Full Palliative Living: A self-help resource for palliative patient distress

An article written by Emeritus Professor Kenneth Pakenham and Dr Christopher Lloyd Martin, School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland

Significant levels of distress are experienced by 29-40% of palliative patients. Hence, palliative patient access to effective psychosocial interventions which reduce distress and enhance wellbeing and quality of life is essential.  Evidence supports the benefits of in-person Acceptance and Commitment Therapy (ACT) for palliative care patients, however there are numerous barriers to accessing in-person psychosocial support (e.g., physical symptom burden, access to mental health clinicians).  Therefore, we developed a self-help ACT intervention called the Full Palliative Living program. We then evaluated it in a pilot study that compared two groups: intervention group with 52 palliative care patients, and a comparison group with 54 palliative care patients who did not receive the Full Palliative Living program. [1] The study had 3 aims, which were to evaluate:

• the efficacy of the program in improving palliative patient psychosocial outcomes (distress, death attitudes, pain, and quality of life),
• its efficacy in improving palliative patients’ psychological flexibility which bolsters resilience
• whether improvements in psychological flexibility contribute to improvements in palliative patients’ psychosocial outcomes.

Results showed that compared with the comparison group, palliative patients demonstrated greater reductions in depression, anxiety, and total distress following completion of the Full Palliative Living program.  In addition, compared with the comparison group, there were significantly fewer intervention participants who used acceptance of death as an escape from an unhappy existence.

Regarding the second aim, results showed that compared with the comparison group, palliative patients demonstrated significant improvements in overall psychological flexibility, as well as improvements in two of its sub-components (acceptance and valued living) following completion of the Full Palliative Living program. 

For the third aim, results showed that improvements in overall psychological flexibility contributed to improvements in depression, anxiety, and total distress for the palliative patient intervention group. Furthermore, the acceptance sub-component also contributed to improvements in anxiety, and total distress.

Palliative patients in the intervention group provided mostly positive feedback on the program, rating it as an acceptable self-help intervention that they were able to successfully complete.  Feedback indicated that the program was beneficial in shifting perspectives on living with a palliative illness and contributing to behavioural changes which improved quality of life.

Overall, findings from this study provide preliminary support for the beneficial effects and acceptability of the Full Palliative Living self-help ACT intervention, particularly with regards to reliving distress for palliative patients.  Given the limited access to mental health clinicians within settings providing palliative care, the availability of a self-help resource such as the Full Palliative Living program can aid multidisciplinary palliative care teams in providing effective psychosocial support, and ultimately improve access to a holistic care approach. 

If you would like to know more about the Full Palliative Living self-help ACT intervention, please contact Dr Christopher Lloyd Martin here. 

Authors

Emeritus Professor Kenneth Pakenham

School of Psychology, Faculty of Health and Behavioural Sciences,

The University of Queensland, St Lucia Campus, QLD

Dr Christopher Lloyd Martin

School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland

Specialist Palliative Care Service, Sunshine Coast Hospital and Health Service