Chapter 6: Providing Psychosocial Care 189 Providing Psychosocial Care What Is Psychosocial Care? The word “psychosocial” refers to the emotional, intel- lectual, spiritual, interpersonal, and cultural aspects of a person. Simply said, it means “everything except the physical.” In this text, physical symptoms and psychosocial issues are addressed in separate chapters. However, it is important to remember that people do not experience life in an unconnected or compartmentalized way. Human be- ings are whole persons and are holistic. Care that is hol- istic recognizes that a person’s whole being is involved in their care. It involves how they are emotionally, spiritually, cognitively, socially, and physically. It is recognized that physical symptoms can have emotional effects, and that emotions can have physical effects. Hospice and palliative care includes a holistic approach that sees the person as more than their illness, more than the sum of their body parts, and more than their emotional reactions to death, dying, loss, and grief. This chapter focuses on ways to provide psychosocial sup- port for the person and family experiencing transitions, uncertainty, loss, and grief. Having difficult conversations about advance care planning, for example, is discussed as a way to help people identify their priorities, concerns, hopes, and fears so that their wishes can be honored when they are unable to speak for themselves. Use the Psychosocial Assessment Form (see pages 83 to 88 in Chapter 4, “Using Standardized Tools”) to help under- stand the person, their goals of care, their family, and their support needs, and to inform goals-of-care conversations. Common Psychosocial Responses to the Diagnosis of Life-Limiting Illness Advances in disease diagnostics and treatments have in- creased the length of life for most people. However, the combined effects of multiple diagnoses that the majority of dying people now experience severely affect their qual- ity of life. While the diagnosis of diseases and the integra- tion of hospice and palliative care are currently moving upstream, management of psychosocial issues must now also move upstream to support people and their families through multiple changes in their health and psychosocial transitions (Pasacreta et al., 2015). People vary in their responses to a diagnosis, depending on the illness, their personal experiences, and the ways that they process information (Pallium Canada, 2013). Emotional responses may include feelings of shock, dis- belief, anxiety, depression, denial, irritability, and turmoil. These responses may present as physical symptoms, such as sleep loss and changes in appetite, as well as diffi- culties with concentrating and performing normal tasks (Pasacreta et al., 2015). Responses may last only days for some people and may extend into weeks or months for others. Ideally, reactions diminish when the person knows the treatment plan and comes to terms with the expected outcomes. Some people may require medication to help settle their reactions. Of particular concern is the assessment and support of people experiencing anxiety and depression in response to an initial diagnosis and during transitions. Anxiety and depression are natural reactions in people with chronic ill- ness. However, physicians/nurse practitioners may not treat these reactions, considering them to be organic, appropri- ate to the situation, or not severe enough to warrant treat- ment. Sometimes this can lead to extended unhappiness, increased family conflict and worry, non-compliance with treatment, and suicidal thoughts (Pasacreta et al., 2015). HCPs can support ill people and their families who are cop- ing with anxiety and depression by offering cognitive behav- ioral therapy and, for some people, medications. Cognitive behavioral therapy has been successful in helping people cope with their anxiety and depression and is more desirable in some cases because it does not involve medication. HCPs, specifically nurses, can help by being aware of the signs and symptoms of depression and anxiety that may occur alongside, but independent of, the progressing dis- ease. When distress is noticed, HCPs need to review all po- tential sources, including unmanaged symptoms. Nurses can support a person experiencing anxiety and depression by providing a caring presence, referring for counseling and alternative therapies, and, for some people, sug- gesting treatment through medications. 6