A Comprehensive Approach to the Patient at End of Life: Assessment of Multidimensional Suffering

Abstract

Pain is a multidimensional, complex experience. There are many challenges in identifying and meeting the needs of patients experiencing pain. Evaluation of pain from a bio-psycho-social-spiritual framework is particularly germane for patients approaching the end of life. This review explores the relation between the psychospiritual dimensions of suffering and the experience of physical pain, and how to assess and treat pain in a multidimensional framework. A review of empirical data on the relation between pain and suffering as well as interdisciplinary evidence-based approaches to alleviate suffering are provided.

A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare

“…Furthermore, they show that patients and relatives also expect that nurses should be medically competent and have good medical knowledge, a vision shared by society at large (Ellegaard and Dybbroe 2015). The philosophy of palliative care has difficult conditions within this historical medical doxic thinking, when it appears that addressing psychological, social, and spiritual dimensions of patients and their families (Wachholtz et al 2016;WHO 2018) is prioritised lower than the physical dimension of the patients.…”

“…The philosophy of palliative care is based on a holistic approach to patients which aims to relieve and control pain and other symptoms and to improve the quality of care for patients and their families. Palliative care is regarded as patient-centred, comprehensive, and multidimensional, addressing physical, psychological, social, and spiritual dimensions of patients and their families (Wachholtz et al 2016). Palliative care is ideally provided by multidisciplinary teams, which include doctors, nurses, psychologists, physiotherapists, clinical pharmacists, occupational therapists, dieticians, and social workers etc.…”

Top Ten Tips Palliative Care Clinicians Should Know About Psychosocial and Family Support

“…44 In addition, religious and spiritual practice often act as a protective factor and increase pain tolerance. 45 PSWs can elicit any strongly held beliefs by asking questions related to ''hope'' instead of ''faith'' or ''beliefs.'' Such early rapport building establishes an emotional connection between patients and their PC team.…”

“…By eliciting goals and refocusing the conversation to address what truly matters to the patient, the team seeks to relieve both psychological suffering and total pain, offering peace for those with serious illness or at EOL. 45…”

Projeto educacional sobre terminalidade da vida para graduandos da área da saúde

“…Curiosamente, pesquisas revelam que a atitude frente à morte exerce influência significativa sobre a qualidade da comunicação e assistência médica oferecida a pacientes terminais 6 . Na literatura, ressalta-se também que, mesmo durante situações de incapacidade curativa, muitos cuidados ainda podem ser oferecidos, tais como diminuição do desconforto e suporte psicológico 7 ; fato que ratifica a necessidade da capacitação dos profissionais da saúde acerca do tema, permitindo maior eficácia em seu desempenho 4 .…”