Emotional, social, spiritual, and family issues

Patients with serious illnesses undergoing palliative care may experience many emotional, social, spiritual, and family issues. In addition to the general fear of addiction, physical symptoms, such as nausea, and increased pain, patients have general anxiety about losses they have already experienced and additional issues they might need to face.

Here is the guideline from the National Consensus Project Clinical Practice on providing emotional support in palliative care.

Domain 3: Psychological and Psychiatric aspects of palliative care

The palliative care IDT systematically addresses psychological and psychiatric aspects of care in the context of serious illness. IDTs conduct comprehensive developmentally and culturally sensitive mental status screenings of seriously ill patients. The social worker facilitates mental health assessment and treatment in all care settings, either directly, in consultation, or through referral to specialist level psychological and psychiatric care. The IDT communicates to the patient and family the implications of psychological and psychiatric aspects of care in establishing goals of care and developing a treatment plan, addressing family conflict, delivering grief support and resources from the point of diagnosis onward, and providing referrals for patients or family members who require additional support.

There are also guidelines for emotional support to the palliative care team.

Guideline1.8: Emotional support to the IDT. Providing palliative care to patients with a severe illness and their families has an emotional impact; therefore, the IDT creates an environment of resilience, self-care, and mutual support (Ferrell, 2019).

Here is a list of some of the known emotional concerns often occurring to palliative care patients about which nurses need to assess:

Emotional responses

• Fear of additional physical deterioration
  
• Loss of independence
  
• Sadness and depression
  
• Anxiety
  
• Inability to carry out certain activities
  
• Guilt about actions that contributed to the illness
  
• Changes in identity
  
• Loss of self-confidence
  
• Uncertainty
  
• Feeling unattractive

Fulton et al. (2018), from a meta-analysis of 32 randomized controlled trials with 1536 participants, found that psychotherapy in palliative care populations reduced depression (large effect) and anxiety (small effect) symptoms. Psychotherapy also improved quality of life (small effect).

The effective therapeutic approaches were cognitive-behaviorally based and therapeutic techniques such as acceptance and mindfulness. Mental health providers such as social workers and psychiatric nurses were also influential. Shorter, more frequent sessions were more effective than longer sessions.

According to a study by Plaskota et al. (2013), hypnotherapy can also effectively reduce anxiety in palliative care patients.

Spiritual

Spirituality is defined as feeling connected to self, others, community, and to a Higher Power; however, a person defines that (Hutchison, 2013). According to Rusnak (2005), when a person is diagnosed with a life-limiting illness, they may hit a "spiritual" brick wall. Some patients have prepared for the potential of a life-threatening illness and may be able to manage with their typical coping mechanisms. Others will need more assistance. A life review can often be helpful.

Any of the following questions and feelings may be occurring:

Confusion about God
Questions about suffering
Loss and grief regarding the relationship with God loved ones, and others
Loss and a diminished role in the community
Loss of independence
Questions about death and the afterlife
An altered sense of the meaning of life
Loss of previously sustained and held beliefs
Feelings of being unworthy and damaged
Anger, guilt, shame, regret

Providing spiritual care involves deep listening without judgment and placing our values on the patient's belief system. We meet the patient where he or she is at the moment.

Here are some key assessment areas with sample questions:

Social

Here are some typical social issues faced by palliative care patients. The palliative care team needs to use their resources to assist with then needs.

• Unable to shop for groceries
  
• Unable to cook
  
• Need help with cleaning and laundry
  
• Trouble mentally paying bills
  
• Need help carrying for children and maybe elderly parents
  
• Unable to participate in sexual activities

Interventions

• Listen to the fears
  
• Show empathy and compassion
  
• Work with the patient to identify family resources to provide assistance
  
• Assist with home health aides
  
• Refer to social services
  
• Identify support groups
  
• Identify patient's religious affiliations.