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

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Emotional Distress:

The Sixth Vital Sign

Presented by: Lucy Kukac

April 27, 2011

Central Hospice Palliative Care Network

Networking Day

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.

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

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

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

Effects of Emotional Distress




oGetting to and from appointments






oChanges in appearance



oMeaning/Purpose of Life



oFeeling a burden to others

oWorry about family/friends

oFeeling alone


oUnderstanding my illness and/or treatment

oTalking with the health care team

oMaking treatment decisions

oKnowing about available resources


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:

Screening Toolkit

  • Distress Thermometer

Screening Toolkit: ESAS

  • Edmonton Symptom Assessment Scale

    • Well-being

    • Anxiety

    • Depression

Screening Toolkit: BATHER

  • Background

  • Affect

  • Trouble

  • Handling

  • Empathy

  • Response/Renewal/Referral

BATHER: Background

  • Beginning to understand the situation


BATHER: Affect

  • Feeling and state

BATHER: Trouble

  • Seek to understand what is troubling the patient about the symptoms or situation

BATHER: Handling

  • Getting an idea of how the patient is functioning/coping with the situation

BATHER: Empathy

  • Indicating appreciation, understanding, and acceptance of someone else’s emotional state

BATHER: Review/Response/Referral

  • Review

    • What have you learned from your patient?

  • Response

    • Support patient, offer coping strategies, problem solve

  • Referral

    • Support services, counselling


  • Being used at Princess Margaret

  • Should be considered in care at HRRH

  • All care should ensure provision of appropriate psychosocial interventions

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

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

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)

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