The Personhood Pentadigm: A transcultural framework for analyzing existential distress in palliative care

Objectives Existential distress at the end of life constitutes a profound crisis of fractured personhood that transcends biomedical suffering. Most models of personhood remain primarily descriptive, static taxonomies and have not been translated into an actionable clinical roadmap. This study aims to address three systemic barriers in conventional palliative psychotherapy—the “somatic-reflective disconnect,” compressed terminal timelines, and Western individualistic biases. By synthesizing and complementing Eastern philosophical concepts with Western clinical frameworks, we derive a novel, secular clinical model (the Personhood Pentadigm [PP]) to map and systematically disrupt end-of-life existential suffering. Methods We employ a dual-stage qualitative design. First, we develop the conceptual framework through transcultural translation of the Eastern psychology of the five aggregates, integrating five secular dimensions—Physical Image, Somatosensory Tone, Role/Narrative, Volitional Behavior, and Consciousness—with Western clinical humanities (including modern grief theories and existentialism). Second, we operationalize the model using a purposive qualitative case vignette methodology based on detailed bedside clinical documentation of contrasting terminal trajectories. Each case is analyzed via a three-phase interpretive analytic procedure: 1) domain-specific qualitative coding, 2) causal pathway mapping, and 3) interdisciplinary care alignment. Results The analysis reveals that existential distress is a dynamic, multi-nodal systemic collapse of personhood rather than a static symptom. Importantly, the selected vignettes demonstrate two coincidental, non-disease specific configurations of suffering: 1) a trajectory (Case A, oncology) that illustrates a sequential, downstream linear cascade where physical and somatosensory fractures systematically dismantle the patient’s global macro-narrative; and 2) a trajectory (Case B, chronic organ failure) that illustrates a complex, non-linear recursive loop where somatic distress and loss of roles feedback to drive death anxiety and fear of sleep. Operationally, the findings prove that establishing a “somatic runway” via physical stabilization is a strict prerequisite for downstream reflective therapies. Additionally, the PP successfully sequences and aligns clinical actions across multidisciplinary specialties. Conclusions By establishing a shared, translational lexicon and clear interdisciplinary role demarcation, the PP empowers front-line multidisciplinary teams to systematically disrupt cascading loops of distress. It serves as an operational care-planning roadmap that democratizes existential care, allowing clinicians to routinely integrate holistic psychospiritual support into bedside palliative care.