Palliative Care

Care for Adults With a Serious Illness

Resources Quality Statements Working Group About

7

Psychosocial Aspects of Care

People with identified palliative care needs receive timely psychosocial support to address their mental, emotional, social, cultural, and spiritual needs.

Background

When people face a progressive, life-limiting illness, psychosocial issues may go undetected or untreated, and this can affect their quality of life. Pain and other symptoms may be the initial focus of treatment, but psychosocial well-being should also be assessed regularly. A holistic psychosocial assessment can facilitate the identification of any supports a person needs during their illness.

Psychosocial issues can manifest as physical symptoms (e.g., pain, constipation, nausea). Therefore, it is important that health care professionals be aware of a person’s total pain and the physiological symptoms that may be an indication of depression and anxiety. The concept of total pain describes the suffering that expands beyond physical pain by encompassing all of a person’s physical, psychological, social, spiritual, and practical struggles.

Illness and the prospect of dying affect and can also be affected by the meaning and purpose of a person’s life. A focus on spirituality may include questions about meaning, value, and relationships, and can lead to spiritual concerns, questions, or distress. Patients may draw on their spirituality as they make health care decisions and as they cope with illness and the experience of dying. No single individual is responsible for addressing all psychosocial needs; rather it requires expertise from an interdisciplinary team.

What This Quality Statement Means

For Patients, Families, and Caregivers

Your care team should assess your mental, emotional, social, cultural, and spiritual well-being. Your needs should be addressed as part of your care plan and according to your wishes, values, and goals of care.

For Clinicians

Ensure that the overall psychosocial well-being of people with identified palliative care needs is assessed, and that their needs are incorporated into the care plan.

For Health Services

Ensure that resources are available for health care professionals to assess and meet the psychosocial needs of people with identified palliative care needs.

Quality Indicators

Process Indicators

Percentage of people who receive palliative care who have assessments of their psychosocial needs documented in their medical record

Denominator: total number of people who receive palliative care
Numerator: number of people in the denominator who have assessments of their psychosocial needs documented in their medical record
Data source: local data collection

Percentage of people who receive palliative care (or their caregivers) who state that they received timely psychosocial support to address their identified mental, emotional, social, cultural, and spiritual needs

Denominator: total number of people who receive palliative care who had identified psychosocial needs (or their caregivers)
Numerator: number of people in the denominator who state that they received timely psychosocial support to address their mental, emotional, social, cultural, and spiritual needs
Data source: local data collection
Note: consider measuring separately by each type of psychosocial need or group together as an overall measure of psychosocial support

Outcome Indicator

Percentage of people who receive palliative care (or their caregivers) who rated the level of support in addressing their psychosocial needs (mental, emotional, social, cultural, and spiritual) as excellent

Denominator: total number of people who receive palliative care with psychosocial needs (or their caregivers)
Numerator: number of people in the denominator who rated the level of support in addressing their psychosocial needs (mental, emotional, social, cultural, and spiritual) as excellent
Data source: local data collection
Similar question available in the CaregiverVoice Survey: “During the last 3 months of his/her life, while he/she was receiving homecare services, what is your assessment of the overall level of support given in the following areas: spiritual support, emotional support, respect and dignity?” (Response options: “Excellent, Very good, Good, Fair, Poor, Does not apply, Don’t know”)
Note: consider measuring separately by each type of psychosocial need or group together as an overall measure of psychosocial support

Definitions Used Within This Quality Statement

Psychosocial support

Psychosocial support involves care related to a person’s state of mental, emotional, social, cultural, and spiritual well-being.

Mental and emotional needs

Mental and emotional needs relate to a person’s psychological and emotional well-being. Issues of concern for a person with a progressive, life-limiting illness may include fear, worry, insomnia, panic, anxiety, nervousness, paranoia, or lack of energy.

Social needs

Social needs relate to a person’s relationships with their family, community, and network (friends, acquaintances, and coworkers). Social needs may relate to family structure and location, family dynamics, communication, social and cultural networks, perceived social support, work and school settings, finances, sexuality, intimacy, living arrangements, caregiver availability, medical decision-making, access to transportation, medications, equipment and nutrition, community resources, or legal issues. Associated practical needs include pet care, child care, transportation, or meals.

Cultural needs

Cultural needs relate to the beliefs and preferences that come from one’s social and ethnic identity. Cultural needs may include linguistic needs, health beliefs and behaviours, traditions, rituals, or cultural barriers to accessing health care.

Spiritual needs

Spiritual needs relate to “the way individuals seek and express meaning and purpose, and the way they experience their connection to the moment, to self, to others, to nature, and to the significant or sacred.” Spiritual needs may include religious practices or philosophical reflection.

Evidence to Improve Care