The Personhood Pentadigm: A transcultural framework for analyzing existential distress in palliative care

This study aimed to address three systemic barriers in conventional palliative psychotherapy-the "somatic-reflective disconnect," compressed terminal timelines, and Western individualistic biases-by developing an integrative, transcultural, and secular care-planning framework to map and systematically disrupt end-of-life existential suffering.

We employed a dual-stage qualitative design. First, we developed the Personhood Pentadigm (PP) by translating the Eastern psychology of the Five Aggregates into five secular dimensions: Physical Image, Somatosensory Tone, Role and Narrative, Volitional Behavior, and Consciousness. We then integrated these dimensions with Western clinical humanities. Second, we operationalized the PP using purposive qualitative case vignettes of contrasting terminal trajectories, analyzed through a three-phase interpretive procedure: 1) domain-specific coding, 2) causal pathway mapping, and 3) interdisciplinary alignment.

The analysis revealed existential distress as a dynamic, multi-nodal collapse of personhood rather than a static symptom. The vignettes demonstrated two distinct configurations of suffering: 1) a sequential linear cascade (Case A) in which physical and somatosensory fractures systematically dismantle global macro-narratives, and 2) a non-linear recursive loop (Case B) where somatic distress and loss of roles feed back to drive death anxiety and fear of sleep. Operationally, establishing a somatic runway via physical stabilization is a strict prerequisite for reflective therapies. Furthermore, the PP successfully aligns clinical actions across multidisciplinary specialties.

By providing a shared, translational lexicon and clear role demarcation, the PP empowers multidisciplinary teams to disrupt cascading distress loops. It serves as an operational roadmap that democratizes existential care, enabling psychospiritual support to be directly integrated into bedside palliative care.