Real world experience of change in psycho-existential symptoms in palliative care
Publication Details
Kissane, D.,
Bobevski, I.,
Appleton, J.,
Michael, N.,
King, T.,
Moss, G.,
Eng, D.,
White, A.,
Carboon, D.,
Eade, R.,
&
Keighley, L.
(2023).
Real world experience of change in psycho-existential symptoms in palliative care.
Journal of Pain and Symptom Management,.
Abstract
Context
Psycho-existential symptoms in palliative care are addressed insufficiently. Routine screening, ongoing monitoring and meaningful treatment of psycho-existential symptoms may contribute to the relief of suffering in palliative care.
Objectives
We sought to explore longitudinal change in psycho-existential symptoms following the routine implementation of the Psycho-existential Symptom Assessment Scale (PeSAS) in Australian palliative care services.
Methods
Using a multisite rolling design, we implemented the PeSAS to longitudinally monitor symptoms in a cohort of 319 patients. We assessed change scores for each symptom in groups with mild (≤3), moderate (4–7) and severe (≥8) symptomatology at baseline. We tested significance between these groups and used regression analyses to identify predictors.
Results
While one half of patients denied clinically important psycho-existential symptoms, for the remainder, overall, more patients improved than deteriorated. Between 20% and 60% of patients with moderate and severe symptoms improved, while another 5%–25% developed new symptom distress. Patients with severe baseline scores improved significantly more than those with moderate baseline scores.
Conclusion
As we better recognize through screening patients carrying psycho-existential distress in palliative care programs, there is considerable room for improvement in ameliorating this suffering. Inadequate clinical skills, poor psychosocial staffing or a biomedical program culture may all contribute to inadequate symptom control. Person-centered care necessitates greater attention to authentic multidisciplinary care that ameliorates psycho-spiritual and existential distress.
Keywords
Existential, palliative care, psychological symptoms, screening, symptom treatment
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