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Clinical guidance for responding to suffering in adults with cancer

Practice points

The identification, assessment and relief of suffering in the cancer context are new and emerging areas of research. These practice points are provided to help guide clinical decisions for psychosocial care relating to suffering in adults with cancer. Practice points are based on expert opinion of the multidisciplinary working group WG consensus when the evidence to make a clinical practice recommendation was insufficient or where the evidence was outside the scope of the systematic review.

Supporting evidence and information relating to the practice points is provided in the corresponding section of the document.

Clinical guidance for responding to suffering in adults with cancer should be considered within a multidisciplinary team setting.

Multidisciplinary care is the best practice approach to providing evidence-based cancer care. Multidisciplinarycare is an integrated team-based approach to cancer care where medical and allied health care professionals consider all relevant treatment options and collaboratively develop an individual treatment and care plan for each patient.

PRACTICE POINT – The importance of responding to suffering References
a Acknowledging and responding to suffering, including spiritual issues, in patients and their families is an important component of clinical care. Naden 20063
Daneault 20064
Ehman 19995
Grant 20046
Ohlen 20047
PRACTICE POINT – Identifying suffering References
b Recognising signs and symptoms of possible suffering, including verbal, emotional and behavioural cues, is an important role for healthcare professionals. WG consensus
PRACTICE POINTS – Responding to suffering References
c It is advisable to briefly assess patients’ level of suffering, including spiritual needs, soon after diagnosis in order to triage those patients with high or urgent need for support or intervention. Additional assessments are advised at readmission, change in prognosis, at the end of a treatment protocol and at end of life. McGrath 20038
Murray 20079
Adelbratt10
Lethborg 200811
d Consider using a validated assessment tool or incorporating open questions relating to suffering into a general conversation about care (See Appendix 1) . WG consensus
e Determine patients’ needs for psychosocial care and establish the personal resources and support networks they can draw on. Ohlen 200212
Lethborg 200811
f Demonstrate an ongoing openness to listening and responding to patients’ and families’ suffering by acknowledging the issue, normalising their feelings, showing empathy and inviting patients and family members to voice concerns as they arise. Naden 20063
McCord 200413
Ehman 19995
Adelbratt 200010
g Consult with family members, if available and with the patient’s permission, to obtain further information about the patient’s spiritual beliefs, to assist in their spiritual care. WG consensus
h Acknowledge patients’ and families’ different cultural and religious needs, and accommodate them where possible while recognising one’s limitations in knowledge or skills. WG consensus
PRACTICE POINTS – Care coordination, referral and interventions (See also Referral flowchart) References
i Following assessment and with the patient’s consent, ensure outcomes and other relevant information are recorded and communicated to other appropriate healthcare professionals. WG consensus
j Confirm which healthcare professionals can respond to the different aspects of a patient’s suffering, remembering that people may already have existing supports in the community. If a relevant healthcare professional is not available in the multidisciplinary team (MDT), the referral may be made to one outside the team (e.g. if a psychologist is not part of the hospital team, you may wish to use an external psychologist). WG consensus
k Consider appropriate referral to a non-health specific professional, such as a multicultural liaison officer, Aboriginal liaison officer or chaplain/spiritual care practitioner. WG consensus
l Consider the use of a psychological intervention designed to address psychosocial suffering or one of its domains such as hopelessness. Herth 200014
Ando 201015
Breitbart 201216
Breitbart 201017
Henry 201018
Rustoen 199819
Duggleby 200720
Badger 201121
Ferguson 201222
Northouse 200523
Delbar 200124
Koinberg 200625
Hansen 200926
Witek-Janusek 200827 Henderson 201228
Garland 200729
Moadel 200730
Chandwani 201031
Antoni 200132
Penedo 200633
Antoni 200634
Danhauer 200935
Fallah 201136
Rummans 200637
Hsiao 201238
m Consider the use of additional supportive care options that may be available at the hospital/clinic or through support groups or spiritual networks, which patients may find beneficial. WG consensus

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