Suffering has been described as a psychological or spiritual state that can diminish an individual’s capacity to find solace or peace in their present situation.  According to Cassell 'suffering occurs when an impending destruction of the person is perceived; it continues until the threat of disintegration has passed or until the integrity of the person can be restored in some other manner.' He observed that modern medicine in its practice can unwittingly contribute at times to patient suffering.  He later emphasised that to appreciate the suffering of others requires a full understanding of the personal narrative of the individual.  Suffering can engender a 'crisis of meaning'  or a spiritual re-evaluation of life’s ultimate importance. Although suffering is widely experienced by palliative care patients, it is often concealed by the individual and not recognised by others.
Important contributing factors include:
Screening of distress is still under development and recommendation of which tool to use depends on context of use. [8,9]
Two major considerations relevant to suffering in the palliative care context are existential distress and the impact of dignity conserving care. Evidence relating to these and their treatment is considered separately in the accompanying pages.
Last updated 27 August 2021