Welcome back. Are you with me so far? In this video, we're going to assess the psychological, social, financial, and spiritual domains of the whole person assessment. Now let's start by looking at the psychological domain of the whole person assessment. All over the world, patients at the end of life and their families, suffer psychological, which is mental, distress. The suffering can be from one extreme to another, with depression, anxiety, thoughts of suicide, loss, grief, complicated anticipatory grief - and that's where you know someone's going to die - and so you are already sad even though the person has not died yet. And fear about the uncertainty of the future. Factors that make the suffering worse can be the presence of psychiatric disorders, dangerous overuse of drugs, dysfunctional and unsupportive family behaviors, poor social support along with spiritual concerns. This psychological distress is common with serious illness. In fact, psychological distress is experienced by 60 percent of patients with advanced disease. And it has a huge effect on the quality of life of patients and their families. There's a direct link between how someone feels physically and how one feels mentally and emotionally. And sometimes it's difficult to tell the difference between depression and normal sadness. This should not be taken lightly. Major depression in a seriously ill cancer population occurs four times more, than the general population. All clinicians caring for these people and their family caregivers, living in the face of serious illness, must be trained in assessing and identifying the major types of psychological suffering. Listening well, and using the advanced communication techniques covered in this course, will help the seriously ill person feel heard and understood. This helps a person work through loss, and connect with strengths and coping resources while gaining a sense of security. A good place to start this assessment is to begin with an open exploratory question, It invites the person to identify any concerns, something like; Is there anything worrying you? Members of the team can assess for mood and interest adjustment to illness, personal resources and strengths, and helping the patient distinguish the various levels of uncontrolled multi-dimensional pain. Let's move on to social and economic assessment. Social and economic challenges make dealing with a serious illness much harder. So, it's important to ask about these challenges, so that ways can be found to intervene and help make a plan for dealing with these challenges. Things that are included in a social economic assessment include safe and affordable housing, a person's access to education, public safety, availability of healthy foods, local emergency, and health services, and homes and workplaces free of life threatening toxins. Does a person have money, for the often expensive treatments and medications needed? Can the person still work or is there a loss of income due to the illness, making the person unable to perform a job? Another part of this assessment looks at social support networks. What are the family caregivers strengths and challenges? The way patients and family caregivers handle an illness and hospitalizations, can predict good future positive health care experiences. Another concern is insurance. Does a person have health care insurance to cover end of life care expenses, medications, medical equipment? In addition, is there access to healthcare? Are there healthcare providers who know the patient and provide a trusted medical home for the patient's care or does that person have to go from different places to different providers, making the care fragmented and even times where the person does not have access to care at all. A good clinical tool to help assess social work needs is something called the Social Work Assessment Tool or SWAT. It can be found at this web address that I have here on my slide. So, pause your screen and write it down, because this is good stuff. I'll give you a minute. Okay. That's enough anyway. The SWAT contains 11 individual, psychological and spiritual issues. These questions were selected based on research results and practice wisdom about areas of major influence on end of life care outcomes. The search for meaning and purpose in life is a basic human experience, finding connection between oneself, others and the sacred is a universal experience. This is especially true in the face of serious illness. Spiritual care is a cardinal domain to be talked about. Searching for and dealing with those struggles in the seriously ill population is critical. Focusing on spirituality and the overall assessment, allows patients to identify spiritual beliefs, practices, and resources, that may positively impact their health. Now this topic has covered a lot in the modules and this course. So, I will go no further on it here. But I would suggest that rather than trying to figure out the spiritual assessment for a patient using a comprehensive assessment tool, it's probably best to use a question you're comfortable asking. Learners are sometimes a bit timid, with wording when it comes to asking about spiritual health. My colleague Kelly Aurora, will help you over this shyness. So, be sure to catch her stuff. Wow! That was a lot of information to go over, I hope I didn't lose anybody. But at this point, you might be wondering is all this work really necessary. And yes, I'm telling you it is. Because as a result of all this hard work in assessing the whole person, we will develop a deeper understanding of the challenges seriously ill people face. What does give them quality to their days and what do they want from life however, long that might be? Recognizing the areas of suffering, will give us a place to start in easing their suffering. In addition, knowing a person well, will help us get them the kind of care they want. At times people will say to me, Nancy, does anyone really have control over the kind of care one receives from their healthcare professionals? Yes, I'm telling you, yes they do. But they have to figure out what kind of care they want. How is this done? Now, that's the real art of palliative care. Palliative care aims to match patient wishes and desires for their care with their actual treatments. How providers learn, what those wishes and desires are, and then how they are sure people get that kind of care, is a topic we will visit and revisit in the modules ahead. Let's get started in the next video. Together we will begin the journey, in exploring these concepts.