best practice for the management of lymphoedema ... - EWMA
best practice for the management of lymphoedema ... - EWMA
best practice for the management of lymphoedema ... - EWMA
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PSYCHOSOCIAL<br />
SUPPORT<br />
FIGURE 44 Algorithm to address<br />
psychosocial problems<br />
Generalist intervention<br />
Specialist intervention<br />
Depression<br />
According to severity <strong>of</strong><br />
depression consider 48 :<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
provision <strong>of</strong> in<strong>for</strong>mation<br />
and support<br />
advice on sleep and<br />
anxiety <strong>management</strong><br />
guided self help<br />
programme<br />
problem solving <strong>the</strong>rapy<br />
cognitive behavioural<br />
<strong>the</strong>rapy (short-term)<br />
counselling (short-term)<br />
antidepressant <strong>the</strong>rapy<br />
referral to mental health<br />
services<br />
Refer to mental health<br />
services if 48 :<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
active suicidal ideas or<br />
plans<br />
psychotic symptoms<br />
severe agitation<br />
accompanying severe<br />
symptoms<br />
self-neglect<br />
poor or incomplete<br />
response to two<br />
interventions<br />
recurrent episode <strong>of</strong><br />
depression within 1 year<br />
<strong>of</strong> last<br />
patient or relatives<br />
request referral<br />
Psychosocial support<br />
Psychosocial support is an important<br />
element <strong>of</strong> <strong>the</strong> holistic treatment <strong>of</strong><br />
<strong>lymphoedema</strong>: it has <strong>the</strong> potential to have<br />
considerable influence on outcome by<br />
enhancing concordance, encouraging self<strong>management</strong><br />
and maximising quality <strong>of</strong> life.<br />
Intervention involves planning and<br />
implementing psychosocial care strategies<br />
•<br />
•<br />
•<br />
•<br />
Poor concordance<br />
with treatment<br />
Assess why<br />
Improve communication<br />
Enhance patient<br />
involvement in care<br />
Repeat or modify<br />
treatment<br />
Patient has:<br />
that help patients and <strong>the</strong>ir family/carers<br />
to take a positive role in <strong>the</strong> <strong>management</strong><br />
<strong>of</strong> <strong>the</strong>ir <strong>lymphoedema</strong> and to achieve as<br />
good a quality <strong>of</strong> life as possible (Figure<br />
44).<br />
If psychosocial problems are not resolved<br />
within three months, <strong>the</strong> patient should<br />
be referred <strong>for</strong> specialist intervention.<br />
Loneliness and isolation<br />
Are <strong>the</strong> problems resolved in 3 months?<br />
No<br />
If low motivation due<br />
to depression<br />
Poor coping<br />
No fur<strong>the</strong>r<br />
action required<br />
48 BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA<br />
No<br />
•<br />
•<br />
•<br />
•<br />
•<br />
Assess why<br />
Access patient support<br />
groups<br />
Arrange volunteer visitor<br />
Encourage family/carer<br />
involvement<br />
Institute financial/o<strong>the</strong>r<br />
measures<br />
No<br />
Refer to social worker<br />
Consider rehousing<br />
Consider home<br />
adaptations<br />
Yes<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
Assess why<br />
Provide patient<br />
in<strong>for</strong>mation<br />
Improve symptoms<br />
Arrange volunteer<br />
visitor<br />
Encourage family/carer<br />
involvement<br />
Increase pr<strong>of</strong>essional<br />
support<br />
Refer <strong>for</strong> cognitive<br />
behavioural <strong>the</strong>rapy<br />
Refer to psychologist