Cicely Saunders International Annual Lecture 2017
5th October 2017
On Wednesday 4th October the Cicely Saunders Institute hosted the 2017 Cicely Saunders International Annual Lecture.
Staff, students, researchers, clinical colleagues and funders were joined online by palliative care research teams in the UK, Italy, Ireland, Northern Ireland and USA to hear Dr David Kissane, of Monash University, Australia deliver a lecture entitled Hope Value and Meaning Counter Demoralization to Sustain Patients, Families and Care Team.
Dr Kissane demonstrated how demoralization differs from depression. Demoralization, defined as a mental state of lowered morale and poor coping, and characterized by feelings of hopelessness, helplessness, and loss of meaning and purpose in life differs from depression. Both demoralization and depression are treatable, but treatments differ.
There is growing recognition of the differentiation of demoralization from depression. Its clinical importance is evidenced by its association with suicidal ideation. Central to the management of demoralization is an understanding of the person. Dr Kissane described interventions such as CALM Therapy and MaP (Meaning and Purpose) Therapy and demonstrated how narrative therapy can help to identify goals and agendas that will provide meaning and purpose until the end of life.
Demoralization can be contagious – palliative care teams and families can be deeply affected by the strain of care, with clinician ‘burn-out’ being a form of demoralization. Dr Kissane also described the process of counter-transference and its impact on the care being provided by healthcare professionals.
Demoralization is also experienced in families when experiencing distress at poorly controlled symptoms; a sense of helplessness at the existential plight of their relative; the perception of loss of dignity; and the strain of care provision leading to a negative perception of the future. Family demoralization is more intense when there is less family cohesion and poorer family functioning.
Dr Kissane looked at the effectiveness of a family focussed RCT for at-risk families in palliative care and bereavement. The main effect was the prevention of prolonged grief disorder (prevalence with standard care 15.5% versus 3% with the intervention).
Dr Kissane also highlighted the impact of demoralization on capacity to consent. A disordered relation to the future impacts on decisions made in the present. If you have decided that your life is pointless and meaningless can you make a competent decision about physician assisted suicide if you are demoralized? Strong faith can protect against demoralization and spiritual interventions may help. ‘Meaning-based’ coping can make a prominent contribution to positivity and resilience: meaning is central to concepts of distress.
Dr Kissane said “Sadness, grief and acceptance of death are normal in the cycle of dying, but this is different from complete demoralization”.
The systematic review is available at: https://www.ncbi.nlm.nih.gov/pubmed/25131888
The Cicely Saunders International Annual Lecture will be available shortly on the Institute’s YouTube channel