• David W Kissane, Irene Bobevski, Jane Appleton, Natasha Michael, Tania King, Graham Moss, Derek Eng, Alison White, Danielle Carboon, Rachel Eade, and Luka Keighley.
• School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; St. Vincent's Hospital (D.W.K., J.A.), Sydney, New South Wales, Australia; Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia; School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia. Electronic address: David.kissane@monash.edu.
• J Pain Symptom Manage. 2023 Sep 1; 66 (3): 212220.e2212-220.e2.

ContextPsycho-existential symptoms in palliative care are addressed insufficiently. Routine screening, ongoing monitoring and meaningful treatment of psycho-existential symptoms may contribute to the relief of suffering in palliative care.ObjectivesWe sought to explore longitudinal change in psycho-existential symptoms following the routine implementation of the Psycho-existential Symptom Assessment Scale (PeSAS) in Australian palliative care services.MethodsUsing a multisite rolling design, we implemented the PeSAS to longitudinally monitor symptoms in a cohort of 319 patients. We assessed change scores for each symptom in groups with mild (≤3), moderate (4-7) and severe (≥8) symptomatology at baseline. We tested significance between these groups and used regression analyses to identify predictors.ResultsWhile one half of patients denied clinically important psycho-existential symptoms, for the remainder, overall, more patients improved than deteriorated. Between 20% and 60% of patients with moderate and severe symptoms improved, while another 5%-25% developed new symptom distress. Patients with severe baseline scores improved significantly more than those with moderate baseline scores.ConclusionAs we better recognize through screening patients carrying psycho-existential distress in palliative care programs, there is considerable room for improvement in ameliorating this suffering. Inadequate clinical skills, poor psychosocial staffing or a biomedical program culture may all contribute to inadequate symptom control. Person-centered care necessitates greater attention to authentic multidisciplinary care that ameliorates psycho-spiritual and existential distress.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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