Overview of emotional, psychological and behavioural symptoms in palliative care
Patients with palliative care needs face many challenges including:
- change of roles and functions in family, social relationships and work
- physical symptoms and changes in bodily functions
- coping with healthcare needs and treatments (eg drugs, chemotherapy, radiotherapy, surgery)
- navigation of the healthcare system, including relationships with healthcare professionals
- loss and grief
- how to find meaning and purpose in life
- fear of death and the experience of dying.
These challenges can significantly disrupt the lives of patients, and the associated strain can potentially result in a range of presentations from mild intermittent distress to acute agitation or development of a psychiatric disorder.
Assess the emotional and psychological needs of patients with palliative care needs and manage identified symptoms (eg distress, depression, anxiety). Effective management can improve quality of life, the experience of dying, and the grieving process.
Comprehensive assessment of emotional and psychological needs involves:
- exploring the patient’s experience of their illness and its consequences on their emotional and psychological health and wellbeing
- identifying physical symptoms (eg fatigue, pain, nausea)—some patients express distress physically rather than emotionally
- identifying psychiatric disorders (current and previous) or disorders of substance use—the added stress of a life-limiting illness can increase symptom frequency or severity, or contribute to a relapse.
Symptom screening tools can help identify and monitor a variety of symptoms when used alongside a clinical history and examination—see Symptom assessment in palliative care for commonly used screening tools.
Closely monitor patients with pre-existing and current psychiatric disorders for changes in mental state and optimise management to maintain stability and function. Patients with severe or longstanding psychiatric disorder in particular can be at an increased risk of relapse—consult with their psychiatrist or mental health team for management. For management of comorbidities in palliative care, see Approach to managing comorbidities in palliative care.
Although cannabinoids are being used, at the time of writing, cannabinoids are not recommended for treatment of psychological symptoms in palliative care. There is insufficient evidence of benefit, and they may cause harmBlack, 2019Mucke, 2018Therapeutic Goods Administration (TGA), 2017.
Many families1 and carers of patients with palliative care needs also experience significant emotional and psychological symptoms which are often under-recognised. Assess how families and carers are coping and determine if any support is required; see Family support in palliative care and Support for carers in palliative care.