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Letter
Existential distress: identification and management by hospice and palliative medicine fellows
  1. Angela Yeh1,2 and
  2. Helen Chernicoff3
  1. 1 Department of Medicine, Palliative Care Section, University of California - Los Angeles, Los Angeles, CA, USA
  2. 2 Department of Medicine, Division of Geriatrics, University of California - Los Angeles, Los Angeles, CA, USA
  3. 3 Department of Medicine, Integrated Geriatrics and Palliative Medicine Fellowship, University of California - Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr Angela Yeh, Department of Medicine, Palliative Care Section, University of California - Los Angeles, Los Angeles, CA 90095, USA; ayeh{at}mednet.ucla.edu

https://doi.org/10.1136/spcare-2023-004239

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    Dear editor,

    Existential distress is a multidimensional construct defining the state of psychological turmoil that can arise when one’s fundamental sense of meaning, control, or identity is threatened.1 There is no widely agreed on definition for existential suffering, but it is commonly referred to as an incapacitating state of despair resulting from an inner realisation that life is futile and without purpose.2 While existential questions at the end of life are natural, these existential concerns can be associated with overt suffering for some patients. Existential distress can manifest psychologically as depression or anxiety and can manifest clinically as uncontrollable pain or other refractory physical symptoms. Importantly, both chronically and terminally ill patients who suffer from existential distress have been shown to have an increased risk for poor health outcomes, high indices of pain and fatigue, and impaired daily functioning.3

    Given the multidimensional nature of existential suffering and its intertwined relationship with spiritual suffering, physical symptoms, and psychiatric symptoms, hospice and palliative medicine (HPM) clinicians must ensure that patients with existential distress receive excellent management of all three of these important domains. When HPM physicians encounter a patient with existential distress, they may feel a need to manage it pharmacologically or may feel powerless to help. This often leads to either inappropriate dose escalations of analgesics, …

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    Footnotes

    • Twitter @A_Y_0_9

    • Contributors AY conceived of the presented idea, developed the survey and obtained face value of the survey. AY piloted the survey with different fellowship classes as part of an educational curriculum improvement prior to submitting request for IRB exemption to administer to HPM trainees outside of the institution. HC assisted in obtaining all the emails and contact information for all the HPM programmes in the USA. Both authors discussed the results and contributed to the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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