Anxiety towards the end of life: Information for patients and carers

This information is sourced from Dr Heather Wells, Clinical Psychologist

Anxiety is a natural response to stresses in our lives and is common in people living with a Palliative diagnosis.

What is anxiety?

Anxiety is a feeling of worry or fear. It can be helpful in the short term by keeping us alert and ready to act in response to danger. However, if these feelings continue for a long time or are difficult to cope with, they can affect quality of life.

Common symptoms of anxiety
  • restlessness and irritability
  • feeling tired
  • bowel discomfort
  • breathlessness
  • excessive worry
  • not being able to concentrate
  • muscle tension
  • disturbed sleep
  • a constant feeling of dread

Some people may have panic attacks, where they feel sudden, intense or overwhelming fear and discomfort, lasting up to 30 minutes. They may cause strong physical symptoms such as: chest pain, dizziness, pounding heart, sweating or shaking.

Accordion body...

Risk factors for anxiety in palliative care

For most patients with advancing illness, symptoms of anxiety are normal and understandable responses to the uncertainties about their future and the possibility of approaching death.

Other possible risk factors for anxiety in patients at this stage of life include:

  • Pain and other overwhelming symptoms
  • End of active treatment for an illness – people may struggle to adjust when their treatment eg chemotherapy stops 
  • Being isolated from friends and family
  • Family worries – for example, worrying about being a burden or worry about dependants
  • Financial worries/ Employment/ immigration status/ housing conditions
  • Spiritual distress
Managing anxiety

Talking to someone you trust. People may find it reassuring if they’re able to speak to the same professional over a period of time

Every Mind Matters offer practical tips for anxiety management 

Breathing exercises are often a helpful way to manage the symptoms of anxiety

Practical help – for example, help housing or finances

Symptom management, such as pain control

Medication (in some cases, a combination of medication and psychological therapy is recommended)

Spiritual care – supporting people to feel a sense of meaning, comfort, strength and connection in their life

Some patients may need additional care and may benefit from initially speaking to their palliative care providers for advice and support. They may consider an onward referral to specialist psychological support within the local Clinical Psychology Service or Talking Therapies Service (IAPT).

Recommended book : Free yourself from Death Anxiety. A CBT Self-Help Guide for a Fear of Death and Dying.  Menzies and Veale 20

 

Recommended Resources

NICE Generalised anxiety disorder and panic disorder in adults: management

Published 5th June 2020

Marie Curie - Symptom Control - Anxiety

Published 10th February 2020

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Pharmacies

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St Francis Hospice Referral Hub

T. 01708 758606

W. https://www.sfh.org.uk/make-a-referral

The St Francis Hospice's referral hub can be accessed by those facing a life limiting condition. 

Please refer a patient or making a self-referral to access hospice services.

St Francis Hospice Specialist Community and Crisis Support
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St Francis Hospice Specialist Community and Crisis Support

T. 01708 758643 / 01708 758610 ext. 2266

W. https://www.sfh.org.uk/crisis-support

The team are clinical specialists that are experts in pain and symptom control.

Urgent advice ia available 24 hours, 365 days a year.

St Luke's Hospice Clinical Outpatients
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St Luke's Hospice Clinical Outpatients team offers convenient, accessible and specialist key clinical procedures and palliative care, in a relaxed environment with appointments to meet your wellbeing and lifestyle needs. 

Key clinical procedures offered to outpatients:

  • Advance Care Planning clinics
  • Ascetic and Pleural drainage
  • Blood product transfusions
  • Clinical Nurse Specialist symptom management clinic
  • CVC line care
  • Intravenous fluids
  • IV Bisphosphonates infusions
  • IV Iron Infusions
  • Long term condition clinic – supporting heart failure, renal and liver conditions
  • Venepuncture

The service opening hours are 9.00am to 5.00pm.

St Luke's Hospice Community Service
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St Luke's Hospice community service provides assessment, support advice and care for people wishing to be cared  and supported in their locality community setting. The team also provide support in care homes, the hospice's rapid access service and there is the provision of clinical nurse specialists.

St Luke's Hospice In Patient Unit
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St Luke's Hospice provide specialist in-patient care for symptom management and end of life care.        

There are a total of 7 beds and 1 emergency bed in Basildon.

Hospice Rapid Access Service (HRAS) with 6 Beds in Thurrock.

St Luke's Hospice Physiotherapy Support
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St Luke's Hospice Physiotherapy team can help when living with a life limiting illness.  Specialist Physiotherapists and Occupational Therapists will listen and assess to support independence and aid mobility to manage symptoms and positively impact quality of life and wellbeing.

Family and loved ones are also supported in their caring roles. Advice, guidance and techniques on how to safely move and handle someone when caring for them can be accessed through conversation with the Physiotherapy team.

The offer includes:

  • individual assessments to help provide appropriate equipment, e.g. mobility aids
  • personalised treatment plans including non-drug pain relief treatments and exercises to improve mobility, independence and balance
  • treatments to assist with shortness of breath, fatigue or insomnia
  • group exercise classes and confidence building

Rehabilitative care is also provided by our Occupational Therapy team. 

St Luke's Hospice South Essex Lymphoedema Service (SELS)
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St Luke's Hospice South Essex Lymphoedema Service (SELS)

T. 01268 524973

W. https://www.stlukeshospice.com/lymphoedema-support

St Luke's Hospice provides the specialist Lymphoedema care team could provide care to you if you are living with primary Lymphoedema, secondary Lymphoedema and Lipoedema. The team can provide clinical expertise, support and practical help for those with any these conditions and live across South Essex.

Tissue Viability Service: North East London Foundation Trust
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Tissue Viability Service: North East London Foundation Trust

T. 0300 300 1831 ext. 52798

This service is for any persons over the age of 18 and supports the management of complex wound care, via clinic based appointments, or homevisits depending on the need of the service user.

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