The total pain1 and total dyspnea2 models can be expanded into a model of the multidimensional suffering of patients experiencing serious or life-threatening illness3. These models describe symptom burden in terms of associated physical symptoms and loss of functioning; psychological impact and its effect on emotion, coping, or adjustment; social impacts on identity, role, and relationships; and spiritual impact on coping, existential distress and meaning.
This suffering model has the potential of being a screening criteria for referral to specialist palliative care based on suffering rather than disease state. A hypothetical paradigm to empower patient self-referral might be:
- Does your disease or its symptoms feel intolerable or make you feel debilitated, weak, or fatigued to an unbearable extent?
- Does your disease or its symptoms cause you to feel sadness, fear, or anger to such an extent that it impairs your functioning?
- Does your disease or its symptoms cause you to question your personal, professional or familial identity or role?
- Does your disease or its symptoms cause you to question your beliefs or cause your beliefs to be unsupportive?
- Dame Cicely Saunders
- Curr Opin Support Palliat Care. 2008; 2(2):110-3