Managing distress in palliative care

Managing distress in palliative care involves identifying cause(s) and, if possible, addressing them. Management is guided by a consideration of the potential benefits, burdens and availability of treatment, and the patient’s stage of illness, ability to participate in management, preferences and goals of care—see Principles of symptom management in palliative care.

Adjustment to changed circumstances takes time and requires reassessment of life goals and the future. Encourage patients to participate in daily life and accept offers of help.

Psychosocial support can improve quality of life. Psychosocial interventions in palliative care lists common psychosocial interventions used in palliative care. Psychosocial interventions can be provided by a range of professionals—see Psychosocial, spiritual and other support for patients with palliative care needs.

Severe distress with multiple causes affecting the entire family may require multimodal treatment, delivered by a multidisciplinary team, including a palliative care physician. For advice on supporting families and carers, see Family support in palliative care and Support for carers in palliative care.

Healthcare professionals may at times feel unable to deal with the level or intensity of distress experienced by patients—see Healthcare professional wellbeing in palliative care. For measures to help build resilience and prevent stress and burnout in healthcare, see Building resilience and reducing the risk of stress and burnout in healthcare professionals.

Figure 1. Psychosocial interventions in palliative care

education about the life-limiting illness and symptom management, including:

  • an explanation of current and future treatment needs
  • an assurance of continuity of support and treatment from the healthcare team when possible (especially during care transitions)

supportive counselling, which involves:

  • exploring and addressing the patient’s distress, fears and concerns, while acknowledging realistic fears and anxiety
  • promoting realistic hope (eg good symptom management)
  • assisting the patient to cope with the personal and social impact of their disease, including strategies to find meaning and purpose
  • promoting connection and involvement in supportive relationships and networks
  • examining ways to help the patient maintain a sense of dignity
  • engaging family and carers in the care of the patient
  • providing an explanation to the patient, family and carers about the nature of distress and its impact on the patient (eg greater apprehension, reliance on others)

relaxation techniques

mindfulness

structured problem solving—helps to identify and reinforce personal resources (eg strengths) and effective coping strategies

psychotherapies (these therapies require specific training), including:

  • supportive-expressive psychotherapy—involves creation of a positive, helpful, empathic relationship with a therapist, which enables the patient to openly express their thoughts and feelings, understand their situation, and consider potential changes in their behaviours and interactions or practical solutions to their problems
  • cognitive behavioural therapy—helps the patient identify and target unhelpful thoughts, emotions and behaviours [NB1]
  • meaning-centred psychotherapyBreitbart, 2014—aims to enhance meaning, spiritual wellbeing and quality of life through awareness of attitudes, connection to others, and legacy
  • dignity therapyChochinov, 2011—aims to alleviate psychological and existential distress at end of life
  • Managing Cancer and Living Meaningfully (CALM) therapyRodin, 2018—aims to alleviate distress and promote psychological wellbeing in patients with advanced cancer
  • couples therapy or family therapyKissane DW, 2011 for strained relationships or family conflict—emphasises relationships as an important factor in psychological health, and can help to improve the patient’s symptoms and level of functioning of a relationship [NB2]

complementary therapies (journaling, music, art, biography)

social support, including assistance with practical matters (eg finance, housing, transport, care of dependents)—may need social work intervention or referral to agencies

support lines and groups—for a list of disease-based organisations and support groups, see the CareSearch website

Note:

NB1: For more information on cognitive behavioural therapy, see Cognitive behavioural therapy in the Psychotropic guidelines.

NB2: For more information on family interventions and family therapy, see Family interventions and family therapy in the Psychotropic guidelines.