Psychosocial and Spiritual Aspects of Care

Abstract

This chapter discusses the spiritual and psychosocial aspects of care using a narrative approach. It suggests that far more suffering in patients with advanced illness results from psychic rather than from physical distress, assuming physical symptoms are reasonably palliated. Categories of psychic distress described include depression, anxiety, and delirium. A discussion of anticipatory and bereavement grief is also presented. The chapter discusses how to assess these forms of psychic distress and provides recommendations for interventions. A discussion of altered states of consciousness in dying patients is presented along with an approach to analyzing and understanding these states, based on the level of consciousness, orientation, and the content of the altered state.