All dimensions of need

Care for all aspects of the person, all dimensions - physical, psychological, social and spiritual - as good general practitioners already do.

Patients have rapidly changing physical, psychological, social and spiritual needs as death approaches. Being alert to these multi-dimensional typical patterns allows us to prevent and timely address suffering; and to explain to patients and carers what the future may hold.

What are 'spiritual' needs?

Everyone has spiritual needs when faced with serious life-threatening illness. An internationally accepted definition states, "spiritual needs are needs that relate to the meaning and purpose of life".(1) People may or may not use religious vocabulary to express such needs. If the spiritual issue or need causes the person distress it becomes "spiritual distress"; this may make pain more painful, anxiety less bearable and lead to increased health services utilisation unless it is identified and addressed.

Are there patterns to look out for?

Work in Edinburgh has confirmed that multidimensional distress can occur from diagnosis, and that in lung cancer social decline runs in parallel with the physical decline: "my old friends won't even take a cup of tea with me now I've got cancer".

Our research also uncovered four times when distress can routinely be expected: at the time of diagnosis, after initial treatment when the patient returned from the hospital, at recurrence or disease progression, and then again in the terminal stage.

How can primary care help?

The bio-psychosocial model of care that is a central tenet of palliative medicine is also a core concept in primary care. General practitioners are trained to identify, acknowledge and deal with spiritual as well as physical, social and psychological needs in people approaching the end-of-life. A relationship of trust and mutual understanding that commonly exists in general practice can help patients receive support and care starting from the time of diagnosis of the potentially fatal illness, when psychological and existential distress may be especially acute.(1,2)

References

1. Murray SA, Kendall M, Grant E, Boyd K, Barclay S, Sheikh A. Patterns of social psychological and spiritual decline towards the end-of-life in lung cancer and heart failure. JPSM 2007; 34:393-402
2. Cavers D, Hacking B, Erridge SE, Kendall M, Morris PG & Murray SA. Social, psychological and existential well-being in patients with glioma and their caregivers: a qualitative study. CMAJ 2012.
3. Recognising and managing key transitions in end of life care. BMJ 2010;341:c4863