Emotional Distress:
The Sixth Vital Sign
Presented by: Lucy Kukac
April 27, 2011
Central Hospice Palliative Care Network
Networking Day
1
What is Emotional Distress?


Unpleasant emotions or cognitions that
may interfere with the ability to cope
with a disease, its physical symptoms,
and its treatment
Wide range of feelings:

Worry, powerless, sadness, fear,
depression, anxiety, panic, loneliness, etc.
2
Why Focus on Psychosocial Issues?



35% of people diagnosed with cancer
experienced clinically significant
distress (1994)
Family members also feel the same or
more emotional distress
Often unnoticed/unrecognized and
untreated by healthcare providers
3
Importance of Early Detection

Emotional distress interferes with
patients ability to cope



Illness trajectory is difficult
Diminishes patient’s quality of life
Early screening helps to identify
emotional issues


Interventions can be offered
Assist patient with coping
4
Recognition of Emotional Distress

Importance of emotional distress is
finally being recognized by healthcare
providers


Development of screening tools
Patience satisfaction surveys
Emotional distress scores the lowest on NCR
Picker Surveys across Ontario

5
Effects of Emotional Distress
6
Screening Toolkit:
Canadian Problem Checklist
Please check all of the following item that have been a concern or
problem for you in the past week including today:
Practical:
o
o
o
o
Work/School
Finances
Getting to and from appointments
Accommodation
Social/Family:
o Feeling a burden to others
o Worry about family/friends
o Feeling alone
o
o
o
o
o
Fears/Worries
Sadness
Frustration/Anger
Changes in appearance
Intimacy/Sexuality
Informational:
o Understanding my illness and/or
treatment
o Talking with the health care team
o Making treatment decisions
o Knowing about available resources
Emotional:
Physical:
Spiritual:
o Meaning/Purpose of Life
o Faith
o Concentration/Memory
o Sleep
o Weight
7
Screening Toolkit

Distress Thermometer
8
Screening Toolkit: ESAS

Edmonton Symptom Assessment Scale



Well-being
Anxiety
Depression
9
Screening Toolkit: BATHER






Background
Affect
Trouble
Handling
Empathy
Response/Renewal/Referral
10
BATHER: Background

Beginning to understand the situation
WHAT DOES THIS MEAN?
11
BATHER: Affect

Feeling and state
12
BATHER: Trouble

Seek to understand what is troubling the
patient about the symptoms or situation
13
BATHER: Handling

Getting an idea of how the patient is
functioning/coping with the situation
14
BATHER: Empathy

Indicating appreciation, understanding,
and acceptance of someone else’s
emotional state
15
BATHER:
Review/Response/Referral

Review


Response


What have you learned from your patient?
Support patient, offer coping strategies,
problem solve
Referral

Support services, counselling
16
Use of BATHER



Being used at Princess Margaret
Should be considered in care at HRRH
All care should ensure provision of
appropriate psychosocial interventions
17
Our Goal





Facilitate effective communication
between patients, families, and care
providers
Effective family meetings
Design and implement plan of care
Engage and support patients and
families in managing their illness
Attain emotional well-being
18
Our Role as Healthcare Providers





Frontline for patients and families
Main source of support and strength
In a position to gain trust
Build a therapeutic relationship
Contribute to holistic care and wellbeing of patients and family members
19
In Conclusion
Who is there in all the world who listens to us?
Here I am- this is me in my nakedness, with my
wounds, my secret grief, my despair, my
betrayal, my pain, which I can’t express, my
terror, my abandonment. Oh, listen to me for a
day, an hour, a moment, lest I expire in my
terrible wilderness, my lonely silence. Oh God,
is there no one to listen? (Seneca)
20