Psychological Distress in End-of-Life Care: A Review of Issues in Assessment and Treatment

The psychological distress and other end-of-life issues experienced by the terminally ill patient are a focus of attention for both the medical and psychiatric communities. The arena has engaged a variety of voices, from those who medicalize end-of-life distress to others who view distress as a normative response within the biopsychosocial-spiritual framework. This article reviews issues in assessment and treatment and suggests that medicalization of distress and DSM-IV-TR criteria are insufficient to describe the dying patient's experience. A broader view is needed. End-of-life care is a rich field of practice where existential concerns impact physical and mental well-being. It is imperative that clinicians in the field equip themselves with psychosocial and spiritual clinical tools. Social workers may have a unique position in understanding and addressing end-of-life issues. Recommendations for social work education include increased training to equip medical social workers to address the specific needs of chronically or terminally ill individuals.