Psychosocial Assessment Tool for Palliative Care: A Comprehensive Guide

Dependence on healthcare due to serious illness can significantly disrupt a patient’s sense of security and predictability. Beyond the physical symptoms, serious illness impacts relationships, social and spiritual support systems, financial stability, and trust in healthcare providers. Psychological, social, and cultural elements are intricately woven into a patient’s developmental stage, family dynamics, financial security, and spiritual beliefs. Therefore, effectively, efficiently, and compassionately addressing these factors is crucial in palliative care, delivered by all clinicians involved in the care of seriously ill individuals. This article serves as a practical guide to conducting a thorough psychosocial assessment for patients facing serious illnesses.

Understanding Psychosocial Assessment in Palliative Care

A psychosocial assessment in palliative care extends beyond the physical aspects of illness to encompass a patient’s emotional, familial, social, and financial well-being. It is essential for clinicians to clearly communicate to patients how this inquiry will enhance their care and how the collected information will be used and documented. This transparent approach respects patient autonomy, allowing them to maintain privacy over certain aspects of their lives if they choose. This assessment is not merely a checklist but a dynamic process that requires sensitivity and adaptability to each patient’s unique situation.

Key Domains of Psychosocial Assessment

A comprehensive Psychosocial Assessment Tool For Palliative Care should explore several key domains to gain a holistic understanding of the patient’s needs and challenges. These domains include:

Thoughts and Feelings about Illness and Care

Understanding the patient’s perspective on their illness, treatment, and overall care is fundamental. This involves exploring their understanding of their condition, their expectations for treatment, and their emotional responses to their illness. Questions in this area aim to uncover what matters most to the patient and their family in the context of their health journey.

Coping Mechanisms and Emotional Well-being

Assessing how patients cope with their emotions, functional changes, and symptoms is crucial. This domain delves into past coping strategies, the impact of the illness on their daily life, and their outlook on the future. It also includes being mindful of substance use as a potential coping mechanism for unwanted feelings, requiring a sensitive and non-judgmental approach.

Cultural Influences and Beliefs

Cultural background significantly shapes a patient’s understanding of health, illness, and end-of-life care. Exploring cultural identity, preferred language, and connections to their culture of origin can provide valuable insights. Understanding cultural preferences, including preferred place of death if appropriate, ensures culturally sensitive and respectful care.

Social Context and Support Systems

The social environment plays a vital role in a patient’s experience of illness. This domain explores family structures (both family of origin and chosen family), living arrangements, and available support systems. It’s important to identify who the patient considers family, their preferred form of address, and whether they anticipate needing additional support at home. Inquiring about veteran status and employment can also provide relevant social context.

Lived Experience of Illness and Quality of Life

This area focuses on the personal impact of the illness on the patient’s life, relationships, and overall quality of life. It includes assessing financial concerns, the impact on work and loved ones, and worries related to their health. Understanding what the patient has shared about their illness with others, who is involved in decision-making, and prior experiences with serious illness or loss provides a deeper understanding of their current situation. For patients with prognostic awareness, discussing funeral or after-death plans may also be appropriate.

Spiritual and Existential Concerns

For many individuals, spiritual and existential beliefs are central to their coping and finding meaning in the face of serious illness. Assessing the importance of religious or spiritual beliefs, support from a spiritual community, and sources of comfort is essential. Exploring how illness influences their relationship with their faith or higher power, and their sense of peace, addresses the deeper aspects of suffering and well-being.

Implementing Psychosocial Assessment: Practical Questions

Below are sample questions, categorized by the psychosocial domains discussed, that can be adapted based on the setting, individual, and specific circumstances of patients and caregivers facing serious illness. Clinicians should use critical thinking, considering the context, urgency, and patient’s emotional and cognitive responses to guide their approach. Knowing when to prioritize questions, pause an interview, shift topics, delve deeper, or involve social work or spiritual care specialists is crucial for an effective and compassionate assessment.

A. Patient’s Thoughts and Feelings about Illness, Treatment, and Care:

What do we need to understand about you and your family to provide you with the best possible care?
How do you and your family prefer to receive medical information?
What is most important to you right now concerning your health? What about as you consider the future? Does this differ from what you believe is important to your family?

B. Coping with Emotions, Functional Changes, and Symptoms:

What have been the most significant life changes you’ve experienced recently?
How does your illness and its symptoms affect your daily life?
What does the future look like to you at this time?
Have you used or experimented with substances like alcohol, marijuana, or other drugs in the past? Have you ever used substances to manage difficult emotions?

C. Cultural Influences:

How do you understand what is happening with your health?
With which cultural or ethnic group do you identify?
What is your preferred language for communication? What language is primarily spoken at home?
Have you been able to maintain connections with family or friends from your country of origin? Do you have plans to visit them in the future?
(If appropriate) Where would you prefer to be when you die?

D. Social Context:

Who do you consider to be your family? This includes both your family of origin and your chosen family.
How would you like to be addressed? What are your preferred pronouns?
Where do you currently live? Do you live alone or with others? Have you considered whether you might need more assistance at home in the future?
Are you a veteran?
Are you currently employed?

E. Lived Experience of Illness and Impact on Quality of Life:

Are you concerned about the financial impact of your illness or how your medical expenses will be managed?
How has this illness affected your work and the people who are important to you?
What or whom are you most concerned about regarding your health?
What have you shared with family and friends about your illness?
Who helps you make decisions about your health? Who do you turn to when things get difficult? Do you have a healthcare power of attorney or agent? Who might have copies of these documents?
Have you or your loved ones managed serious illnesses in the past? Have you experienced any recent losses?
(If appropriate) Have you made any funeral arrangements or after-death plans, such as cremation or burial?

F. Suffering and the Existential/Spiritual Domain:

Are religious or spiritual beliefs or practices important to you?
Do you feel supported by a spiritual community? Does your illness affect your ability to access this support? If so, can this support be provided to you in person or through technology?
What brings you comfort during challenging times?
How does this illness affect your thoughts about and relationship with God or a higher power?
Do you feel at peace?

By utilizing this comprehensive psychosocial assessment tool, clinicians can provide more patient-centered and holistic palliative care, addressing not only the physical but also the intricate psychosocial needs of individuals and their families facing serious illness.

References:

Loscalzo, M.J. (2007). Social workers: The connective tissue of the health care system. In: L. Emanuel & S. Librach. (Eds.) Palliative care: Core skills and competencies. (pp.507-523). Philadelphia, Pa. Saunders/Elsevier.
Institute of Medicine (US) Committee on Psychosocial Services to Cancer Patient / Families in a Community Setting. Adler, N.E. & Page, A.E.K.(Eds). (2008). Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC. National Academies Press. https://www.ncbi.nlm.nih.gov/pubmed/20669419
National Association of Social Work. (2016). NASW standards of practice for social workers in health care settings. Retrieved from https://www.socialworkers.org/LinkClick.aspx?fileticket=fFnsRHX-4HE%3D&portalid=0
Reith, M. & Payne, M. (2009). Social work in end of life and palliative care, pp. 190-193. Chicago, Il. Lyceum Books Inc.
Randall, F. & Downey, R.S. (2006). The philosophy of palliative care: Critique and reconstruction. Oxford, England: Oxford University Press.
Houmann, L., Rydahl-Hansen, S., Chochinov, H., Kristjanson, L, Groenvold, M. (2010). Testing the feasibility of the Dignity Therapy interview: Adaptation for the Danish culture. BMC palliative care. 9 (1): 21.
Sumser, B., Leimena, M. & Altilio, T. (Eds). (2019) Palliative Care: A Guide for Health Social Workers. New York: Oxford University Press.
Borneman T, Ferrell B, Puchalski CM. Evaluation of the FICA tool for spiritual assessment. Journal of Pain and Symptom Management 2010; 40(2): 163-173.
Steinhauser, K.E., Voils, C.I., Clipp, E.C., Bosworth, H.B., Cristakis, N.A. & Tulsky, J.A.(2006) “Are you at peace?”: One item to probe spiritual concerns at the end of life. Archives of Internal Medicine, 166(1), 101-105. Doi:10.1001/archinte.166.1.101