Assessing distress in palliative care
Assessing distress in a patient with palliative care needs requires careful communication to identify causes and contributing factors, which in turn can guide management. Misunderstandings, miscommunication and limited knowledge about patient beliefs and attitudes can add to their distress.
Ask about distress in patients with palliative care needs because they may not raise these issues, and distress may not be evident—see Causes and presentation of distress in palliative care for symptoms to consider. Consider whether the patient could be experiencing symptoms of depression or anxiety that could be causing distress.
Incorporate open questions about how the patient is coping into general conversations with the patient about their care. Acknowledge and respond empathically to a patient’s feelings; convey willingness to listen to their concerns and invite them to voice concerns as they arise. Encourage patients to share further with statements such as ‘Please go on’ or ‘I would like to know more’ with genuine concern and compassion.
Explore the patient’s experiences, interpersonal relationships, sociocultural background, and spiritual and religious needs; these factors can influence distress expression and management. Questions about the patient’s beliefs and values can identify existential or spiritual distress. Examples of questions include:
- ‘What matters to you?’
- ‘What gives you meaning and purpose?’
- ‘What is the importance of spirituality or religion in your life?’ and ‘Is this providing support for you at this time?’
- ‘Are you at peace?’Steinhauser, 2006
Self-assessment needs tools (eg the Needs Assessment Tool1) and other screening tools (see examples in Principles of symptom management in palliative care) may assist in assessment, but are no substitute for comprehensive evaluation.
Carers or family members may notice symptoms. Family meetings can help identify distress and provide an opportunity for intervention.