Distress at End of Life: A Concept Analysis (RP519)

Objectives Recognize the attributes, antecedents, consequences of, and empirical referents for distress at end of life. Describe how this operational definition will aid the multidisciplinary team's approach to end of life care. Importance. Distress is a common phenomenon at end of life (EOL). While the concept of distress has been researched and documented in multiple patient populations, contexts, and from specific dimensions (e.g. physical or psychological distress), a complete conceptualization of distress at EOL is limited in the current literature. Objective(s). The purpose of this concept analysis was to synthesize the interdisciplinary literature related to distress to define attributes, antecedents, and consequences of distress at EOL. Additionally, empirical referents for validated measures of distress were also explored. Method(s). The Walker and Avant method for concept analysis was utilized to choose a relevant concept of interest; determine the purpose/importance of analysis; identify all uses of the concept in the current literature; define attributes, antecedents, and consequences; identify a model, borderline, related, and contrary cases; identifying empirical referents; and synthesize an operational definition. Findings. Based on the attributes, antecedents, and consequences defined through the literature review, the following operational definition of distress within the context of EOL was formulated: Distress at end of life is a multidimensional (physical, psychosocial, existential, or spiritual) phenomenon involving moderate to severe discomfort, anguish or suffering due to mental and/or physical upset caused by severely unpleasant symptoms or stressors that are reported or observed and quantified by the patient, family, or provider. This distress threatens or causes harm and burden to the person or their family/caregiver and ultimately decreases quality of life. Conclusion(s). A new operational definition of distress at EOL can aid the multidisciplinary team providing holistic care through timely assessment of and intervention for distress in its many dimensions. It will support the development and validation of appropriate measures and foster a unified interdisciplinary approach to distress management, EOL research, and ultimately increase comfort and quality of life for patients at EOL.