Psychosocial and spiritual care within palliative care in humanitarian stations and emergencies:
During humanitarian aid situations and crises, the immediate needs of palliative care patients often focus on the correct assessment and treatment of physical pain and symptoms that are resulting in physical distress with a patient with a life-limiting illness. However, the WHO affirms that palliative care must address all aspects of the human condition. “Palliative care is a crucial part of integrated, people-centered health services. Nothing is more people-centered than relieving their suffering, be it physical, psychological, social, or spiritual.”
The “generalist/specialist” model of palliative care service provision builds the capacity of all health care clinicians in humanitarian settings are able to provide basic and essential assessment and care for the palliative care needs of presenting patients with further referral to palliative care specialists when required. This must also include basic assessment for psychosocial well-being, assessing and responding to anxiety, depression and emotional trauma. Clinicians should be familiar with basic psychological first aid and realize that their compassionate presence and relationship with the patient is critical to provide a soothing, calming presence and the beginning alleviation of distress and trauma. Clinicians providing palliative care in humanitarian situations should familiarize themselves with the growing evidence on the importance of trauma-informed end-of-life care.
Palliative care must also include screening and assessment of every patient for spiritual distress. “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” Assessing and responding to spiritual distress and pain is essential in humanitarian situations where patients may have significant spiritual and existential questions. Spiritual distress can be defined as “the impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself.” The FICA spiritual history tool is one example how clinicians can begin the conversation to assess spiritual distress and spiritual needs.
- WHO https://www.who.int/health-topics/palliative-care (accessed 14 February 2021)
- National Child Traumatic Stress Network & National Center for PTSD (2006). Psychological First Aid (PFA) Field Operations Guide 2nd Edition.
- National Hospice and Palliative Care Organization (NHPCO) https://www.nhpco.org/education/tools-and-resources/trauma-informed-end-of-life-care/ (accessed 14 February 2021)
- Puchalski, C. M., Vitillo, R., Hull, S. K., & Reller, N. (2014). Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus. Journal of Palliative Medicine, 17(6), 642–656.
- Puchalski, C. M. (2012). Spirituality as an essential domain of palliative care: Caring for the whole person. Progress in Palliative Care, 20(2), 63–65.
- Borneman, T., Ferrell, B., & Puchalski, C. M. (2010). Evaluation of the FICA Tool for Spiritual Assessment. Journal of Pain and Symptom Management, 40(2), 163–173.