At a recent scientific conference in New York City, a student asked one of the scientists participating in a panel discussion on science and religion a provocative question. “Can you be a good scientist and also believe in God?” The scientist, a Nobel laureate, quickly responded: “Belief in the supernatural, especially belief in God, is not only incompatible with good science, this kind of belief is damaging to the well-being of the human race!” But disdain for religion is far from universal among scientists. Francis Collins, who directs the U.S. National Genome Research Institute and was head of the first team to map the entire human genome, is an example of a highly visible and respected scientist who also openly embraces a religious Christian faith. As palliative care clinicians and researchers, we, as well as our patients, are constantly confronted with this very dilemma: the age-old tension between faith and reason, God and science.

Perhaps I best not mention his name; his lawyers, after all, are much more familiar with The Color of Money than mine will ever be. Nevertheless, these outrageous rantings by one of Hollywood's alleged Top Guns—denouncing psychiatry and challenging the legitimacy of psychiatric illness—has got to stop.

Objective: Individuals in the helping professions are subject to unique stressors that may lead to burnout, and research has shown that those who work with dying or bereaved individuals might be particularly at-risk. This study explores how factors such as spirituality and level of training might buffer the stress of working with terminally ill clients and their families.

Method: A total of 80 medical and mental health practitioners attending palliative care seminars were surveyed, with each completing validated measures of daily spiritual experiences and caregiver burnout, as well as assessments of demographic factors, their general education and training experiences specific to working in end-of-life care and bereavement settings.

Results: Findings indicate that daily spiritual experiences might mitigate physical, cognitive, and emotional forms of burnout in the workplace. In addition, a negative correlation was found between the amount of end-of-life training received and burnout in the physical and cognitive domains. However, training was not related to professionals' level of emotional exhaustion.

Significance of the research: Results reinforce a growing literature on the salutary effects of spirituality, and underscore its relevance as one possible form of constructive coping for professionals attending to the needs of the dying and bereaved. The study carries further implications for how the stresses of such work might be ameliorated by enhanced training efforts, as well as creative facilitation of diverse spiritual expressions (e.g., inclusive forms of ritual recognition of loss) in the workplace.

Background: Sociologists, anthropologists, and psychologists agree that grief is a universal phenomenon. Reactions to it are, however, socially constructed and patterned.

Objective: To compare the outcomes of bereavement among family or close friends of deceased first-generation black Caribbean and white native-born patients living in the United Kingdom.

Design: Comparative cross-sectional questionnaire survey in three inner London health authorities administered 10 months after the patient's death.

Participants: Family and close friends of 50 deceased first-generation black Caribbean and 50 native-born white patients with advanced disease.

Main outcome measures: 28-item General Health Questionnaire (GHQ-28), Core Bereavement Items scale, a 17-item measure of grief.

Results: The intensity of grief, measured using the Core Bereavement Items was similar between the two groups. Seventy-two respondents had visited their family doctor subsequent to bereavement, and of these, black Caribbean respondents reported more psychological problems. Depression and anxiety measured by the GHQ-28 were significantly higher among black Caribbean respondents (28.00 vs. 21.2) (t-test = −2.28, p = 0.025). Multiple regression analysis revealed this difference was best accounted for by bereavement concerns such as legal and housing problems.

Conclusions: This study has observed higher psychological morbidity among the bereaved Caribbean individuals. Family doctors are a source of support for three-quarters of respondents, and they may need to focus on the needs of black and minority ethnic minorities.

Objectives: To investigate health-related quality of life (HRQOL) in children eligible for Phase 1 trials and the reasons why families consider participating in these trials.

Methods: Individual, semistructured interviews were conducted with parents (seven mothers, two fathers) and three children, after a child was invited to participate in a clinical trial. Information regarding disease and treatment progression, daily life, and decision making about experimental treatments was elicited. Interviews were recorded, transcribed, and coded for themes.

Results: HRQOL themes were grouped into four main domains: physical, psychological, social, and spiritual. Minimal physical restrictions, maintaining normalcy and control, information sharing, and having hope for life seemed to be critical HRQOL components. Hope for a cure and prolonging the child's life were the main reasons for enrolling in Phase 1 trials.

Conclusions: Normalcy and control are key end-of-life HRQOL components, and hope for life is a main reason for participating in Phase 1 trials.

Little is known about the role of exercise in improving cancer patients' mood while undergoing chemotherapy. In this phase II study changes in self-reported anxiety and depression and fitness (VO2max) are reported in relation to a 6-week, 9 h weekly, multidimensional exercise program. A total of 91 patients receiving chemotherapy, between 18 and 65 years old, completed a Hospital Anxiety and Depression Scale Questionnaire (HADS; response rate 91%, adherence rate 78%). Anxiety (p < 0.001) and depression (p = 0.042) was significantly reduced. The mean ± SD of the change was −1.14 ± 2.91 for anxiety and −0.44 ± 2.77 for depression. Improvements in fitness were correlated with improvements in depression, χ2(1) = 3.966, p = 0.046, but not with improvements in anxiety, χ2(1) = 0.540, p = 0.462. The research suggests that exercise intervention may have a beneficial impact on psychological distress for cancer patients receiving chemotherapy with low to moderate levels of baseline psychomorbidity. The study furthermore indicates that changes in distress may be associated with disease status and levels of physical activity undertaken during disease. The study is followed up by an ongoing randomized clinical controlled trial to evaluate potential causal effects of exercise intervention on psychological distress and fitness in cancer patients undergoing chemotherapy.

Objective: The purpose of this research was to investigate outcome expectation and self-regulation measures within a sample of cancer patients and to explore relationships of these variables with benefit finding. The outcome expectation and self-regulation measures were evaluated for reliability and initial factor structure.

Method: A convenience sample of 141 cancer patients completed study measures while waiting for appointments at a cancer center.

Results: The measures demonstrated good reliability (alphas = .88 and .92, for outcome expectation and self-regulation respectively). Initial factor structure suggested six outcome expectation factors (managing symptoms, expressing emotions, talking about cancer, learning about cancer, managing self-image, and managing needs) and one self-regulation factor. Gender and treatment status were related to outcome expectations but not self-regulation. Outcome expectations and self-regulation were significant predictors of benefit-finding, F(8, 80) = 3.1, p = .005.

Significance of the research: Measures of outcome expectations and self-regulation are reliable, are related to gender and clinical variables, and may be useful as predictors of cancer patients' ability to find benefits in their cancer experience.

There have been intensive debates about euthanasia and attempts to change laws on euthanasia in all countries. What doctors and particularly oncologists think about euthanasia must be taken into consideration, as their voices are crucial in this dialogue. The aim of this study was to find out how Turkish doctors approach euthanasia in the context of cancer. A questionnaire was used to collect data from 85 oncologists out of a total 800 in active oncology practice.

Of the oncologists surveyed, 43.8% did not object to euthanasia. Some 33.7% had been asked to perform euthanasia and 41.5% believed that euthanasia was performed secretly although it is against the law in Turkey. Forty-two doctors (50.6%) noted that they had withdrawn treatment in patients.

Doctors who encounter terminally ill patients with cancer should update their knowledge about patients' rights and euthanasia. Doctors, who are often asked to perform euthanasia, especially in the cancer setting, can help to illuminate the debates about euthanasia.

Objectives: To review the existing literature of atypical antipsychotics in the treatment of delirium and make recommendations regarding their use in the treatment of delirium.

Methods: I conducted a literature search in Pubmed, Psychlit, and Embase for studies using atypical antipsychotics in the treatment of delirium. In the absence of studies, case reports were used.

Results: Overall 13 studies examined the use of risperidone, olanzapine, and quetiapine, two cases were reported about ziprasidone, and no publication was found using aripiprazole in the treatment of delirium. Among the existing studies were retrospective and prospective, open label studies in addition to one with a double blind design using risperidone. Risperidone, olanzapine, and quetiapine may be all similarly effective in the treatment of delirium, whereas there may be limited efficacy in the use of olanzapine in the hypoactive subtype of delirium in elderly populations, which may generalize to the other atypical antipsychotics. The use of atypical antipsychotics in the treatment of delirium is safe and carries a low burden of side effects.

Significance of results: Although atypical antipsychotics are widely used in the treatment of delirium, well-designed studies do not exist. Among the existing studies, stronger data supports the use of risperidone and olanzapine, and also quetiapine may be considered in the treatment of delirium. Recommendations are made based on the existing data and literature. The need for well-designed studies to validate the use of atypical antipsychotics in the treatment of delirium continues.

Under a traditional medical model, discussion of issues related to death and dying are usually avoided with clients who hold a psychiatric diagnosis. Too often the result is that individuals in inpatient, psychiatric facilities are left to face grief without emotional or spiritual support. With its focus on the individual, family, and community involvement, and fostering independence, the psychosocial model affords an opportunity to change how mental health professionals address the topic of death. In this article the authors give practical suggestions for working with clients who are dying or who have experienced the death of a loved one. Two case studies are used to illustrate how these ideas can be translated into action.

According to the Journal of Pain and Palliative Care Pharmacology, 25–88% of all hospice patients, caregivers, and hospice staff will observe significant changes in a patient's behaviors. Some of the changes include picking at sheets or Depends, restlessness movements of the arms and legs, confusion, tight clutching at caregiver's hands, and twitching and jerking. These signs are usually categorized as terminal restlessness. Sometimes, the cause is a medical condition that can be treated.

Prayer for Cicely.

Clinical update: Literature abstracts.

Calendar of events.