Suffering - A review of its measurement and management

To outline some conceptualisations of suffering, critically review methodology to assess suffering and propose a framework for interventions aimed at alleviating suffering in clinical practice.

Narrative review.

There are numerous terms in the literature which may be synonymous with suffering. This, and the absence of a universally agreed conceptualisation of suffering, have hampered progress in understanding and research. Eric Cassell's conceptualisation has gained wide acceptance and several other conceptualisations are consistent with his. However, Cassell's model has also been criticised. It is proposed that, aside from Cassell's full model, his basic definition of suffering is valid and helpful clinically. Available methods to assess suffering are reviewed. Problems of validity and generalisability are likely to arise when measures include symptoms causing suffering as well as attributes of suffering. Although available measures have been criticised for lacking a theoretical basis, this would not be a problem if measures are developed using clinimetric methods. This approach is recommended. Cassell's model is helpful in guiding interventions to alleviate suffering. Despite the severe distress caused by suffering, simple interventions can sometimes be very effective.

Suffering is ubiquitous in illness. Whether a universally applicable measure of suffering can be developed remains to be seen, but a limitation of most research to date is that studies have focused on selected patient groups without testing generalisability. Suffering can be considered the 'universal currency' of ill health and a generalisable measure of suffering therefore offers the prospect of becoming a truly person-centred health outcome measure.