Research on psychological and social factors in palliative care: an invited commentary.
BACKGROUND
Psychosocial factors are a major determinant of well-being in patients with advanced disease. However, the development of valid and reliable measures of meaningful and relevant outcomes and randomized controlled trials to assess the impact of novel interventions are relatively recent accomplishments.


OBJECTIVE
To discuss significant developments in psychosocial research, including work of the author, in palliative populations and to identify areas where uncertainty and controversy persist.


METHODS
The impact of systematic research on psychosocial factors in palliative care over the past four decades is discussed. Particular attention is paid to the development of relevant measures of psychological outcomes and to the results of pilot studies and randomized controlled trials of psychosocial interventions.


RESULTS
A variety of factors, including methodological limitations, protective attitudes of health-care providers, and the progressive deterioration of patients with terminal disease, have presented obstacles to psychosocial research in palliative care. The more recent development of valid and reliable measures of psychological distress and psychological well-being has significantly advanced research in the field. Pilot studies and randomized controlled trials of psychosocial interventions have yielded promising results, although the demonstrated impact on primary outcomes in these studies has typically been modest.


CONCLUSIONS
Psychosocial research in palliative care has grown in rigor and volume over the past several decades, and a variety of novel interventions have been developed and evaluated. However, the findings from this research have only begun to have an impact on clinical practice in palliative care.
Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Gary
G
Rodin
D006302:Health Services Research / Q000379:methods*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods; D010166:Palliative Care / Q000379:methods / Q000523:psychology*; D010865:Pilot Projects; D011613:Psychotherapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012944:Social Support; D019452:Terminally Ill / Q000523:psychology
Palliative care; psychological factors; psychosocial factors; research