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      Luto antecipatório em pacientes com indicação para o Transplante de Células-Tronco Hematopoéticas Translated title: Anticipated grieving in patients requiring Hematopoietic Stem Cell Transplantation

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          Abstract

          O objetivo deste estudo foi compreender como o processo de luto antecipatório se instala em pacientes a serem submetidos ao Transplante de Células Tronco-hematopéticas (TCTH). Foi realizado um estudo transversal, na abordagem clínico-qualitativa. Amostra de 17 pacientes, a maioria mulheres casadas, entre 20 e 42 anos de idade e diagnóstico de Leucemia Mieloide Crônica. Dados coletados por um roteiro de entrevista semiestruturada, aplicado individualmente e submetidos à análise de conteúdo temática. Os resultados indicam que a perda da saúde impõe um luto em uma história de vida já permeada por privações e perdas prematuras. Constatou-se que as reações esperadas frente ao luto normal foram expressas pelos participantes e que a estratégia de enfrentamento privilegiada foi o apego à fé. Os planos futuros envolviam alcançar a cura, retorno à normalidade e reinserção profissional. Os resultados podem auxiliar as equipes multiprofissionais a compreenderem as implicações emocionais do adoecimento/tratamento para implantação de estratégias preventivas e interventivas. Como pontos críticos, a equipe deve atentar para a forma de comunicar o diagnóstico e a possibilidade de traçar um plano terapêutico que mantenha vivo o espírito de luta do paciente, reforçando o elo de confiança com os profissionais de saúde.

          Translated abstract

          The scope of this study was to understand how the process of anticipated grieving is imbued in patients undergoing Hematopoietic Stem Cell Transplantation (HSCT). A cross-sectional clinical-qualitative study was conducted on a sample of 17 patients, mostly women, married, aged between 20 and 42 years and diagnosed with Chronic Myeloid Leukemia. Data was collected by semi-structured interviews applied individually and subjected to thematic content analysis. The results indicate that the loss of health imposes a new challenge in a life history already permeated by great hardships and premature losses. It was found that the expected reactions faced with normal grieving were expressed by the participants and that the most prevalent coping strategy was holding steadfast to their faith. Future plans involved being healed, returning to normality and vocational rehabilitation. The results may help the multidisciplinary teams to understand the emotional implications of the illness/treatment for implementing both preventive and intervention strategies. The critical aspect is that staff must be attentive as to how to communicate the diagnosis and the possibility of outlining a therapeutic plan, in order to augment the fighting spirit of the patient and strengthen the bond of trust with health professionals.

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          Most cited references34

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          Stress, Appraisal, and Coping

          Here is a monumental work that continues in the tradition pioneered by co-author Richard Lazarus in his classic book Psychological Stress and the Coping Process. Dr. Lazarus and his collaborator, Dr. Susan Folkman, present here a detailed theory of psychological stress, building on the concepts of cognitive appraisal and coping which have become major themes of theory and investigation.As an integrative theoretical analysis, this volume pulls together two decades of research and thought on issues in behavioral medicine, emotion, stress management, treatment, and life span development. A selective review of the most pertinent literature is included in each chapter. The total reference listing for the book extends to 60 pages.This work is necessarily multidisciplinary, reflecting the many dimensions of stress-related problems and their situation within a complex social context. While the emphasis is on psychological aspects of stress, the book is oriented towards professionals in various disciplines, as well as advanced students and educated laypersons. The intended audience ranges from psychiatrists, clinical psychologists, nurses, and social workers to sociologists, anthropologists, medical researchers, and physiologists.
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            Psychological responses of patients receiving a diagnosis of cancer.

            Current recommendations on how to break bad news are primarily based on expert opinion. Little is known about the association between communication practices and patients' psychological response. One-hundred and thirty-one patients with newly diagnosed melanoma were surveyed 4 months after the initial consultation at the Sydney Melanoma Unit regarding their communication experiences and their satisfaction with these experiences. They completed the Hospital Anxiety and Depression Scale (HADS) at this time, and 4 and 13 months later. Both patients' satisfaction with communication and their psychological morbidity were found to be associated with particular communication practices. Practices linked to lower anxiety included preparing the patient for a possible diagnosis of cancer; having the people wanted by the patient present to hear the diagnosis; giving the patient as much information about the diagnosis as desired; providing written information; presenting the information clearly; discussing the patient's questions the same day; talking about the patient's feelings; and being reassuring. Practices linked with lower levels of depression included using the word 'cancer'; discussing the severity of the situation, life expectancy and how the cancer might affect other aspects of life; and encouraging the patient to be involved in treatment decisions. This study provided preliminary evidence that communication strategies recommended in the literature produce positive patient outcomes. Further studies are needed which document actual communication.
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              Apoio psicológico na terminalidade: ensinamentos para a vida

              Em meio à crescente negação do sofrimento humano na contemporaneidade, a morte é cada vez mais banida do cotidiano e confinada aos hospitais. O presente trabalho tem por objetivo relatar uma experiência de intervenção psicológica junto a um paciente portador de leucemia linfoide aguda, uma doença potencialmente fatal, focalizando o acompanhamento proporcionado ao longo do seu tratamento, do diagnóstico à ausência de possibilidades terapêuticas, até o momento de sua morte, em uma enfermaria de um hospital geral, no contexto dos cuidados paliativos. O corpus do trabalho foi constituído pelo material clínico sistematizado a partir das intervenções psicológicas ocorridas no período de dois anos (2001-2003). Procurou-se compreender as fases do luto vivenciadas pelo paciente e a construção de possibilidades de intervenção psicológica na proximidade da morte. A possibilidade de acompanhar todas as etapas do adoecer, culminando com o momento da morte, configurou-se como uma experiência única e transformadora tanto para o paciente como para a psicóloga que o assistiu em sua despedida.
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                Author and article information

                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                September 2013
                : 18
                : 9
                : 2567-2575
                Affiliations
                [01] Ribeirão Preto SP orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto orgdiv2Hospital das Clínicas Brazil erikaao@ 123456ffclrp.usp.br
                [02] orgnameUniversidade de São Paulo orgdiv1Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto orgdiv2Departamento de Psicologia Brazil
                Article
                S1413-81232013000900011 S1413-8123(13)01800900011
                c4f5b16c-d6dc-4536-90a1-12a13a1161eb

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 30 April 2013
                : 04 June 2013
                : 22 May 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 9
                Product

                SciELO Brazil

                Categories
                Artigo

                Morte,Stem cells,Grieving,Death,Células-tronco,Transplante de medula óssea,Luto,Bone marrow transplant

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