Thursday, March 24, 2016

Suffering As A Screening Criteria For Palliative Care Referral

The total pain1 and total dyspnea2 models can be expanded into a model of the multidimensional suffering of patients experiencing serious or life-threatening illness3. These models describe symptom burden in terms of associated physical symptoms and loss of functioning; psychological impact and its effect on emotion, coping, or adjustment; social impacts on identity, role, and relationships; and spiritual impact on coping, existential distress and meaning.

Total symptom model 001

This suffering model has the potential of being a screening criteria for referral to specialist palliative care based on suffering rather than disease state. A hypothetical paradigm to empower patient self-referral might be:

  • Does your disease or its symptoms feel intolerable or make you feel debilitated, weak, or fatigued to an unbearable extent?
  • Does your disease or its symptoms cause you to feel sadness, fear, or anger to such an extent that it impairs your functioning?
  • Does your disease or its symptoms cause you to question your personal, professional or familial identity or role?
  • Does your disease or its symptoms cause you to question your beliefs or cause your beliefs to be unsupportive?
If you answered yes to any of the above questions, would you like to see a team that deals exclusively with diagnosing, managing, treating and preventing this kind of distress?

If they answer yes referral to specialist palliative care team should follow. Just a thought.


  1. Dame Cicely Saunders
  2. Curr Opin Support Palliat Care. 2008; 2(2):110-3

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