This information is sourced from Dr Heather Wells, Clinical Psychologist
Anxiety is very common in advancing illness.
For many people death is a taboo subject. Unexpressed fears about the end of life can worsen anxiety, affect quality of life and impact a persons ability to have a good ending.
Leaning in to exploring individual worries is key and requires brave empathic communication. Patients can feel overwhelmed and the conversations can't be rushed. Depending on your clinical setting it may require several appointments to explore, and your patient should control the pace.
Causes of anxiety can range from the practical to the spiritual. Some of these worries can be resolved and others can be shared, explored and often become more tolerable over time.
Discussing fears and worries often leads on to identifing goals of care, and can help people to plan how they want to live.
Common worries we see in practice
Pain – people may worry about dying in pain; those with cancer may worry that new pain is a sign of the cancer spreading
End of treatment – people may struggle to adjust when active treatment of an illness stops eg chemotherapy
Being isolated from friends and family
Family worries – for example, worrying about being a burden
Legal, financial and housing worries - often not explored by clinicians
Spiritual distress
Assessment of severity
A validated tool such as GAD-7 can be helpful to guide treatment
Treatment
Talking with a trusted professional often helps
For many people with mild levels of anxiety, self-help resources may be enough
Breathing exercises are often a helpful way to manage the symptoms of anxiety
Browsing books can be a gentle way to feel less alone and more in control
Practical help – for example, help in making advance care plans, support for housing or financial worries
Anti-depressant or anti-anxiety medication can be considered
Spiritual care - focussing on what gives meaning, legacy,reminiscence and faith if appropriate
Recommended book : Free yourself from Death Anxiety. A CBT Self-Help Guide for a Fear of Death and Dying. Menzies and Veale 2022