Distress within spiritual, psychological and social domains. Usually linked with physical disease burden.
Feelings of loss of control, loss of role, hopelessness, meaningless, feeling a burden to others, depression, anxiety, loss of will to live, wish to die. Screening scale
Strong relationship between hopelessness and suicidality, often lack family/friend and social supports.
Ensure all physical and psychological symptoms are assessed thoroughly and managed optimally
Clinicians need to provide “intensive caring”:
- Nonabandonment, taking interest in patient as person, holding/containing hope, dignity-affirming tone of care, therapeutic humility.
- Target achievable goals, focused on ways of affirming that patient matters.
- Elements of caring encompass presence, compassion, and hope.
Validated methods for addressing existential distress:
- Dignity Therapy
- CALM – Managing Cancer and Living Meaningfully
https://academic.oup.com/book/35493 - Cognitive behavioural therapy
Consult Palliative Care for consideration of further therapy. Psylocibin for severe death anxiety requires training in administration of psylocibin, and have trained psychotherapist.