Palliative care concentrates on alleviating both the physical and mental distress of serious illness.
The World Health Organisation (WHO) defines palliative care as, “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
- Provides relief from pain and other distressing symptoms;
- Affirms life and regards dying as a normal process;
- Intends neither to hasten or postpone death;
- Integrates the psychological and spiritual aspects of patient care;
- Offers a support system to help patients live as actively as possible until death;
- Offers a support system to help the family cope during the patient’s illness and in their own bereavement;
- Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
- Will enhance quality of life, and may also positively influence the course of illness;
- Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
It can be a misconception that palliative care is only for those with non-curable conditions or is a byword for end of life care. Palliative care works with a range of diagnoses, including those treated using aggressive curative therapies, for example the role of pain management in cancer treatment. In fact, palliative care is deemed appropriate across all age groups and is suitable for persons at any stage of a serious illness.
The role of a psychologist is usually to provide support as part of a multidisciplinary approach with medical professionals, such as specialist doctors and nurses, as well as other allied health professionals. Their overarching goals are to relieve suffering and improve quality of life for both persons experiencing serious illness and their carers.
Five central working areas have been identified by the European Association for Palliative Care for psychologists: psychological assessment, therapy, staff support including supervision, education, and research. Let’s take a closer look at the first two issues, which may in a multidisciplinary setting fit the NICE guidelines, where mental health specialists undertake assessment, diagnosis, and psychological interventions for issues such as complex grief, anxiety, and depression.
Depending on the symptoms experienced, the assessment process can vary.
Initial assessment provides both a basis for deciding appropriate intervention, as well as a baseline against which future severity can be compared. For example, the Edmonton Symptoms Assessment Scale is a common measure that uses eight visual analogue scales, scoring each from zero (absent symptoms) to ten (worst possible severity). The scales assess pain, activity, nausea, depression, anxiety, drowsiness, appetite, and wellbeing. Shortness of breath is an additional scale if relevant. After the initial assessment, looking at relevant domains, comparative follow up assessments take place to update and monitor functioning over time.
Medical management for serious illness likely includes drug treatment and other appropriate interventions, depending on the diagnosis.
Psychological care can be put in the broader context of “total suffering”, attributed to Dr Cicely Saunders, which addresses the physical and psychological nature of distress. Psychologists may work with individuals, couples, families, or groups.
Palliative care clients and their carers may engage with psychological services to address a range of relevant issues. Common areas of distress may relate to pain management, loss of independence, the experience of disablement and prejudice, as well as grief and worry. Example worries of palliative patients may include anxious thoughts regarding finances, mortality, earlier life choices, current decision making, or a fear of being a burden on loved ones.
Common treatments include:
- Visualisation strategies;
- Cognitive strategies;
- Relaxation strategies;
- Therapy animals.
Exploring relevant issues with a psychologist can be of great benefit, but only as fits the person. Not everyone wants to talk. The process of palliative care is ultimately that of respect, so the aim is to offer services and not deny anyone the opportunity to develop psychological supports over time.
Author: Dr Amanda White, PhD, B Psych (Hons), B Beh Sc, DipH, MAPS.
Dr Amanda White is a highly experienced clinician, offering tailored treatment plans based on her client’s needs. Her emphasis is working with individual adults and older adolescents, rather than couples or children, as these individuals hold greater agency, ie the power to act. Her treatment programs are based on an eclectic approach, meaning evidence-based best practice is merged with the presentation and problem solving approach of each client.
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