Palliative Care: Addressing Psychosocial Needs in End-of-Life Care

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Contents
INTRODUCTION...........................................................................................................................................1
BODY...........................................................................................................................................................1
PALLIATIVE CARE.........................................................................................................................................2
THERAPEUTIC RELATIONSHIP IN HOLISTIC CARE.........................................................................................4
PRINCIPLES OF PALLIATIVE CARE.................................................................................................................5
CONCLUSION...............................................................................................................................................8
REFERENCES................................................................................................................................................9
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INTRODUCTION
Psychosocial needs are referred to as those needs that every human being attempts to achieve
related to three basic needs that are autonomy, relatedness and competence (Weissman et al,
2015). Every human being thrives best in his entire life to achieve self-actualization that is
considered as an integral part of personality and psychology development. This assignment aims
at discussing the psychosocial, emotional, ethical and spiritual needs of an individual with
relevance to a case study provided of a 65 year old man named Peter. Peter is a person residing
alone as he is identified as gay in his late 40s and rejected by his family. Recent scenarios shows
how his son George who is married and has two kids is getting along with him and meets him
every day and he also has a daughter named Angela who lives far of so could visit only once in
two months. Living alone with a metastatic lung disease he has various aspects of his
psychosocial, ethical and spiritual life that are impacted. It is seen that globally around 40% of
people every year are considered eligible to receive palliative care (Hanson et al, 2012).
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Irrespective of the beneficial effects of palliative care still it is seen that only 14% of people from
whole mass who requires palliative care receives it (Murtagh et al, 2014). In given case study
Peter denied to receive any kind of hospice care and chose to live alone in spite of such a
debilitating disease persisting. Palliative care is defined as the care provided for the condition
that cannot be cured and such care promotes comfort and better quality life to the sufferer. This
assignment aims to determine with the evidence based approach different aspects of care and life
of the patient that are significantly impacted by his condition.
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BODY
Psychological distress is a term that is generally used to define the unpleasant or bad feeling that
significantly impacts the level of functioning of the individual (Weissman et al, 2015).
Psychological distress is a risk factor that drives a person towards mental illness and somehow
impacts the emotional, physical and social wellbeing of the individual as well as his family. It is
seen that 64% of adult who experienced stress reported to has psychological issues associated
such as depression and anxiety (Wentlandt et al, 2012). 37% of people who reported stress also
reported the feeling of being lonely and rejected (Murtagh et al, 2014). People with chronic
conditions as well as life limiting disease also undergo psychological stress and reports to be
overwhelmed. As seen in given case Peter lives alone with a metastatic debilitating lung disease
that needs medical attention and some amount of facility care such as palliative care can improve
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the quality of life of an individual. Rather Peter chose not to receive any sort of care and stay
alone in his home as having a strong spiritual belief of God and life to take its natural course.
Denying palliative care in most of the cases is due to spiritual beliefs and values that make a
person deny any care that can prolong their life and provide better comfortable or quality life.
PALLIATIVE CARE
As discussed palliative care is the care that is provided to the person suffering from an incurable
disease and making sure that his symptoms are relieved to provide a comfortable remaining life
(Quill and Abernethy, 2013). Palliative care has various domains that can be analyzed effectively
to prove that it is a kind of care that enhances the ability and functioning of an individual by not
only promoting physical assistance but also enhancing the psychological, emotional and ethical
aspects of life. It is seen that newly diagnosed cancer patients usually undergo psychological
distress that may be related to patient factors, medical factors or social or cultural factors.
According to the research by Mehta and Roth, (2015) it was seen that majority of patient who
were reported to palliative care after cancer diagnosis were experiencing high levels of
psychological distress and anxiety. Issues related to this condition were financial distress, home
care issues and emotional upsets. The research also revealed that community services for
advanced cancer patients are usually not adequate and does not address their psychological
requirements and palliative care is the best possible intervention in order to provide better quality
life to individuals suffering from life limiting diseases (Smith et al, 2012). Communication is
thought as an integral part of palliative care. Talking out the emotions is the best key to heal
emotionally r psychologically. As palliative care services provide a dimension to focus on the
therapeutic relationship building; that is referred to as the rapport between the clinician and
patient under nursing and medical guidelines. Communication is an important aspect that
promotes therapeutic relationship formation. It is widely seen and proved with concrete
evidences that therapeutic relationship formed in palliative care is beneficial in addressing the
psychological aspects of care and focus on the patient’s mental and behavioral modifications due
to disease and condition. A study by Powazki, Walsh, Hauser, and Davis, (2014) revealed that
communication among the clinician and patient as well as the family conferences in palliative
care are proved to be highly beneficial in promoting better physical as well as mental health to
the patient. Communicating about end of life before the end of life is also a crucial aspect that
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can help in modifying behavior regarding the condition. Palliative care professionals usually are
trained to communicate well but they face some basic challenges of causing distress, prognostic
uncertainty, feeling unpreparedness and navigating the patient unprepared. Such challenges
restrict the clinicians for communicating regarding end of life to the patient or their families. Yet
communication in overall aspect in palliative care is important and proved to be highly beneficial
for the service user ad their families (Brighton and Bristowe, 2016).
A well formulated programme under the name of CPE (Clinical Pastoral Education) was
promoted to educate the clinicians and health care professionals to be skilled and focused
regarding their practices to aim for bereavement focused and palliative care focused pastoral
care. Spirituality is an important aspect in end of life care as well as palliative care and grief
(Spencer, 2013). All these domains are interrelated to each other. The programme defined the
importance and requirement addressing the spiritual, cultural and religious requirements of the
individual during palliative care ad bereavement. This programme makes sure the palliative care
provided to patient consists of spiritual aspect as well as practiced as desired by the patient and
the family. Simultaneously with palliative care a grief and bereavement programme or care
should be provided to the family in order to address their psychosocial needs and reduce the
stress caused by the condition (Wiener, Weaver, Bell, and Sansom-Daly, 2015). As in given case
Angela may undergo acute stress due to guilt she may possess with an inability to visit her father
frequently or to be able to help him during his last days of life. The programme should focus to
address the emotional aspects of the care for the family of Peter including his son, daughter and
grandchildren. Anticipatory grief is also one factor that may be present including Peter’s family.
The anticipatory grief is process of feeling loss and grief before the loss actually happens.
Grandchildren of Peter as well as George may experience such grief due to close attachment to
their father. Johansson and Grimby, (2012) identified that anticipatory grief is a common issue
associated with the family members of the patient in palliative care. The study showed how
family members reported the pre loss or anticipatory period of care more stressful than post loss
period. Psychosocial status was also proved to be significantly affected due to anticipatory grief.
Peter is a gay man and he beelives he is socially rejected after being rejected by his family
earlier. He has thoughts of not accepting palliative care or any end of life support from medicine
and therapies but can accept religious approaches for the same. It is a difficult time for him as
having different sexual preferences usually leads a person to loneliness and cultural isolation at
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times. Being a gay man has affected hi spiritually as in many culture being gay is considered as
taboo and stigmatization overdraws the individual in despair and loneliness (Spencer, 2013).
THERAPEUTIC RELATIONSHIP IN HOLISTIC CARE
Therapeutic relationship or therapeutic alliance is referred to as the relationship between the
health care professional and the patient (Hui et al, 2013). It is the way by which trust is built
between the patient and the service provider that helps them to engage with each other with hope
of beneficial changes in the patient. Holistic nursing is defined as the practices that help the
person to heal as a whole by making sure all the aspects of health and wellbeing are addressed by
such care. Palliative care is a kind of holistic care as it provides overall care for physical,
emotional, psychological, spiritual and social wellbeing of the person. Holistic care is considered
as a comprehensive model of caring. It includes various factors that influence the care one of
which is therapeutic relationship (Ronaldson, Hayes, Aggar, Green and Carey, 2012).
Importance of therapeutic relationship for the holistic care delivery is well renounced by
different researchers. Dossey and Keegan, (2012) have identified that therapeutic relationship is
one of the important factors that helps and is proved to be beneficial in addressing mental issues
and psychosocial care in palliative as well as holistic nursing.
The qualities of therapeutic relationship are well identified and addressed by clinician in order to
provide a holistic care to the patient. Empathy is considered as one of the most important quality
of building a therapeutic relationship. Empathy refers to the feeling that a person shows or
expresses for the condition of the patient it helps individual to understand the condition,
requirements and motive of the patient. It establishes the foundation for care in therapeutic
relationship as it helps in enhancing contact, trust and rapport within the patient and the clinician.
Holistic care not only provides good results but it helps in enhancing the quality of life of an
individual both physically as well as mentally providing mental health a parity with physical
health. In given case Peter is living alone and is surely undergoing a lot of distress which he
hides behind his spiritual belief and values by denying palliative care. The requirement here
greatly denotes that the patient needs a therapeutic relationship from family as well as care
provider and that addresses his holistic needs in end of life care. A professional tries to build
trust during care and avoid judgment or phoniness in the relationship (Hui et al, 2013).
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PRINCIPLES OF PALLIATIVE CARE
Palliative care is a leading field in medical and nursing care that is being promoted to high level
in order to achieve clinical competence and better hospice care for life threatening disease care.
Palliative care mainly aims at focusing on the improvement of quality of life of patient and their
family that is being affected due to the disease and its prognosis. National Council of palliative
Care that is leading agency of palliative care in UK publishes definition of palliative care as the
one that affirms life and giving as a normal process but provides relief from pain and symptoms
of the disease (Vallurupalli et al, 2012). The basic principles of palliative care includes foster
autonomy, neither postpones nor hastens death, integrates psychological and spiritual aspects,
provide support system for patient to live an active life and provide relief from pain and
symptoms.
The autonomy of the patient is usually fostered through palliative care and the care focuses on
promoting autonomy to the individual (Vallurupalli et al, 2012). Life threatening diseases usually
bring with it some sort of emotional disturbances that can make a person feel loss of
independency and dependency or burden on others. This principle of care manages to ensure the
patient feels autonomous and empowered for his own life and has complete control over it.
Palliative care does not hastened or delays death it only provides the facilities as per the
requirement of patient and their family to treat the symptoms of disease and provide relief from
it. It includes some of the medicinal as well as complimentary therapies for the patient and their
family in order to provide coping strategies with grief, bereavement and phases of death
experience. As the palliative care does not manipulate death in any manner and do not try to
change its course it is successful in fostering the spiritual and cultural aspects of the patient
(Ferrell, Otis-Green and Economou, 2013).
Providing care under multidisciplinary team approach is another principle of palliative care that
promotes holistic care. According to National Consensus Project eight factors of palliative care
are identified that should be addressed effectively to manage better and effective palliative care.
One of these eight aspects focused on spiritual and religious requirements on the person
(Richardson, 2014). Also under the delivery of care as MDT the spiritual and religious
confirmation of the person should be considered. It not only helps in better communication and
building therapeutic relationship with the patient but it also allows the care process to attain
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better results and achieve outcomes of care that is helpful for enhancing the quality of life of an
individual (Borras et al, 2013).
Communication in given case is also as important as in any other case. Communicating with him
regarding his condition, care he requires and the palliative care benefits that may help him to
spend quality life is essential. Grief and anticipatory grief is an important part of lives of an
individual suffering from cancer. Communicating with the person regarding his feelings and
fears help in reducing the anxiety and promoting better quality of life. Grief, bereavement and
mourning on other hand are essential aspect that denotes sense of loss. Difference between grief
and bereavement is the time of loss grief can occur before loss has occurred and bereavement is
the state of grief after the loss of loved ones. Grief as five different stages, according to Kubler
Ross the stages of grief includes denial, anger, , bargaining, depression and acceptance.
Communicating the grief and its stages to Peter is an important part of his care. For now as per
the case scenario the patient is under depression and also has denied any facilities of palliative
care (Wolfelt, 2015). Communicating grief, bereavement with him and his family will provide
base for his direction towards the acceptance phase with better thought process.
(Online source http://changingminds.org/disciplines/change_management/kubler_ross/
kubler_ross.htm )
Talking to Peter may help him cope with the mental barriers he has and issues that he faces
during his disease and conditions. Communicating well will provide better relationship with him
that will ensure better health and quality of life with active role in life. Talking to the son and
daughter of the patient here will help them understand bereavement and modify their behavior. It
will provide them with the programme to overcome their loss and be prepared for the loss
indicated by advanced metastatic lung carcinoma their father has. It will be effective to
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communicate about grief, bereavement and end of life with the siblings and their children to
prepare them well and avoid any risks towards severe depression that they may enter into due to
loss. While the referral from G is made for palliative care due to enhanced deteriorating
condition of Peter the care professional manages to communicate well with the patient and his
family as well as foster the spiritual needs of the individual. Palliative care aims to address
social, physical as well as spiritual issues of the person. Jui-Tzu Lee, Shu-Ming Chen and Ya-
Lie, (2017) in their study denoted that it was found that spiritual needs of a patient were highly
specific to be addressed in palliative care that includes six of the domains of spiritual
requirements that the patient and his family desired for. This includes care skills and
communication with patient, interaction with the family, religious belief, wish fulfillment,
alleviation of grief, terminal care and spiritual care of conscious and unconscious patient both. In
given case the spiritual requirements of the patient should include his preferences and his
identification as a gay without any judgment and discrimination. It is the role of the palliative
care provider to assess ad manage the spiritual requirements of the patient by providing all the
wish fulfillment and therapies in accordance of the requirements. Peter wanted to receive no care
that would prolong his life and wanted a natural course to death whereas his family required to
be prepared well in order to afford the loss the patient was accepting to make.
Assessment refers to the assessing of the risks and the condition before being able to manage it
or plan a care for it. Assessment involves evaluating the condition and providing a judgment to
it. Management refers to preparing a care plan to treat a patient with help of different
interventions of care. In given scenario the assessment is done by communicating to the patient
and his family before producing palliative care (Hanson et al, 2014). The model here advocated
for care of Peter is suitable as it allowed cherishing his spiritual needs and autonomy. Also the
communication helps in yielding good therapeutic relationship formation with him and his
family that will help the service provider to promote better quality care.
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CONCLUSION
Palliative care is leading field in medicine that has helped various people suffering from life
limiting disorders to spend their end of life with better quality life and reduced pain and
discomfort (Lynch, Connor and Clark, 2013). Palliative care as defined aims promotes
psychosocial, emotional and social wellbeing of an individual to promote quality of life. In given
case the patient suffering from advanced metastasizing cancer has very little time left and
palliative care support is essential for his condition as he lives alone. This model of care will help
him to spend his life with having an active role with the limited body functioning. Hence,
palliative care has proved to be beneficial in providing better quality of life for incurable diseases
and the families to cope with the loss of their loved ones.
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