Existential pain--an entity, a provocation, or a challenge?

"Existential pain" is a widely used but ill-defined concept. Therefore the aim of this study was to let hospital chaplains (n=173), physicians in palliative care (n=115), and pain specialists (n=113) respond to the question: "How would you define the concept existential pain?" A combined qualitative and quantitative content analysis of the answers was conducted. In many cases, existential pain was described as suffering with no clear connection to physical pain. Chaplains stressed significantly more often the guilt issues, as well as various religious questions (P<0.001). Palliative physicians (actually seeing dying persons) stressed more often existential pain as being related to annihilation and impending separation (P<0.01), while pain specialists (seeing chronic patients) more often emphasized that "living is painful" (P<0.01). Thirty-two percent (32%) of the physicians stated that existential suffering can be expressed as physical pain and provided many case histories. Thus, "existential pain" is mostly used as a metaphor for suffering, but also is seen as a clinically important factor that may reinforce existing physical pain or even be the primary cause of pain, in good agreement with the current definition of pain disorder or somatization disorder.

Spiritual needs as defined by Swedish nursing staff.

A study was undertaken to describe how Swedish nursing staff at six different units characterize spiritual needs in a broad context, including both religious and existential issues. Another aim was to study whether there are any special groups of patients for whom these needs are considered to be of utmost importance. A questionnaire comprising two open-ended questions (the focus of the study) and six background questions was mailed to 191 nurses. Data were obtained from 141 nurses who worked on the oncology, palliative, neurological, neurosurgery and psychiatric units or in nursing homes. Data from the open-ended questions were analysed using content analysis and classified into three categories: (i) (general) spiritual issues, (ii) religious issues, and (iii) existential issues. Sub-categories of the latter were (a) meaning, (b) freedom, (c) isolation and (d) death, i.e. the four central issues in existentialism as previously defined by existential philosophers. A majority of the nurses only had limited theoretical knowledge about definitions. Nevertheless, their suggestions for improved spiritual and existential support contained essential elements that could be allocated to the three main categories. They had some difficulty distinguishing between spiritual and psychosocial care. According to the nurses, special groups of interest for spiritual and existential support were severely ill, dying persons and immigrants who actively practiced their religion. We conclude that there is a willingness to pay attention to spiritual and existential needs, but nurses still have difficulty defining what such care should include. The study revealed that nursing staff needed, and also made inquiries about, more education in order to deepen their knowledge.

Questions posed to hospital chaplains by palliative care patients.

CONTEXT: Questions of vital importance are actualized when facing one's own death. Studies on patient need for a hospital chaplaincy as an integral part of hospital care are lacking. OBJECTIVE: To categorize the three most important questions patients pose to hospital chaplains at the end of life and to assess the degree to which hospital staff should be able to handle them. DESIGN AND SETTING: A Swedish national survey using an open-ended questionnaire and content analysis. PARTICIPANTS: One hundred seventy-two Swedish hospital chaplains (national coverage, 74% response rate). Categories developed from open-ended questions. Categories of questions posed to hospital chaplains. RESULTS: Five main categories were identified: meaning (34%); death and dying (21%); pain and illness (13%); relationships (15%); and religious issues (8%). Questions of a general existential nature concerned with meaning-related issues and with death and dying were frequently the primary issue. Many questions dealt with pain, fear of suffocation, and illness in general (i.e., questions that the palliative team should be able to handle). Only 8% of the issues were explicitly religious and these were often third-hand choices. CONCLUSION: The role of the hospital chaplaincy has changed. Today it entails specialized competence and is needed in existential discussions with different patients in crisis, regardless of their personal faith or lack of faith. Nonetheless, physicians and other staff members should be able to handle many of the questions that are of a more general/medical character.