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Recognizing and Addressing Emotional Distress in Palliative Care

This presentation by Lucy Kukac on April 27, 2011, explores the concept of emotional distress as the sixth vital sign in palliative care. It delves into the various emotions and issues patients face, emphasizing the importance of early detection and intervention. Tools such as screening toolkits like Canadian Problem Checklist and ESAS are discussed, along with the BATHER framework for assessing distress. The ultimate goal is to improve communication, support, and emotional well-being for patients and families in managing illness.

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Recognizing and Addressing Emotional Distress in Palliative Care

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  1. Emotional Distress: The Sixth Vital Sign Presented by: Lucy Kukac April 27, 2011 Central Hospice Palliative Care Network Networking Day

  2. What is Emotional Distress? • Unpleasant emotions or cognitions that may interfere with the ability to cope with a disease, its physical symptoms, and its treatment • Wide range of feelings: • Worry, powerless, sadness, fear, depression, anxiety, panic, loneliness, etc.

  3. Why Focus on Psychosocial Issues? • 35% of people diagnosed with cancer experienced clinically significant distress (1994) • Family members also feel the same or more emotional distress • Often unnoticed/unrecognized and untreated by healthcare providers

  4. Importance of Early Detection • Emotional distress interferes with patients ability to cope • Illness trajectory is difficult • Diminishes patient’s quality of life • Early screening helps to identify emotional issues • Interventions can be offered • Assist patient with coping

  5. Recognition of Emotional Distress • Importance of emotional distress is finally being recognized by healthcare providers • Development of screening tools • Patience satisfaction surveys • Emotional distress scores the lowest on NCR Picker Surveys across Ontario

  6. Effects of Emotional Distress

  7. Practical: o Work/School o Finances o Getting to and from appointments o Accommodation Emotional: o Fears/Worries o Sadness o Frustration/Anger o Changes in appearance o Intimacy/Sexuality Spiritual: o Meaning/Purpose of Life o Faith Social/Family: o Feeling a burden to others o Worry about family/friends o Feeling alone Informational: o Understanding my illness and/or treatment o Talking with the health care team o Making treatment decisions o Knowing about available resources Physical: o Concentration/Memory o Sleep o Weight Screening Toolkit: Canadian Problem Checklist Please check all of the following item that have been a concern or problem for you in the past week including today:

  8. Screening Toolkit • Distress Thermometer

  9. Screening Toolkit: ESAS • Edmonton Symptom Assessment Scale • Well-being • Anxiety • Depression

  10. Screening Toolkit: BATHER • Background • Affect • Trouble • Handling • Empathy • Response/Renewal/Referral

  11. BATHER: Background • Beginning to understand the situation WHAT DOES THIS MEAN?

  12. BATHER: Affect • Feeling and state

  13. BATHER: Trouble • Seek to understand what is troubling the patient about the symptoms or situation

  14. BATHER: Handling • Getting an idea of how the patient is functioning/coping with the situation

  15. BATHER: Empathy • Indicating appreciation, understanding, and acceptance of someone else’s emotional state

  16. BATHER: Review/Response/Referral • Review • What have you learned from your patient? • Response • Support patient, offer coping strategies, problem solve • Referral • Support services, counselling

  17. Use of BATHER • Being used at Princess Margaret • Should be considered in care at HRRH • All care should ensure provision of appropriate psychosocial interventions

  18. Our Goal • Facilitate effective communication between patients, families, and care providers • Effective family meetings • Design and implement plan of care • Engage and support patients and families in managing their illness • Attain emotional well-being

  19. Our Role as Healthcare Providers • Frontline for patients and families • Main source of support and strength • In a position to gain trust • Build a therapeutic relationship • Contribute to holistic care and well-being of patients and family members

  20. In Conclusion Who is there in all the world who listens to us? Here I am- this is me in my nakedness, with my wounds, my secret grief, my despair, my betrayal, my pain, which I can’t express, my terror, my abandonment. Oh, listen to me for a day, an hour, a moment, lest I expire in my terrible wilderness, my lonely silence. Oh God, is there no one to listen? (Seneca)

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