Existential or spiritual distress in palliative care

Existential or spiritual distress can arise when fundamental expectations, beliefs and attitudes about one’s life and self-concept are challenged. As a result, patients may struggle to make sense of their situation or find meaning and purpose to their existence.

Existential or spiritual distress may manifest as:

• loss of independence
• perceived loss of dignity
• feelings of guilt (real or unjustified), shame or anger
• a sense of meaninglessness, despair and demoralisation
• a profound sense of sadness, grief, loneliness and disconnection
• exacerbations of physical or psychological symptoms that are difficult to treat (eg severe pain not responsive to analgesic therapy)
• a perception of being a burden to othersVehling, 2018.

Patients who have religious beliefs, may express such distress in religious terms (eg ‘a crisis of faith’).

Manage existential or spiritual distress using the management principles for distress. Targeted psychotherapies such as dignity therapy, meaning-centred psychotherapy, and managing cancer and living meaningfully therapy (CALM) may be of particular benefit—see Psychosocial interventions in palliative care.

Encourage use of pastoral care, chaplaincy or spiritual support as appropriate to the patient and family preferences and belief systems.