School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; St. Vincent's Hospital (D.W.K., J.A.), Sydney, New South Wales, Australia; Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia; School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia.
School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia; School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia.
J Pain Symptom Manage. 2023 Sep;66(3):212-220.e2. doi: 10.1016/j.jpainsymman.2023.05.015. Epub 2023 Jun 7.
Psycho-existential symptoms in palliative care are addressed insufficiently. Routine screening, ongoing monitoring and meaningful treatment of psycho-existential symptoms may contribute to the relief of suffering in palliative care.
We sought to explore longitudinal change in psycho-existential symptoms following the routine implementation of the Psycho-existential Symptom Assessment Scale (PeSAS) in Australian palliative care services.
Using a multisite rolling design, we implemented the PeSAS to longitudinally monitor symptoms in a cohort of 319 patients. We assessed change scores for each symptom in groups with mild (≤3), moderate (4-7) and severe (≥8) symptomatology at baseline. We tested significance between these groups and used regression analyses to identify predictors.
While one half of patients denied clinically important psycho-existential symptoms, for the remainder, overall, more patients improved than deteriorated. Between 20% and 60% of patients with moderate and severe symptoms improved, while another 5%-25% developed new symptom distress. Patients with severe baseline scores improved significantly more than those with moderate baseline scores.
As we better recognize through screening patients carrying psycho-existential distress in palliative care programs, there is considerable room for improvement in ameliorating this suffering. Inadequate clinical skills, poor psychosocial staffing or a biomedical program culture may all contribute to inadequate symptom control. Person-centered care necessitates greater attention to authentic multidisciplinary care that ameliorates psycho-spiritual and existential distress.
在姑息治疗中，心理-存在症状未得到充分重视。常规筛查、持续监测和对心理-存在症状的有效治疗，可能有助于减轻姑息治疗中的痛苦。
我们旨在探讨在澳大利亚姑息治疗服务中常规实施心理-存在症状评估量表（PeSAS）后，心理-存在症状的纵向变化。
采用多站点滚动设计，我们使用 PeSAS 对 319 例患者进行了纵向监测。我们评估了基线时轻度（≤3）、中度（4-7）和重度（≥8）症状组的每个症状的变化分数。我们对这些组之间进行了显著性检验，并使用回归分析来确定预测因素。
虽然有一半的患者否认存在有临床意义的心理-存在症状，但对于其余患者，总体而言，改善的患者多于恶化的患者。有中度和重度症状的患者中，有 20%-60%的患者得到了改善，而另有 5%-25%的患者出现了新的症状困扰。基线评分严重的患者改善幅度明显大于基线评分中度的患者。
通过在姑息治疗计划中筛查出存在心理-存在困扰的患者，我们对缓解这种痛苦有了更好的认识，仍有很大的改进空间。临床技能不足、心理社会人员配备不足或生物医学项目文化等因素都可能导致症状控制不佳。以患者为中心的护理需要更加关注能够改善心理-精神和存在困扰的真正的多学科护理。
