Lecture
Semiglazova T.Yu., Chulkova V.A., Vagaytseva M.V., Pestereva E.V., Kondratyeva K.O., Karavaeva T.A., Krylova O.A., Semiglazov V.V., Donskikh R.V., Karitsky A.P., Shcherbakov A.M., Belyaev A.M.
The improvement of methods for diagnosing oncological diseases, the use of high-technology methods of their treatment, and the application of new forms of pharmaceutical drugs create the preconditions for increasing the life expectancy of patients with malignant neoplasms. In this regard, questions concerning the quality of life of oncological patients are becoming extremely relevant, since the patient's quality of life during and after treatment is one of the factors of the effectiveness of therapy. As a necessary component of comprehensive treatment, the rehabilitation of oncological patients must also be included. Defining the role of each specialist in the rehabilitation process of a particular patient depending on the professional activity they carry out corresponds to the biopsychosocial approach in the rehabilitation of oncological patients. At the same time, psychological rehabilitation is an integral part of the rehabilitation of an oncological patient. It underlies both the treatment process itself and specialized types of rehabilitation and represents, first and foremost, the restoration of the mental balance that has been disrupted by the disease.
The situation of an oncological disease does not pass without leaving a trace for any patient and, practically, for any family that has an oncological patient. A life-threatening disease is accompanied by a feeling of loss of control over the situation and over life as a whole. Characteristic of them are extremely intense and agonizing experiences caused by the unexpectedness and fatality of the disease, the fear of death,
uncertainty, the collapse of ideas about the future, the need to undergo lengthy and difficult treatment, and a feeling of loneliness. The patient's experiences in the situation of an oncological disease create a threat of psychological traumatization, as a consequence of which one form or another of an adjustment disorder may arise in the patient.
It is difficult for an oncological patient to cope with the psychological problems that have arisen without qualified help and support, and over time these problems are not only left unresolved but not infrequently even aggravated. Timely and adequate psychological help can improve the quality of life of an oncological patient and, as numerous studies show, significantly affect the effectiveness of the combined antitumor treatment being carried out.
The aforementioned has increased the interest of the medical community and society as a whole in the psychological component of oncological diseases. An understanding of the significance of the personality of the oncological patient themselves in treatment and rehabilitation has contributed to the development of oncopsychology, which studies the psychological consequences of oncological diseases and, thereby, expands the possibilities of psychological rehabilitation of oncological patients.
If in the last century psychological studies of oncological patients and professional psychological help for them were encountered quite rarely in our country, then already at the beginning of this century the situation began to change: medical psychologists and psychotherapists began to appear on the staff of oncological institutions, and oncopsychologists' offices began to be created. As in any new type of activity, questions arise among specialists as to how best to organize the work, how to identify those patients who are most in need of psychological help.
In this respect, we can share the experience accumulated at the N.N. Petrov Research Institute of Oncology, in which for many years
psychological counseling of oncological patients was carried out, but it was not of a systematic nature, and only the organization of a psychological service at the Institute made it possible to provide this type of help more effectively and in a more multifaceted manner.
Of interest is a study conducted in 2016 at the N.N. Petrov Research Institute of Oncology of the level of emotional tension of patients who are at the stages of diagnosis and hospitalization in the inpatient department, with the aim of identifying groups of oncological patients who are most in need of psychological help. The next stage of the study included a focused examination of the content of emotional tension in the groups of patients that were "leading" in this indicator.
It should be noted that psychological studies of oncological patients conducted earlier indicate that the most difficult stages for the patient are the stages of diagnosis and hospitalization in the clinic [4, 7]. During this time, the patient is informed about the malignant disease and the need to undergo lengthy, agonizing, and at times mutilating treatment. A sharp change in a person's life, the collapse of life plans, and the destruction of their relatively safe picture of the world are accompanied by strong negative experiences of the patient, causing in them a state of extreme emotional tension. As studies and our experience testify, this period is very important for the patient's further psychological adaptation [4, 7]. The world standard for providing psychological help in oncology includes the psychological support of patients. One of the forms of such support is emergency professional psychological help for the patient.
The basis of the study is the distress self-assessment method of the International Psycho-Oncology Society (IPOS): on a vertical scale, made in the form of a conventional "thermometer," patients independently mark the subjectively assessed level of their
distress in connection with the oncological disease and the changes associated with the disease. The maximum level of assessment equals eight, the minimum equals zero. In the distress self-assessment method that we modified, the term "distress" is replaced by the term "experience," which seemed more consistent with our approach and study. In our version, patients must assess the level of their experiences associated with the disease, the treatment, and the changes in life in connection with them. Indicators from 1 to 6 points are recognized as relatively normative in the situation of treatment of an oncological disease. Data with normative indicators are also subject to analysis (appendix 6). A total of 4,113 patient forms were processed, of which 2,113 forms were in the consultative-diagnostic department and 2,000 upon hospitalization in the inpatient department. In the course of the study, data are compared between groups of patients divided by the characteristics of outpatient or inpatient treatment, various localizations, stages of the disease, as well as demographic characteristics.
As the conducted study has shown, both at the diagnostic stage and at the stage of hospitalization in the inpatient department, the largest number of patients assessing their experiences associated with the disease, the treatment, and the changes in life in connection with them are breast cancer (BC) patients. In other words, BC patients are more in need of psychological help than other patients.
Results of the study of emotional tension in patients of the consultative-diagnostic department
The results of the analysis of data collected among outpatients reflect the following tendency: 41% of patients note in themselves an above-normal level of experiences in connection with the disease (the average age of the described subgroup being 54.4 years). At the same time, men in this group make up 28% (57.8 years), and women 72% (53 years).
The distribution of patients by age showed that 18% of patients are aged 19-40 years, 44% are 41-60 years, 25% are 61-70 years, and 13% of patients are older than 71 years.
The percentage ratio of those aware of their own emotional tension and those suppressing it among men is 66% (56.8 years) and 34% (59.8 years), and among women 77% (53 years) and 23% (52.8 years).
The percentage ratio of outpatients who mark on the self-assessment scale a level of experiences outside the norm is distributed by nosology as follows: breast 22%, gynecology 18%, urology 16%, unspecified diagnoses 13%, gastrointestinal tract 11%, lungs 7%, connective tissue and skin at 5% each, bones 3%.
Results of the study of emotional tension in patients hospitalized in the inpatient department
The results of the analysis of the processed forms filled out by patients upon admission to the inpatient department make it possible to speak of the following tendency, which is also characteristic of the patients of the outpatient-diagnostic department: 44% of patients upon admission to the inpatient department indicate a level of experiences outside the norm. Of these, 34% of patients acknowledge the highest level of their experiences in connection with the disease, while 10% of patients completely deny their experiences regarding the disease.
In the group of patients with an above-normal level of experiences, 24% of the sample consists of men and 76% of women. At the same time, in the group of men, 60% note a high level of experiences and 40% of patients deny any experiences. The average age of men with an above-normal level of experiences upon admission to the inpatient department is 54.7 years. In the group of women, 82% of patients note a high level of experiences upon admission for treatment, and 18% of patients note a zero indicator of experiences. The average age of women in this group is 51.7 years.
An analysis of the distribution of data by inpatient departments showed that of those patients who note an above-normal level of experiences, 21% are admitted to the breast tumors department, 16% to the gynecology department, 10% to the head and neck tumors department, 9% to the radiology department, 8% each to the chemotherapy, thoracic surgery, and urology departments, 7% to the abdominal surgery department, 6% to the high-dose chemotherapy department, and 5% of patients experience an above-normal level of experiences upon admission to the inpatient department of general oncology.
The data on the level of experiences of day-hospital patients and of the parents of patients of the children's department were not compared with the aforementioned data.
Thus, the results of the study of emotional tension in patients of the outpatient clinic and the inpatient department revealed a common tendency: for more than 40% of the oncological patients who sought medical help at the N.N. Petrov Research Institute of Oncology, an above-normal level of experiences associated with the disease, the treatment, and the changes in life in connection with them is characteristic. At the same time, men less often than women acknowledge a high level of tension and more often poorly differentiate their emotional state or suppress it. Such data correspond to the data of world studies in psychology.
The age ratio of the patients draws attention. The majority of them are in a productive age, implying active interaction in the family and at work. It is generally accepted that emotional tension is a substantial factor of induction in interpersonal communication. In other words, the patient's emotional tension exerts a substantial influence on their immediate environment and may contribute to the mythologization of cancer, reducing the effectiveness of preventive measures in the field of oncology.
The conducted study of the level of emotional tension of patients makes it possible to fruitfully solve three tasks in the work of the psychological service of the N.N. Petrov Research Institute of Oncology: to study the general situation of the emotional tension of oncological patients, to provide emergency psychological help to those patients who are in acute need of it, and also to strengthen the professional interconnection between the oncologist and the medical psychologist.
Observations show that emergency psychological help in the departments makes it possible to sufficiently reduce the emotional tension of patients.
The form of work in the emergency-help mode implies a primary diagnostic clinical-psychological conversation with the patient in the inpatient department and, if necessary, the referral of the patient for an appointment with a medical psychologist during the hospital period, or the referral of the patient for an appointment with a psychotherapist. Some patients, in the primary conversation, note a spontaneous reduction of emotional tension in the process of accepting active treatment after a conversation with the attending physician.
It should be taken into account that the majority of the Institute's patients are visitors from other regions. For residents of Saint Petersburg, the possibility of outpatient prolonged psychological support is provided, whereas for out-of-town patients short-term psychological support at the Institute becomes a unique chance to receive such help, since at their place of residence they do not have the opportunity to receive psychological help.
The planned psychological support of a patient may take place individually or in a group. Mainly, the psychological help group is of an open nature, which is due to the characteristics of the period of active treatment.
At the same time, there also exists a certain contradiction between the need to receive professional psychological help and
the actual readiness to seek out this help. This contradiction is entirely natural and reflects the attitudes and myths that currently exist in our society regarding professional psychological help, which it is necessary to patiently overcome.
Oncopsychology as a direction of clinical/medical psychology in its content-related aspect comes into contact with social, developmental, family, and other types of psychological disciplines that are undoubtedly present in the crisis and extreme situations of an oncological disease.
This circumstance must be taken into account both when planning scientific research in the field of oncopsychology and when providing professional psychological help to oncological patients. And this same circumstance raises the requirements for the training of oncopsychologist specialists. Not infrequently, psychologists who have not undergone training in clinical psychology and oncopsychology become oncopsychologists, which creates no small number of difficulties for them themselves and may affect the effectiveness of their work.
At present, the meaning and further development of oncopsychology is seen in the creation of a system that includes three elements that are interconnected and organizationally coordinated: scientific research in the field of oncopsychology; the professional training of clinical/medical psychologists, oncologists, and nurses; and professional psychological help for patients and their relatives. The priority in this system is the element of professional psychological help for patients and their relatives, which is based on the first two elements, while scientific research in the field of oncopsychology serves as the basis both for the professional training of clinical/medical psychologists, oncologists, and nurses, and for psychological help for patients and their relatives.
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