Palliative Care Does Not Alleviate Psychological Distress

Palliative Care

According to a Rutgers study, palliative care — specialized medical care focused on quality of life for people with serious illnesses such as cancer or heart failure — is unlikely to reduce psychological distress. The study combined the findings of 38 previously published studies to examine the average effect of interventions on psychological distress.

The meta-analysis of 38 randomized clinical trials of palliative care interventions found no statistically significant improvements in patient or caregiver anxiety, depression, or psychological distress.

General psychosocial support is frequently provided in palliative care, but this approach is less effective than evidence-based therapeutic interventions such as cognitive behavioural therapy. Palliative care interventions vary greatly in terms of team members professional backgrounds and the use of evidence-based therapies for psychological distress.

End-of-Life Psychological Distress

Psychological distress symptoms such as depression, sadness, anxiety, negative affect, and fear are frequently encountered by palliative care clinicians in patients and their families. As the end of life approaches, cancer, heart failure, and lung disease patients frequently exhibit increased depressive symptoms.

Palliative care aims to identify, assess, and manage pain and physical, psychological, social, and spiritual concerns among patients and their families afflicted with life-threatening conditions. To manage psychological distress, palliative care has frequently failed to fully integrate advances from psychological science and psychiatry.

Researchers from Rutgers, led by doctoral student Molly Nowels, conducted a protocol-based systematic review and meta-analysis to determine whether palliative care interventions alter psychological distress.

Integrating Evidence-based Interventions

The researchers found no evidence to support the notion that palliative care interventions reduce psychological distress, but they did identify conceptual and methodological flaws in the literature that could be addressed, such as including patients with pre-existing mental health conditions in studies and increasing transparency and accountability through pretrial registration.

More research is needed to adapt and integrate evidence-based psychological interventions into palliative care studies and evaluate outcomes in critically ill populations. according to the scientists. In a recent randomized controlled trial, metacognitive therapy (MCT) was found to reduce symptoms of depression, anxiety, and post-traumatic stress disorder in patients with heart disease, for example.

The authors discovered that people with pre-existing mental health conditions were excluded from more than a third of the randomized clinical trials included in their study.

“This means that some of the people who might be most in need of palliative care’s integrative approach to suffering are not being represented in clinical trials, which could perpetuate inequalities for people with mental health conditions,”

said Nowels.

To improve the quality of care for this group, the authors believe that researchers should include patients with existing mental health conditions in future palliative care intervention studies.

  1. Molly A. Nowels et al. Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis. Journal of Pain and Symptom Management (2023). DOI: 10.1016/j.jpainsymman.2023.02.001