Real World Experience of Change in Psycho-Existential Symptoms in Palliative Care

J Pain Symptom Manage. 2023 Sep;66(3):212-220.e2. doi: 10.1016/j.jpainsymman.2023.05.015. Epub 2023 Jun 7.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia
  • Hospice and Palliative Care Nursing*
  • Humans
  • Palliative Care / psychology
  • Stress, Psychological / psychology
  • Terminal Care* / psychology