Understanding emotional pain in palliative care

Working in palliative and end-of-life settings where caring is predominantly for patients nearing the end of their life brings the health worker closer to some of the components of emotional pain. While emotions are invisible, the behaviours that underpin them are overt. It is possible that the same behaviour (for example, crying) can be provoked by different emotions; therefore, it is important that clear distinctions are understood. This column discusses the complexities of emotional pain, some of the main emotional components, their triggers and how to accurately interpret them in order to fully understand the patient's situation.

The components of emotional pain are multi-faceted (Figure 1) and impact the overall wellbeing of patients and their relatives at the end of life. When patients are being cared for at home, community nurses may encounter some, if not all, of these emotions.

Let us consider a case. Brodie was a 34-year-old man who was given a poor prognosis of a few months' life expectancy by doctors following a diagnosis of lung cancer with cerebral metastases. He had responded well to radiotherapy initially, but his condition was deteriorating, with episodes of confusion and headaches. In terms of his socio-nursing history, Brodie had experienced urinary continence for the first time in his life, with limited unsteady mobility. He was frightened of dying but stayed strong for his wife Jodie; they had no children. Brodie's parents had gone through a bitter divorce and used to visit his home separately. They felt their divorce had contributed to their son's suffering and lacked joined-up parental love and care. On the other hand, Jodie felt helpless at home with her husband, as she felt she was not able to care for him alone. She was also angry with him for ‘doing this to us’, and felt that he was too young to be helpless and dying, and not pursuing all their dreams (travelling, starting a family and pursuing a career).