Emotional Distress:

1. Emotional Distress: The Sixth Vital Sign Presented by: Lucy Kukac April 27, 2011 Central Hospice Palliative Care Network Networking Day

2. What is Emotional Distress? • Unpleasant emotions or cognitions that may interfere with the ability to cope with a disease, its physical symptoms, and its treatment • Wide range of feelings: • Worry, powerless, sadness, fear, depression, anxiety, panic, loneliness, etc.

3. Why Focus on Psychosocial Issues? • 35% of people diagnosed with cancer experienced clinically significant distress (1994) • Family members also feel the same or more emotional distress • Often unnoticed/unrecognized and untreated by healthcare providers

4. Importance of Early Detection • Emotional distress interferes with patients ability to cope • Illness trajectory is difficult • Diminishes patient’s quality of life • Early screening helps to identify emotional issues • Interventions can be offered • Assist patient with coping

5. Recognition of Emotional Distress • Importance of emotional distress is finally being recognized by healthcare providers • Development of screening tools • Patience satisfaction surveys • Emotional distress scores the lowest on NCR Picker Surveys across Ontario

6. Effects of Emotional Distress

7. Practical: o Work/School o Finances o Getting to and from appointments o Accommodation Emotional: o Fears/Worries o Sadness o Frustration/Anger o Changes in appearance o Intimacy/Sexuality Spiritual: o Meaning/Purpose of Life o Faith Social/Family: o Feeling a burden to others o Worry about family/friends o Feeling alone Informational: o Understanding my illness and/or treatment o Talking with the health care team o Making treatment decisions o Knowing about available resources Physical: o Concentration/Memory o Sleep o Weight Screening Toolkit: Canadian Problem Checklist Please check all of the following item that have been a concern or problem for you in the past week including today:

8. Screening Toolkit • Distress Thermometer

9. Screening Toolkit: ESAS • Edmonton Symptom Assessment Scale • Well-being • Anxiety • Depression

10. Screening Toolkit: BATHER • Background • Affect • Trouble • Handling • Empathy • Response/Renewal/Referral

11. BATHER: Background • Beginning to understand the situation WHAT DOES THIS MEAN?

12. BATHER: Affect • Feeling and state

13. BATHER: Trouble • Seek to understand what is troubling the patient about the symptoms or situation

14. BATHER: Handling • Getting an idea of how the patient is functioning/coping with the situation

15. BATHER: Empathy • Indicating appreciation, understanding, and acceptance of someone else’s emotional state

16. BATHER: Review/Response/Referral • Review • What have you learned from your patient? • Response • Support patient, offer coping strategies, problem solve • Referral • Support services, counselling

17. Use of BATHER • Being used at Princess Margaret • Should be considered in care at HRRH • All care should ensure provision of appropriate psychosocial interventions

18. Our Goal • Facilitate effective communication between patients, families, and care providers • Effective family meetings • Design and implement plan of care • Engage and support patients and families in managing their illness • Attain emotional well-being

19. Our Role as Healthcare Providers • Frontline for patients and families • Main source of support and strength • In a position to gain trust • Build a therapeutic relationship • Contribute to holistic care and well-being of patients and family members

20. In Conclusion Who is there in all the world who listens to us? Here I am- this is me in my nakedness, with my wounds, my secret grief, my despair, my betrayal, my pain, which I can’t express, my terror, my abandonment. Oh, listen to me for a day, an hour, a moment, lest I expire in my terrible wilderness, my lonely silence. Oh God, is there no one to listen? (Seneca)