Psycho-existential distress in hospice patients and their caregivers

To assess the psycho-existential distress of patients and their caregivers in a specific setting, like hospice.

Patients consecutively admitted to two hospices for a period of 8 months were enrolled. At admission (T0), patients were assessed by a routine data recording: age; gender; Edmonton Symptom Assessment Scale (ESAS); Memorial Delirium Assessment Scale (MDAS); Cut down, Annoy, Guilt, Eye-opener (CAGE); Karnofsky level; primary diagnosis; education; religiosity and comorbidities. Psycho-existential distress was assessed at T0 by the Psycho-existential Symptom Assessment Scale (PeSAS). The measurements were repeated 1 week after comprehensive palliative care treatment.

159 patients and 87 caregivers were considered. The majority of patients had a cancer diagnosis (88.7%). Non-cancer patients were older (p<0.0005), had a lower Karnofsky (p<0.0005) and higher cognitive decline (MDAS, p<0.0005). After 1 week of comprehensive palliative care treatment, significant changes were observed for most ESAS items and total ESAS in both patients and caregivers. PeSAS items were mild-moderate. All symptoms of PeSAS, except for depression, significantly decreased after 1 week of comprehensive palliative care with a significant decrease in total PeSAS. Caregivers showed similar psycho-existential distress, but total PeSAS did not significantly change. There was a positive correlation between patients and caregivers in the changes from T0 to T7 (Δ) for PeSAS (p=0<004) and total ESAS (p=0.005).

Admission to hospice improved both physical symptoms and psycho-existential distress in patients significantly and non-significantly in caregivers.