Existential Distress in Palliative Care: Age-Related Differences and Provider Perspectives

Abstract

This study centers around existential distress in the palliative care setting, a common phenomenon observed during life-threatening illnesses, such as cancer. The aim of the study was to explore how existential concerns and distress manifests across advanced cancer patients, how it is identified and assessed for severity, and how developmental differences (between older and younger patients) influence its presentation. Eleven palliative care providers from cancer centers across the United States participated in this study. The sample included both inpatient and outpatient practitioners from sites with robust palliative care programs. This qualitative study utilized semi-structured interviews to gather insights on the nature of existential concerns and distress in their patient population. The findings revealed universal manifestations of existential and patient concerns, irrespective of a patient's age. However, there were differences in the way those manifestation was expressed across age groups. Key time points for identifying existential distress were identified (acute prognosis, when role shifts and losses occur, and when behavioral changes occur), and developmental differences in existential domains and patient concerns were explored. The unexpected finding of countertransference and self-identification of providers with younger patients was also examined.