors: Sullivan Mark D. , Ballantyne Jane C. 
Published: January 2023

Abstract
This chapter argues that our mechanical causal theories about pain provide the basis for our moral theories about pain and our policies about opioids, including the right to pain relief. Our modern medical view of pain sees it as a natural event with causes but not reasons. We separate pain (as produced by impersonal mechanisms originating within the body) from suffering (as arising from personal and interpersonal meanings originating between bodies). Patients with pain have done nothing to cause or deserve the pain they experience. This causal passivity and its moral corollary, innocence, are the basis for the claim of a right to pain relief. That is why this right to pain relief is limited to the use of prescribed opioids for the treatment of physical pain, never for the rest of human suffering.
Finding a place for pain in medicine, in policy, and in life
Authors: Sullivan Mark D. , Ballantyne Jane C. 
Published: January 2023

Abstract
This chapter argues that we cannot cure or abolish pain from human life. The utilitarians argued that all pain is bad, and professional pain medicine has argued that pain relief should be among the core universal human rights provided by all societies. We argue that health professionals have misunderstood not only opioids, but also pain itself. We work our way backward through the Western history of pain, gradually unwinding the tight knots of pain problems bequeathed to us: from pain conceived as a medical problem, to pain as a social problem, and finally to pain as an existential or religious problem. The great promise of the biomedical model is that chronic pain can be killed with pills or procedures while leaving the person untouched. This promise is one of the deep roots of our opioid epidemic.
Epilogue: Clinician’s perspective
Authors: Sullivan Mark D. , Ballantyne Jane C. 
Published: January 2023

Abstract
This chapter describes a primary care physician’s experience with treating four returning patients and two new patients with chronic pain. The focus is on the personal challenge posed by these patients. Each patient has a unique set of medical and social problems, but each poses a challenge about continuing, escalating, tapering, discontinuing, or starting long-term opioid therapy. Difficulties in making correct medical and psychiatric diagnoses are reviewed.
Epilogue: Patient’s perspective
Authors: Sullivan Mark D. , Ballantyne Jane C. 
Published: January 2023

Abstract
This chapter reviews the experience of Reggie Winston, a mechanical engineer with chronic low back pain. It begins with his divorce, followed by the onset of his back pain after a fall while backpacking. He gets temporary relief from epidural steroid injections, but soon progresses to a lumbar fusion. This provides partial relief, but after a hard plane landing he is in significant pain again. He is treated with Percocet, then Oxycontin, with an initial good response. He continues drinking alcohol and gradually escalates his dose. After a breakup with a girlfriend, he accidentally overdoses on opioids and alcohol. He enters alcohol and drug rehabilitation, followed by a pain rehabilitation program. He readily takes to the exercise focus, but finds addressing his chronic anger to be more challenging.
Depressive Disorders
Authors: Fujisawa Daisuke , Akechi Tatsuo , Uchitomi Yosuke 
Published: January 2023

Abstract
This chapter covers etiology, assessment, and clinical management of depression, which is a syndrome characterized by depressed mood and/or loss of interest and pleasure, and is common among patients with life-threatening illness. Since the presentation of depression may be masked or mimicked by other physical conditions, routine screening for depression is strongly recommended. This chapter provides a list of screening tools for depression, along with methods of detailed assessment and a list of key differential diagnoses. Psychotherapy and pharmacotherapy, which are the two major treatments of depression, are illustrated. Since the patients’ vulnerability and shortened prognosis may limit some use of antidepressants in palliative care settings, the use of other psychotropics is discussed. Some of the complementary and alternative medicines that have been proven effective for depression are also discussed.
Care of Dependent Children When a Parent Is Dying of Cancer
Authors: Turner Jane , Henry Melissa 
Published: January 2023

Abstract
The impact of parental cancer and death is strongly influenced by the developmental stage of the child. Younger children may be anxious and fearful of abandonment and express distress behaviorally. Adolescents may be particularly vulnerable because of their greater awareness of the impact of parental death and expectations they will assume greater domestic responsibility. The function of the family as a whole, especially high levels of parental emotional distress interfering with daily ability to function or family conflicts, will affect adjustment of children, along with social adversity or preexisting childhood health conditions. Open communication aligned with the developmental stage of the child is the cornerstone of all interventions, along with recognition of distress, assurances of ongoing loving care, and strategies to maximize routine. Health professionals have a role in providing support, education, and encouragement for parents to embark on these conversations, which need to be adapted over time as the parent’s clinical condition changes. Parents will benefit from information about positive steps they can take to mitigate distress and promote longer-term resilience of their children. Childhood bereavement has a lasting emotional impact; however, it does not inevitably lead to disorder. Practical strategies are likely to facilitate coping. Focused professional interventions should be reserved for families and children who are most vulnerable.
Bereavement Care
Authors: Lichtenthal Wendy G. , Rosa William E. , Neimeyer Robert A. 
Published: January 2023

Abstract
Grief often begins at the time of a cancer diagnosis, commonly emerging as patients and their families of choice confront multiple losses throughout their illness and as the disease progresses, and often surging most intensely following the patient’s death. This chapter aims to promote family-centered care by equipping psycho-oncology clinicians with the skills needed to support those who are grieving, identify common grief reactions and risk factors for poor bereavement outcomes, and manage the grief experience using evidence-based interventions. Remaining mindful of the family’s cultural and spiritual needs as well as sources of disenfranchised grief, psycho-oncologists can provide empathic support, provide psychoeducation about adaptive reactions to loss and change, assess for maladaptive grief reactions, and make referrals for more specialized bereavement support when warranted.
50 Studies Every Occupational Therapist Should Know
Authors: Lee Elissa , Pyatak Beth 
Published: January 2023

Abstract
50 Studies Every Occupational Therapist Should Know presents a curated collection of the most influential studies guiding occupational therapy practice today. The text is organized into six practice areas, following the American Occupational Therapy Association (AOTA) framework for OT practice: productive aging, health and wellness, work and industry, rehabilitation and disability, children and youth, and mental health. Each section contains a series of chapters, each of which outlines the design, findings, and implications of a key study from that area of practice. Each chapter also includes a case scenario designed to illustrate how the findings of the study relate to clinical practice. This text will be a valuable resource for occupational therapy students and practitioners seeking to understand the breadth, rigor, and trustworthiness of research informing occupational therapy practice, and for others interested in better understanding the profession.
Emerging Occupational Therapy Practice for Inclusive Work Transition and Vocational Programming
Authors: Washington Selena , Jaegers Lisa 
Published: January 2023

Abstract
The provision of occupational therapy services for work transitions is an emerging area of community-based practice. The study discussed in this chapter indicates a broad perspective of occupational needs to be explored when designing evidence-informed interventions for vocational or work outcomes. Specifically, the Employment Options program examined in this study with individuals experiencing AIDS revealed the importance of considering personal narratives to inform work interventions that are tailored to individual needs. Implications for vocational programming in occupational therapy that addresses health challenges, physical limitations, environmental factors, and contextual influences on work pursuits are explored. Related research, resources, and a case study are provided to assist practitioners in applying these vocational programming concepts in occupational therapy practice.
Occupational Time-Use Intervention for People with Serious Mental Illness
Authors: Lambdin-Pattavina Carol 
Published: January 2023

Abstract
Engagement in meaningful occupation is frequently limited in individuals with severe mental illness due to symptomatology as well as societal marginalization and occupational deprivation resulting from stigma. This chapter presents evidence from a randomized study of Action over Inertia (AOI), a manualized program intended to support clients in recognizing the link between occupational engagement and health and move from a state of inertia to action. Results indicated that differences in occupational balance between the intervention and control group were statistically significant, with the intervention group sleeping less each night versus the control group following the 12-week study period. Intervention participants shifted the time gained from sleeping less to activities of interest rather than non-health-promoting behaviors. Intervention administrators described the clinical utility of the program, and participants reported increased time-use awareness and well-being. AOI provides a program focused on developing the occupational potential of those with severe mental illness.