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

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.


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:

Key Assessment Areas Sample Question
Concept of god  or deity Is religion or God significant to you?
Sources of hope and strength

Why do youturn to when you need help?
Are they always available?

Important religious practices Are any religious practices important to you?
Relationship between spiritual beliefs and health Has being sick made any differencein your feelings about god or the practice of your faith?
(Benorden, M. 2016)


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.


Instant Feedback:

Deep listening without judgment or placing values on a patient's belief system is a helpful intervention.



Anderson, L. (2011). Psychosocial support for the palliative care patient.
Wound Essentials.6, 84-86.

Benorden, M. (2016). Reflections on conducting a spiritual assessment: An interdisciplinary approach for palliative care professionals. National Hospice and Palliative Care Organization.

Burzotta, L. & Noble, H. (2010). Providing psychological support for adults living with cancer. End of Life Care 4(4), 9–16.

Hearn, F., Jackman, E., Lake, T., Popplestone-Helm, S. & Young, A. (2008). Re-emphasizing the social side: a new model of care. European J Palliative Care 15(6), 276–8.

Fulton, J.J., Newins, A.R., Porter, L.S. & Ramos, K. (2018). Psychotherapy Targeting Depression and Anxiety for Use in Palliative Care: A Meta-Analysis. J Palliat Med. 21(7),1024-1037.

Hutchison, E. (2013). Essentials of Human Behavior: Integrating Person, Environment, and the Life Course. Thousand Oaks, CA

Lloyd, W. M. (2008). Psychosocial Issues in Palliative Care. Oxford: Oxford University Press.

Plaskota, M., Lucas, C. Evans. R., Pizzoferro, K. Saini, T. & Cook, K. (2013). A hypnotherapy intervention for the treatment of anxiety in patients with cancer receiving palliative care. International Journal of Palliative Nursing. 18(2) 69.

Rusnak, K. (2011). Because You've Never Died Before: Spiritual Issues at the End of Life. Greenfield, MA: The Brick Wall 2.

Von Blanckenburg, P. & Leppin, N. (2018). Psychological interventions in palliative care. Curr Opin Psychiatry. 31(5), 389-395.