Overview
Suffering has been described as a psychological or spiritual condition that robs individuals of their capacity to find solace or peace in their present state. [1] Cassell (1982) wrote about the nature of suffering defining it as an actual or perceived impending threat to personal integrity. He observed that modern medicine in its practice unwittingly contributed at times to patient suffering. [2] He later emphasised that to know the suffering of others demands an exhaustive understanding of what makes them the individuals they are. [3]
The prevalence of suffering amongst patients with advanced cancer has been recently measured. While almost half of the 381 Canadian respondents did not consider themselves to be suffering, one quarter were suffering at a moderate-to-extreme level. [4]
Suffering may occur in the palliative context when there is:
- Uncontrolled pain or other symptoms
- Transition from active or curative to palliative care
- Inability to maintain control of the disease process
- Increasing loneliness and isolation.
Important contributing factors include:
- Sense of dread of the unknown
- Loss of equilibrium and being overwhelmed by life’s circumstances
- Family distress or dysfunction
- Spiritual or existential concerns
- Co-morbid depression and / or severe anxiety.
Key messages
Suffering is a multidimensional experience related most strongly to physical symptoms, but with contributions from psychological distress, existential concerns, and social-relational worries.
Active research areas
- The strength of the patient doctor relationship has been emphasised in writings on the nature of suffering. [1,2]
- Research into the nature of suffering is gaining momentum. [5] It continues to be conceptually explored. [6,7] The research however is still not population specific so that our understanding of the nature of suffering at particular phases of the life cycle is still poor.
- The first validated scale to measure suffering at the end of life has now been reported from an Israeli research group. [8] The research team recommends its use by an interdisciplinary team for initial assessment into palliative care. The team considers it can also be used as a continuous clinical audit tool.
Finding out more
Related CareSearch Pages
Existential Distress
Dignity Conserving Care
References
- Williams BR. Dying young, dying poor: a sociological examination of existential suffering among low-socioeconomic status patients. Journal of Palliative Medicine 2004 Feb;7(1):27-37.
- Cassell EJ. The nature of suffering and the goals of medicine. New England Journal of Medicine 1982 Mar 18;306(11):639-645.
- Cassell EJ. The nature of suffering and the goals of medicine. Oxford: Oxford University Press; 1991
- Wilson KG, Chochinov HM, McPherson CJ, LeMay K, Allard P, Chary S, et al. Suffering with advanced cancer. Journal of Clinical Oncology 2007 May 1;25(13):1691-7.
- Lethborg C, Aranda S, Cox S, Kissane D. To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliative and Supportive Care 2007 Dec;5(4):377-388
- Chochinov HM. Dying, dignity, and new horizons in palliative end-of-life care. CA: a Cancer Journal for Clinicians 2006 Mar-Apr;56(2):84-103.
- Breitbart W. Upright and whole: an approach to suffering in the face of death. Palliat Support Care. 2007 Dec;5(4):347-9
- Adunsky A, Zvi Aminoff B, Arad M, Bercovitch M. Mini-Suffering State Examination: suffering and survival of end-of-life cancer patients in a hospice setting. American Journal of Hospice & Palliative Medicine 2007 Dec–2008 Jan;24(6):493-498.
This page was created on 14 May 2008 and is due fore review in May 2010