Abstract
Palliative care patients have been associated with a high probability of having depression and spiritual distress. However, there is a gap in research about the clinical indicators that can promote an effective differential diagnosis of depression and spiritual distress. This study aimed to identify the prevalence and the clinical indicators of depression and spiritual distress in palliative patients in primary care. An observational and cross-sectional study was conducted in 2016 in a Portuguese primary care unit. From a General Practitioners patients’ file of 1457 adult patients, a sample of 30 palliative patients was recruited throughout two steps: (1) selection of patients with chronic disease criteria; (2) selection of patients with Prognostic Indicator Guidance criteria. Exclusion criteria included cognitive impairment and psychotic disorders. Participants completed the self-assessment Hospital Anxiety and Depression Scale (HADS) and Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale (FACIT-Sp12) scales, which were sealed in opaque envelopes. Clinical data collection used semi-structured interviews for the diagnosis of depression and spiritual distress. The prevalence of depression was 23% (n = 7), while the prevalence of spiritual distress was 23% (n = 7). Four patients (13%) fulfilled both the depression and the spiritual distress criteria. Depression and spiritual distress seem to be both linked to the spiritual dimensions of the human being, but seem to differ in the dimensions of suffering and pharmacologic treatment.
Highlights
IntroductionPalliative care is an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illnesses (WHO 2015)
The null hypothesis was as follows: there is no relationship between depression and the expression of suffering and lack of meaning in life (1A); there is no negative relationship between depression and FACIT-Sp scores (2A); there is no relationship between the use of antidepressants and FACIT-Sp scores (3A); there is no relationship between the use of sedative/anxiolytic medication and FACIT-Sp scores (4A); there is no relationship between depression and clinical diagnosis (5A); there is no relationship between spiritual distress and psychotropic medication (6A), Hospital Anxiety and Depression Scale (HADS) scoring (6B) and clinical diagnosis (6C); there is no relationship between FACIT-Sp scores and HADS scores considering
This study aimed to identify the prevalence in addition to the clinical indicators of depression and spiritual distress in palliative patients in primary care
Summary
Palliative care is an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illnesses (WHO 2015). It is intended to prevent and relieve suffering through the early identification, correct assessment and treatment of pain and other problems, whether they are physical, psychosocial, or spiritual. Palliative care is concerned with managing physical pain, but, as perceived by a palliative care community physician, with “the management of psycho-social struggle, the psycho-social pain and suffering that goes with dying”. (Mistry et al 2015, p. A phenomenological study that enrolled a range of community palliative care providers emphasized the importance of this holistic palliative care approach. This study valued the following as much as the traditionally symptom-oriented concerns: the addressing of the patients’
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