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Survivorship of severe medically unexplained symptoms in palliative care
  1. Justin Dwyer1,
  2. Keryn Taylor1 and
  3. Mark Boughey2
  1. 1Department of Psychosocial Cancer Care, St Vincent's Hospital, Fitzroy, Victoria, Australia
  2. 2Vincent's Hospital, Fitzroy, Victoria, Australia
  1. Correspondence to Dr Justin Dwyer, Department of Psychosocial Cancer Care, St Vincent's Hospital, P.O. Box 2900, Fitzroy VIC 3065, Australia; Justin.dwyer{at}svha.org.au

Abstract

Objectives Patients who articulate their psychological distress primarily through physical symptoms (referred to as medically unexplained symptoms (MUS)) pose a challenge to the skills of most clinicians, including palliative care physicians. The philosophical underpinnings of palliative care with a stated focus on symptom management and care of the person in their psychosociospiritual context lend itself to the care of these patients. The aim of this study was to investigate the characteristics to improve identification of this patient group within palliative care.

Methods Here, we report a case series of 6 patients with severe MUS who were referred to palliative care. We use illustrative case vignettes, examine clinical and demographic characteristics and review the perspectives of the multidisciplinary team to identify the common threads.

Results This case series highlights the complexities and challenges that are inherent in providing assessment and care for patients with MUS that present to palliative care. Characteristics that were identified included the clustering of ‘trigger’ symptoms, backgrounds of multiple chronic illnesses and relationship dysfunction. Patient outcomes in this group were universally poor, including the death of 2 patients.

Conclusions Knowledge of this patient group is vital given the likely increase in prevalence of MUS as palliative care broadens its focus earlier in the trajectory of illness. The strengths of palliative care, including psychosociospiritual assessment, multidisciplinary input and communication skills holds the potential to accurately identify patients with MUS and allow the opportunity for specialist psychiatric input with the hope of improving outcomes for patients and their families.

  • Psychological care
  • Social care
  • Survivorship
  • Clinical assessment
  • Received 11 January 2017.
  • Accepted 15 February 2017.

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  • Received 11 January 2017.
  • Accepted 15 February 2017.
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Footnotes

  • Contributors JD planned the study. JD and KT collected the data. All authors analysed the data, drafted, reviewed and approved the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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