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320490
Are We Doing Enough In Managing Emotional Distress:Impact on Patient Symptoms and End of LIfe ?


Tuesday, November 3, 2015

Shibani Ray-Mazumder, Sc.D, Ph.D, Department of Geriatric Medicine and Palliative Care, NYU Langone Medical Center, New York, NY
Emotional distress (ED) in the palliative care setting is a frequently neglected aspect of the patient’s experience. ED is associated with patient pain, end of life decision making and caregiver stress. Barriers to ED care include differing definitions, multiple standardized ED instruments with varying success, poor referral and treatment follow up and absence of  mental health personnel on the palliative care team. OBJECTIVE: The purpose of this feasibility study is to evaluate whether ED can be assessed and treated in the palliative care inpatient setting.  In addition, it is of interest to determine the impact ED assessment and treatment has on patient outcomes as well as upon the practice of the palliative care team (PCT).

METHODS: To date, thirty-three English speaking, cognitively alert patients have been interviewed during morning PCT rounds over 6 months. Once the PCT completes their medical questions and exits the room, the psychologist asks the patient to rate their ED using the NCI Distress Thermometer (DT) on a 0-10 scale.   Patients  scoring higher than 4 receive cognitive behavioral therapy (CBT) by the psychologist to help them cope with their distress. The PCT is also asked for their ED assessment of the patient and a mean ED score is calculated.  Data collection is ongoing.

RESULTS: To date,  mean patient Emotional Distress (ED) score is higher than PCT ED assessment.  Patient ED is sometimes still high even with controlled pain. CBT treatment improves well-being, decreased pain and anxiety.

DISCUSSION:  ED assessment and treatment infrastructure should be included in caring of the palliative care patient for quality and effective practice. Recommendations for ED treatment guidelines will be presented.

Learning Areas:

Administration, management, leadership
Clinical medicine applied in public health
Diversity and culture
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Evaluate the current understanding of Emotional Distress and how it impacts palliative care patients symptom management and end of life.

Keyword(s): End-of-Life Care, Practice Guidelines

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal of several private funded studes focussing on the awareness and impact of emotional distress on symptom management and end of life decision making in the palliative care inpatient population. Among my research interests is to promote nonpharmacological strategies that complement existing medical treatment and improve patient pain , emotional distress and end of life experiences.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4097.0: Palliative Care Roundtable