Abstract
Backgroundpatients with palliative needs often experience high symptom burden which causes suffering to themselves and their families. Depression and psychological distress should not be considered a “normal event” in advanced disease patients and should be screened, diagnosed, acted on and followed-up. Psychological distress has been associated with greater physical symptom severity, suffering, and mortality in cancer patients. A holistic, but short measure should be used for physical and non-physical needs assessment. The Integrated Palliative care Outcome Scale is one such measure. This work aims to determine palliative needs of patients and explore screening accuracy of two items pertaining to psychological needs.Methodsmulti-centred observational study using convenience sampling. Data were collected in 9 Portuguese centres. Inclusion criteria: ≥18 years, mentally fit to give consent, diagnosed with an incurable, potentially life-threatening illness. Exclusion criteria: patient in distress (“unable to converse for a period of time”), cognitively impaired. Descriptive statistics used for demographics. Receiving Operator Characteristics curves and Area Under the Curve for anxiety and depression discriminant properties against the Hospital Anxiety and Depression Scale.Results1703 individuals were screened between July 1st, 2015 and February 2016. A total of 135 (7.9%) were included. Main reason for exclusion was being healthy (75.2%). The primary care centre screened most individuals, as they have the highest rates of daily patients and the majority are healthy. Mean age is 66.8 years (SD 12.7), 58 (43%) are female. Most patients had a cancer diagnosis 109 (80.7%). Items scoring highest (=4) were: family or friends anxious or worried (36.3%); feeling anxious or worried about illness (13.3%); feeling depressed (9.6%). Using a cut-off score of 2/3, Area Under the Curve for depression and anxiety items were above 70%.Conclusionsmain palliative needs were psychological, family related and spiritual. This suggests that clinical teams may better manage physical issues and there is room for improvement regarding non-physical needs. Using the Integrated Palliative care Outcome Scale systematically could aid clinical teams screening patients for distressing needs and track their progress in assisting patients and families with those issues.
Highlights
Palliative care is a holistic approach of care, which can be integrated early in the disease trajectory, alongside active, curative treatment, [1] and aims to alleviate physical and non-physical symptoms of patients and their families [2,3,4,5,6,7]
Though physical symptoms may be more identified by healthcare professionals, patients and carers, non-physical symptoms can disrupt the patient and family’s quality of life and cause suffering [8]
Psychological distress has been associated with greater physical symptom severity, suffering, and mortality in cancer patients [10]
Summary
Palliative care is a holistic approach of care, which can be integrated early in the disease trajectory, alongside active, curative treatment, [1] and aims to alleviate physical and non-physical symptoms of patients and their families [2,3,4,5,6,7]. Psychological distress has been associated with greater physical symptom severity, suffering, and mortality in cancer patients [10]. These symptoms and needs should be properly assessed with validated outcome measures, and, the intervention(s) to solve or manage them should be selected [11, 12]. Depression and psychological distress are two examples of such needs, which should not be considered a “normal event” in an advanced disease trajectory [13] Rather, they should be screened, diagnosed, acted on and followedup by appropriate support services and specialised healthcare professionals, whether by pharmacologic treatment, psychological treatment, psychiatric treatment or a combination of those [13]. These measures are short, but multidimensional and some items may be used to screen for certain palliative needs, common in this population [19]
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