Fear, anxiety, and adjustment disorder in palliative care

Palliative care has major implications for the psychological well-being of not only the patient, but also family members and those close to them. Being offered palliative care can send a variety of signals to a patient, including a sense that the medical system has failed them and that their life is about to end, or maybe a sense of relief in knowing that their suffering will end soon. The family of the patient also experience a range of emotions associated with palliative care, often mimicking that of the patient. Although palliative care aims to minimize suffering and improve the quality of death for the patient, it is critical that the psychosocial well-being of the patient is addressed; neglect of these concerns will compromise the quality of palliative care, the quality of death, and overall psychological, emotional, and spiritual well-being of the patient, despite improvements in physical suffering. This chapter discusses the key importance of the need for reciprocal open communication and information provision during this difficult time between the patient, their family, and the palliative healthcare team. Ineffective communication can jeopardize the psychosocial well-being of the patient, with feelings of existential threat, isolation, depression, fear, anxiety, hopelessness, and wishing for a hastened death commonly reported. This chapter highlights these issues and provides an overview of evidence-based established approaches addressing the psychological well-being of both the patient and their family. An overarching theme across all intervention approaches is to maintain honest, open communication between medical staff, the patient, and their family.