Psychosocial and Existential Wellbeing in Palliative Care

Routine Clinical Assessment of Psychosocial and Existential Symptoms in Palliative Care: A National Quality Improvement Project through Education and Supervision

Patients with unrecognised depression, unaddressed demoralization and unabating anxiety account for some of the most vulnerable patients in palliative care. Despite effective, evidence-based treatments being available, non-recognition has been a major barrier. These under-served patients form a population in dire need of treatments to optimise their adjustment and prevent suicidal thinking. Several evidence-based medication and counselling approaches are available to effectively help these patients, but these remain underutilised in palliative care. This is compounded by a lack of focus on the education of frontline staff on this area, with the majority of face-to-face or e-learning resources for palliative care lacking any of these components. 

This education and knowledge translation project has two objectives: 

  1. To roll out online and face-to face educational workshops across states and territories to train and upskill clinicians (nurses, physicians, psychosocial health providers) about how to explore and discuss psycho-existential symptoms, treat or refer to appropriate expertise; 
  2. Train services to assess for unmet psycho-existential need through the 10-item Psycho-Existential Symptom Assessment Scale, which uses six items that assess Demoralization and existential concerns and four items assessing other psychosocial issues.

Train-the-trainer workshops with experiential role-plays in a simulated setting will complement the online educational program which will be incorporated within the established End-of-Life Essentials e-learning platform (funded by the Australian Government Department of Health and developed by a team at Flinders University). This education will build skills to converse about and assess psycho-existential wellbeing, familiarise staff with medication algorithms developed by experts, and create local champions. Benchmarking outcomes (e.g. training completion rates, staff confidence, patients assessed) with comparable services locally and nationally will create quality improvement goals.

This implementation and quality improvement project will be rolled out progressively across six states and the two territories. Service development will be planned through local site leaders to then expand training through service components sequentially until confidence and competence is achieved in routine screening and care provision.

To ensure adequate and ongoing service engagement and local communication strategies, we will develop specific new linkages with state-wide palliative care networks, consortia and state-wide palliative care peak bodies. We will use communication and education opportunities provided by these groups to promote participation in the project and ongoing opportunities for training.

The project will deliver education to front line providers to enhance their skill development to better respond to these symptoms. Thus improving nationally the quality of palliative care service delivery in community and acute care settings, and in the process potentially reduce health costs (reduced hospitalisations and length of stay) through this preventive and early recognition model of care.


Project Lead and Chief Investigator: 
Prof David Kissane

Project Coordinators: 
Ms Jane Appleton

Mr Jonathon Lennon


Page created 08 October 2020