Psycho-Existential Symptom Assessment Scale (PeSAS) Screening in Palliative Care.

CONTEXT: Psycho-existential symptoms are common yet often missed or neglected in palliative care. Screening can be an effective way to recognize and respond to this need. OBJECTIVES: We aimed to implement routine use of the Psycho-existential Symptom Assessment Scale (PeSAS) as a screening tool in Australian palliative care services and discern the symptom prevalence identified. METHODS: In a multi-site rolling design, we established implementation site committees and embarked on experiential workshops to train clinicians in the tool's efficient use. Patient symptom prevalence data were collected to compare uptake across sites. Descriptive statistics were applied. RESULTS: Over one year, we trained 216 clinicians across six palliative care services in the use of the PeSAS as a screening tool and collected data from 1405 patients. Clinicians reported significant growth in their sense of efficacy in assessing psycho-existential wellness. Services using electronic records implemented most easily. Psycho-existential symptoms with clinically significant prevalence (scores ≥ 4/10) included anxiety 41.1%, discouragement 37.6%, hopelessness 35.8%, pointlessness 26.9%, depression 30.3%, and the wish to die 17%. The precision of measurement within 3% was found for severe ratings (score ≥ 8/10) including anxiety 10.6%, depression 10.2%, the wish to die 7.6%, and confusion 3.6%. CONCLUSION: Clinicians can be trained to screen with the Psycho-existential Symptom Assessment Scale, which serves as a valuable measure to better recognize symptoms of psycho-existential distress among palliative care patients. Implementation barriers included the prior ethos of the service, confidence in talking about these themes, electronic data entry, and perceived time pressures.

Parental bonding, adult attachment, and theory of mind: A developmental model of alexithymia and alcohol-related risk.

OBJECTIVE: A developmental model of alexithymia in relation to alcohol-related risk was examined. METHOD: Validated indices of parental bonding, adult attachment, alexithymia, theory of mind (ToM), alcohol-related risk, and mood were administered to a nonclinical sample of 286 alcohol-using men and women. RESULTS: Hierarchical regression incorporating demographic and psychosocial variables accounted for 44% of the variance in alexithymia. Modeling indicated a significant path from dysfunctional maternal bonding to insecure adult attachment to alexithymia to risky drinking; a separate path indicated an indirect effect of alexithymia in association between the deficient ToM and risky drinking. CONCLUSIONS: Findings were consistent with a developmental model where dysfunctional parental bonding in childhood manifests in adulthood as insecure attachment and alexithymia, the latter reflecting the insufficient acquisition of emotion regulation skills; alexithymia, in turn, increases the risk of problematic drinking as an emotion regulation strategy.