The huge problems related to chronic, ultimately fatal diseases involve disability, pain, suffering and the perception of one's doom; this calls for reappraising the conventional concepts of health and disease, life and death, encompassing spirituality and the mystery of death beyond any limited perspective. The management of suffering and pain to enhance resilience plays a central role in palliative care (PC) and is the core of the patient-centered approach, focused on the "to care" instead of the "to cure" of the illness-centered medicine. In this article, the perspectives supporting these instances are analyzed, focusing on hypnosis, to be considered as a powerful technique able to improve patient's control over mind and body (including relaxation, fairness, analgesia, improved stability of physical parameters and wellbeing).
L’hypnose est une pratique de plus en plus courante en milieu hospitalier. Ainsi, en oncologie pédiatrique cette technique est efficace pour la gestion de l’anxiété et de la douleur liée à la maladie, aux traitements ou à des procédures invasives. L’hypnose et l’autohypnose améliorent aussi le confort et de bien-être des enfants malades et de leurs familles. L’hypnose est une approche centrée sur le vécu subjectif du patient et de son propre ressenti au niveau corporel. Elle permet également d’accéder à des souvenirs agréables tout en activant les modalités sensorielles liées à ceux-ci. Nous décrivons comment, dans notre service d’oncologie pédiatrique, nous utilisons l’hypnose avec une attention particulière pour les soins palliatifs.
OBJECTIVE: The case of a non-oncological patient at the end of his life, admitted to a Palliative Care Unit (PCU), is presented. After a failed attempt to place a central venous catheter (CVC) and another placement of a peripherally inserted central catheter (PICC), the patient exhibited high anxiety regarding a midline catheter (MC) and refused its placement, even though this was necessary for the administration of intravenous drugs to control dyspnea and other complex symptoms that he presented.
METHOD: An intervention through clinical hypnosis for successful MC placement and symptom control is described.
RESULT: Through clinical hypnosis and interdisciplinary teamwork, it was possible to place a MC, necessary for symptomatic control of a complex patient.
SIGNIFICANCE OF RESULT: This case exemplifies hypnosis as a simple procedure that is easy to apply, accepted by the patient, and effective in the implementation of invasive procedures and symptom control in PCUs.
In this study we analyzed retrospectively a database of 44 alleged death experiences between incarnations, as reported by 36 participants during hypnotic life regression sessions with the same hypnotist. The descriptions of these experiences were evaluated using the Italian version of the Near-Death Experience Scale. A large part of the reported experiences were categorized as “Affective”, with a majority reported as: “Feeling a sense of joy” and “Seeing and being enveloped by a bright light”, as well as in the “Transcendental” category, with all experiences showing a similar frequency. Regarding the “Paranormal” category, the most often reported experience is that of: “The feeling of being separated from one’s physical body”. With respect to the total score, 18% fell within the range commonly used to identify true near-death-experiences. The death experiences undergone during the hypnotic life regressions contain very similar characteristics to those reported in classic near-death-experiences. Whether these experiences were actually lived or were, instead, accounts of events previously learned through conventional means, remains an open question.
BACKGROUND: Interventional radiology procedures in cancer patients cause stress and anxiety. Our objective was to relate our experience in the use of sophrology techniques during interventional radiology procedures and evaluate the effects on patient's pain and anxiety.
METHODS: We present a prospective observational study on 60 consecutive patients who underwent interventional radiology procedures in a context of oncologic management from September 2017 to March 2018. Forty-two patients were asked if they wished to benefit from the sophrology and hypnosis techniques during their procedure. A control group was also made including 18 patients. Anxiety level and pain were evaluated using the visual analog scale (VAS) before and during procedures.
RESULTS: We observed a significant decrease in anxiety experienced by patients during interventional radiology procedures compared to before procedures in the sophrology group (P=3.318E-08), and a level of anxiety and pain during gestures inferior to that of the control group (P=2.035E-06 and 7.03E-05 respectively).
CONCLUSIONS: Relaxing therapies, such as sophrology and hypnosis, seems to be an interesting additional tool for the management of patients in interventional oncology, inducing a decrease of stress, pain, and anxiety in patients.
Peu d’études à ce jour ont été publiées dans la littérature permettant d’évaluer l’efficacité de l’hypnose dans la prise en charge des symptômes dans un contexte de soins palliatifs. L’objectif de notre étude est de continuer à évaluer cette pratique. Cette étude rétrospective observationnelle s’est effectuée au sein d’un service de soins palliatifs, sur une période de deux ans, en monocentrique. Pour y parvenir, il a été pratiqué une analyse quantitative de « fiche de suivi et d’évaluation » des séances d’hypnose.
Trente-sept patients ont été suivis en séance d’hypnose, principalement pour une prise en charge de la douleur (41 %) et de l’anxiété (27 %). Dans l’ensemble, la pratique de l’hypnose a permis dans 51 % des cas une diminution des symptômes, voire même une disparition de leur intensité dans 35 % des situations.
Malgré un faible échantillon, les résultats corroborent ceux retrouvés dans les quelques études menées en soins palliatifs : une efficacité notable de l’hypnose sur les symptômes généraux des patients, et plus particulièrement sur la douleur, l’anxiété, les nausées et les troubles respiratoires.
Palliative care spans a wide-ranging spectrum: from pain-management to spiritual support. As the demand for end-of-life care increases, so does the demand for innovative, effective, interventions. Mind-body techniques seem especially advantageous in a palliative context. Here we show that hypnosis serves an excellent adjunct therapy in palliative care to boost the efficacy of standard treatments. With the overarching goal of bridging clinical and scientific insights, we outline how five core principles of hypnosis can benefit the diverse needs of palliative care.
Context: Patients with advanced cancer rarely complain of unexplained dizziness after excluding identifiable causes. Some patients become anxious because they attribute the dizziness to the progression of their cancer. We hypothesize that unexplained dizziness is associated with neck muscle hypertonicity, a noncancer-related secondary effect. However, most cases are associated with neck muscle hypertonicity, a noncancer-related secondary effect.
Aims: We evaluated the usefulness of hypnotic intervention that made patients aware of the relation between dizziness and neck muscle hypertonicity through the experience of muscle relaxation and recognition of muscle tension.
Settings and Design: Advanced cancer patients requiring palliative care with unexplained dizziness who received the intervention to induce neck muscle relaxation were retrospectively compared with patients who did not.
Subjects and Methods: The severity of dizziness that was evaluated using a numeric rating scale and the intervention efficacy rate were compared between the hypnotic and nonhypnotic groups as the primary endpoints, 7 days after the start of the intervention. Secondary endpoints included the effect size based on dizziness handicap inventory (DHI) scores before and after the intervention, and changes in patients' awareness of the cause of dizziness.
Results: The hypnotic intervention had a significantly greater efficacy rate (0.67, 95% confidence interval: 0.46-0.88) than the nonhypnotic intervention (0.26, 95% confidence interval: 0.08-0.44). DHI scores, especially on the emotional subscale, showed significant improvement after the intervention, and 71% of the patients were aware that neck muscle hypertonicity was the cause of dizziness.
Conclusions: The rapid improvement in dizziness in the hypnotic group was considered to result from a change in patients' awareness of self-manageable neck muscle hypertonicity as the cause of dizziness.
Dans notre société, l’hypnose a parfois une image négative et tronquée.
Depuis plusieurs années, elle s’est démocratisée dans le domaine de la santé et s’est développée dans la prise en charge de symptômes comme la douleur et l’anxiété.
Elle peut être d’une grande aide en situation palliative.
L'aide-soignante fait part de ses réflexions autour de la fin de vie et des diverses façons de l'appréhender. Elle propose plusieurs outils et exercices pour accompagner les personnes et les familles vers un mieux-être : sophrologie, hypnose ou encore visualisations. Avec des pages blanches pour exprimer son ressenti.
At least 8 million children would need specialized pediatric palliative care (PPC) services annually worldwide, and of the more than 42,000 children and teenagers dying annually in the United States, at least 15,000 children would require PPC. Unfortunately, even in resource-rich countries the majority of children dying from serious advanced illnesses are suffering from unrelieved, distressing symptoms such as pain, dyspnea, nausea, vomiting, and anxiety. State of the art treatment and prevention of those symptoms requires employing multi-modal therapies, commonly including pharmacology, rehabilitation, procedural intervention, psychology, and integrative modalities. This article describes the current practice of integrating hypnosis into advanced pain and symptom management of children with serious illness. Three case reports of children living with a life-limiting condition exemplify the effective use of this clinical modality to decrease distressing symptoms and suffering. Hypnosis for pediatric patients experiencing a life-limiting disease not only provides an integral part of advanced symptom management, but also supports children dealing with loss and anticipatory loss, sustains and enhances hope and helps children and adolescents live fully, making every moment count, until death.
Psychosomatic disorder is a condition in which psychological stresses adversely affect physiological (somatic) functioning to the point of distress. It is a condition of dysfunction or structural damage in physical organs through inappropriate activation of the involuntary nervous system and the biochemical response. In this framework, this review will consider anxiety disorders, from the perspective of the psychobiological mechanisms of vulnerability to extreme stress in severe chronic illnesses. Psychosomatic medicine is a field of behavioral medicine and a part of the practice of consultation-liaison psychiatry. Psychosomatic medicine in palliative care, integrates interdisciplinary evaluation and management involving diverse clinical specialties including psychiatry, psychology, neurology, internal medicine, allergy, dermatology, psychoneuroimmunology, psychosocial oncology and spiritual care. Clinical conditions where psychological processes act as a major factor affecting medical outcomes are areas where psychosomatic medicine has competence. Thus, the psychosomatic symptom develops as a physiological connected of an emotional state. In a state of rage or fear, for example, the stressed person's blood pressure is likely to be elevated and his pulse and respiratory rate to be increased. When the fear passes, the heightened physiologic processes usually subside. If the person has a persistent fear (chronic anxiety), however, which he is unable to express overtly, the emotional state remains unchanged, though unexpressed in the overt behavior, and the physiological symptoms associated with the anxiety state persist. This paper wants highlight how clinical hypnosis and meditative states can be important psychosocial and spiritual care, for the symptom management on neuro-psychobiological response to stress.
À travers deux cas cliniques, nous illustrons de quelle manière l’hypnose peut être un outil efficace dans le soulagement des symptômes gênants, tout en permettant un accompagnement en soins palliatifs singulier et très respectueux. L’hypnose clinique permettra alors de redonner la main au patient pour le rendre actif dans sa prise en charge, vers un objectif qu’il aura lui-même déterminé.
Hypnosis has been shown to alleviate symptoms and side effects of cancer and its treatment. However, less is known about the use of hypnosis at the end of life in individuals with cancer. Our goal was to systematically review the literature on the use of hypnosis to manage the most common symptoms of end-of-life cancer patients: fatigue, sleep disturbances, pain, appetite loss, and dyspnea. EMBASE, MEDLINE, COCHRANE, PsychINFO, and SCOPUS databases were searched from inception through November 7, 2016. No studies met the inclusion criteria. It appears that hypnosis has never been rigorously tested as a means to ameliorate the most common symptoms in individuals with cancer at the end of their lives. This finding is troubling, as it strongly implies that a population most in need has been largely neglected. However, a clear future research direction is revealed that may have significant clinical impact.
Ce dossier thématique contient les articles suivants : le burn-out : une question de société ? ; pour éviter le burn-out, soyons vigilants ; institution et soignants en maisons de repos : partenaires pour prévenir l'épuisement professionnel ; la méditation de pleine conscience, un espace de coulisse à la souffrance du soignant ; prenons du recul pour voir l'horizon qui se cache derrière l'arbre ; témoignage d'une soignante ayant vécu un burn-out.
Rejoindre le patient là où il se trouve, dans son vécu, et aller dans la direction qu'il souhaite, sans la prédéterminer. Les soins palliatifs, comme l'hypnose, ont pour socle un réel engagement dans la relation. C'est la relation incarnée et focalisée sur les sensations et le corps. Une partie de nous, non consciente, est appréhendée comme réservoir actif de ressources, encouragé à se mobiliser loin des limitations que l'esprit a acquis.
Origine : BDSP. Notice produite par EHESP 9R0xG8B8. Diffusion soumise à autorisation