Behavioral Management of Sleep-disordered Breathing

The goal of palliative medicine is to actively treat distressing symptoms that are associated with advanced illness. Pain and other physical symptoms, emotional and spiritual distress, and caregiver burden become the focus of the palliative care team. As a physical illness progresses, patients and their caregivers may experience increasing or continual emotional distress caused by the awareness of a limited prognosis. Psychotherapy is a psychological intervention that can help patients and caregivers improve coping and reduce the suffering resulting from the awareness that death may be near. It can also be used effectively to improve communication between patients and other members of the treatment team. The delivery of psychotherapy in the palliative care setting requires a modification of the traditional outpatient model. This article reviews conceptual and clinical issues related to psychotherapy in the palliative care setting and offers suggestions that can be utilized by clinicians working with palliative care patients and their caregivers. Traditionally, the various schools of psychotherapy have not focused on patients with advanced illness who may be facing death. Palliative care brings unique demands and perspectives to the psychotherapeutic process. This article reviews conceptual and clinical issues that arise in this setting.