Smith EM, St Ann's Hospice, Manchester
Gomm SA, St Ann's Hospice, Manchester
Dickens CM, University of Manchester, Manchester Royal Infirmary, Manchester

BACKGROUND: The aim of palliative care services is to ensure the best quality of life for patients and their carers. Depression is common amongst palliative care patients and has been shown to adversely affect quality of life. This study aimed to examine the independent contribution of depression to quality of life.

OBJECTIVE: To investigate the hypothesis that a) illness severity, pain, anxiety and depression are all associated with impaired health-related quality of life and b) once the effects of illness severity have been adjusted for, there is further independent contribution to quality of life from anxiety and depression.

METHOD: Consecutive patients with advanced cancer under the care of palliative care services were screened. Sixty-eight patients were evaluated for levels of anxiety and depression, severity of illness, pain severity and health-related quality of life. RESULTS: Thirty-three males and 35 females were recruited and had an age range of 41-93 years (median 71). Seventeen (25%) of patients were anxious [anxiety score > or = 11 on the Hospital Anxiety and Depression Scale
(HADS)], 15 (22%) were depressed (HADS depression score > or = 11). After controlling for the effects of pain and illness severity, anxiety and depression were independently associated with global health status, emotional and cognitive functioning, and fatigue. Anxiety further contributed significantly towards social functioning, nausea and vomiting.

CONCLUSIONS: This study has confirmed that pain, anxiety and depression were associated with impaired quality of life.
Anxiety and depression contributed independently towards various dimensions of quality of life. Longitudinal studies are required to examine the direction of the causal association between pain and depression in patients receiving palliative care.

Allison Kabel
PhD Candidate, Wayne State University, Detroit

Dr Dai Roberts (Head of Research and Development)
St Ann's Hospice, Manchester, UK

This qualitative study examines the attempts made by hospice staff to support and maintain the personhood of hospice patients. The study was conducted over a 6 month period at two hospice facilities in northwest England. Thirty staff members were interviewed about their interpretation of the hospice philosophy and how this influences their work with regard to patient personhood. Staff employed methods of normalising the often distressing symptoms that accompany serious illness, with the aim of maintaining personhood and dignity. Related to the support of personhood, is the concept of the ‘special’ patient. Staff members discussed feelings of attachment towards particular patients that had developed out of the care-giving relationship. There was no suggestion that staff perceived special patients as receiving preferential treatment at the expense of other patients. However, experiences with ‘special’ patients positively impacted staff members by reinforcing occupational choice and the inherent rewards of the profession.

Kate Kirk (Psychodramatist)
Child and Adolescent Mental Health Service, Isle of Man

Mick McManus (Social Worker)
St Ann's Hospice, Manchester, UK

This article explores the literature relating to the needs of bereaved children and families and describes the course of a family bereavement group run in a hospice. The interventions involved dramatherapy and other creative arts media. The group comprised of four families all of whom had a parent die in the hospice. Their ages ranged from 6-46 years. Two one-day workshops were followed closely by six closed-group evening sessions. The aims and interventions for each session are outlined and a short commentary on the process given. Significant aspects of containing families' grief through the use of therapeutic group work is highlighted.

Caroline Melliar-Smith (Senior Social Worker)
St Ann's Hospice, Manchester, UK

An effective bereavement risk assessment document used in a palliative care setting was identified which could ensure bereavement support for those in need, be it a family or carer group. The nursing team were used as assessors with a system to indicate carers' and relatives' immediate need following the death of a patient. The aim of this bereavement risk assessment system was to lessen the possible long-term effects of unresolved grief for family and carers of patients who died within a hospice setting. The assessment document is a useful education tool for nurses, allied support professionals and bereavement support volunteers in their work with grief and loss.

Rosemary A Gray (Cancer Support Nurse)
St Ann's Hospice, Neil Cliffe Cancer Care Centre, Manchester, UK

This paper reviews and analyses the literature surrounding the issue of massage within palliative care. This is of direct relevance to the author's practice as an oncology nurse. The author reflects upon her practice and discusses how the care can be enhanced through the use of massage. In the presence of a life-threatening illness such as cancer, the attitudes, values and beliefs of the family, nurse and other members of the multidisciplinary team are particularly pertinent.

Anne Cawthorn (Lecturer Practitioner)
The Christie Hospital

Ann Carter
Complementary Therapist
St Ann's Hospice, Neil Cliffe Cancer Care Centre, Manchester, UK

Maura Hindley (Staff Nurse), Sue Johnston (Occupational Therapist)
St Ann's Hospice, Manchester, UK

There is a broad consensus that following cancer diagnosis, patients' lives can be disrupted by diffuse, long-term psychosocial problems. There is also increasing evidence to suggest that group cognitive behavioural techniques, as used in stress management and relaxation may be an effective means of offering help. In the context of increasing interest in psychological interventions for patients suffering from cancer, this article discusses the rationale for a stress management programme, incorporating relaxation techniques, for women with breast cancer. The content and implementation of the programme are described and psychological approaches including stress management and relaxation techniques for the wellbeing of patients in cancer care are outlined.