Helping people cope with the challenges of a life-limiting illness 

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Psychosocial and spiritual support is a common need for people affected by a life-limiting illness. Identifying and addressing these needs is an integral part of palliative care.

What it is

Psychosocial care attends to the psychological and social aspects of a person’s life. Psychological characteristics include emotions, thoughts, attitudes, motivation, and behaviour. Social aspects include the way in which a person relates to and interacts with their environment. This includes a person’s sense of identity, relationships and living arrangements.

A psychosocial approach looks at a person in the context of their psychological status and the surrounding social environment and the way they influence the person’s physical and mental health and ability to function.

Why it matters

As palliative care seeks to address the physical, psychological, social, and spiritual needs of the person and their family and carers, psychosocial care is a fundamental part of this.

In practice

Nurses are in a unique position to monitor for psychosocial care needs and distress. By building rapport, nurses can begin to understand how patients view themselves, what is important to them, and how their relationship with others may affect their decisions and their ability to live as they approach death.

Good communication and assessment skills can help nurses develop a strong relationship with the person and their family. A structured and holistic assessment enables nurses to identify the needs of people in their care and help connect them to services that can provide appropriate support.

It is not uncommon for people to require repeated conversations to make sense of new information or changes, particularly if they are anxious. Allow them to ask questions, repeat information and offer a space for people to absorb and understand their situation. This can help prevent misunderstandings, alleviate worries, and decrease feelings of isolation.

Applying a “total” approach to symptoms helps to understand the symptom(s) within the person’s context. For example, management of pain or breathlessness may need to consider the relationship with the person’s feelings such as anxiety, fear, guilt, and anger or worries about the family. Responding to changes in appetite may need to consider the social and cultural attitudes of the person and their family to eating and drinking.

Physical symptoms can indicate possible psychosocial needs include:

A psychosocial needs assessment can include different questions depending on the person and the context of care. The Palliative Care Network of Wisconsin has suggestions on what to say when assessing psychosocial needs including the person’s:

  • thoughts and feelings about illness, treatment, and care
  • social context
  • lived experience of illness, impact on self, others, and quality of life.
  • suffering and considerations across the existential/spiritual domain.

Assessment tools

The validated tools available to assess and monitor psychosocial needs include:

If you use a tool, continue to use the same tool to monitor for change.

In supporting a person’s psychosocial needs nurses can:

  • use the fundamental skills of nursing care such as active listening, comforting touch (as appropriate), empathy, and encouragement.
  • listen to concerns and acknowledge and respond empathically to feelings that are expressed
  • ask open questions to invite the person to talk about how they are feeling.
  • encourage the person to talk about their fears and worries in a calm, private and safe environment.
  • listen actively and without judgement.
  • acknowledge how the person is feeling and find out how they prefer to be supported emotionally.
  • be prepared for people in their care to cry. Crying is a common emotional response and expression of distress. If a person cries suddenly, avoid feeling pressured to 'say the right thing' and sit with them in silence. Showing empathy, offering respectful physical touch, and offering a chance to talk, are good ways to support a person who is crying.
  • encourage the person to think about how they want to be cared for; this may help them feel more in control.
  • for people who are vulnerable or face barriers to accessing care, identify someone to assist with communication between palliative care services and other services (mental health, disability support, social services).

Psychosocial interventions

Psychosocial interventions should address the specific needs of the person, whether it is ways to cope with symptoms, enhance their sense of dignity, or start a difficult conversation with healthcare providers about prognosis and treatment.

Common psychosocial interventions used in palliative care include

  • cognitive-behavioural therapy
  • dignity therapy and life review
  • creative-arts-based therapies
  • music therapy
  • counselling
  • mindfulness
  • education.

These interventions may need to be brief to improve quality of life and reduce emotional and existential distress in end-of-life care.

This information was drawn from the following resources:

  1. Ahmed N, Ahmedzai SH, Collins K, Noble B. Holistic assessment of supportive and palliative care needs: The evidence for routine systematic questioning. BMJ Support Palliat Care. 2014 Sep;4(3):238-46. doi: 10.1136/bmjspcare-2012-000324. Epub 2014 Jan 10.
  2. Butow P, Price MA, Shaw JM, Turner J, Clayton JM, Grimison P, et al. Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psychooncology. 2015 Sep;24(9):987-1001. doi: 10.1002/pon.3920. Epub 2015 Aug 13.
  3. Kamal AH, Gradison M, Maguire JM, Taylor D, Abernethy AP. Quality measures for palliative care in patients with cancer: a systematic review. J Oncol Pract. 2014 Jul;10(4):281-7. doi: 10.1200/JOP.2013.001212. Epub 2014 Jun 10.
  4. Lee JZJ, Chen HC, Lee JX, Klainin-Yobas P. Effects of psychosocial interventions on psychological outcomes among caregivers of advanced cancer patients: a systematic review and meta-analysis. Support Care Cancer. 2021 Dec;29(12):7237-7248. doi: 10.1007/s00520-021-06102-2. Epub 2021 Jul 8.
  5. Lloyd-Williams M, editor. Psychosocial issues in palliative care: A community based approach for life limiting illness. 3rd ed. Oxford: Oxford University Press; 2018.
  6. Lloyd-Williams M, editor. Psychosocial issues in palliative care. 2nd ed. Oxford: Oxford University Press; 2008.
  7. Palliative Care Australia (PCA). National palliative care standards. 5th ed. Canberra: PCA; 2018.
  8. Palliative Care Australia (PCA). National palliative care standards for all health professionals and aged care services: For professionals not working in specialist palliative care. Canberra: PCA; 2022.
  9. Park CL, Pustejovsky JE, Trevino K, Sherman AC, Esposito C, Berendsen M, et al. Effects of psychosocial interventions on meaning and purpose in adults with cancer: A systematic review and meta-analysis. Cancer. 2019 Jul 15;125(14):2383-2393. doi: 10.1002/cncr.32078. Epub 2019 Apr 29.
  10. Teo I, Krishnan A, Lee GL. Psychosocial interventions for advanced cancer patients: A systematic review. Psychooncology. 2019 Jul;28(7):1394-1407. doi: 10.1002/pon.5103. Epub 2019 May 23.
  11. Therapeutic Guidelines Limited. Psychological symptoms in palliative care [Internet]. 2016. [cited 2022 Aug 11].
  12. Warth M, Kessler J, Koehler F, Aguilar-Raab C, Bardenheuer HJ, Ditzen B. Brief psychosocial interventions improve quality of life of patients receiving palliative care: A systematic review and meta-analysis. Palliat Med. 2019 Mar;33(3):332-345. doi: 10.1177/0269216318818011. Epub 2019 Jan 16.
  13. World Health Organization (WHO). Palliative care [Internet]. 2020 Aug 5. [cited 2022 Aug 11].

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