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  1. What steps are most likely to relieve caregiver distress?

  2. What steps are most likely to address a patient's anger?

  3. What questions have been found to be moderately effective in screening for health care literacy?

  4. What is the FICA Spiritual History Tool?

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Case 218-1

A 62-year-old woman who is regaining function after a recent stroke was observed to be crying at each clinical visit.

Psychosocial aspects of care influence patient outcomes, compliance, and decision making. Patients experience illness within the context of their cultural and spiritual experience and do so surrounded by a network of family and caregivers. This chapter will identify and discuss the assessment and management of cultural, spiritual, and family caregiver aspects of care.

Emotional Distress

Response to emotional distress is an important aspect of forging the therapeutic relationship. Patient encounters may reveal intense emotions such as fear, anger, sadness, and hopelessness, especially when patients face unexpected serious or life-threatening illness. The patient may already be experiencing significant life stressors prior to hospitalization, such as divorce, death or illness of a close relative, financial worry, difficulty with family relationships, or substance use or abuse. The patient may have undiagnosed or undertreated psychological or behavioral issues including anxiety or depression. When presented with empathetic opportunities, physicians often shift their focus to biomedical explanations. Responding to emotional distress with a supportive approach can help promote an atmosphere of trust, improved patient satisfaction, and better patient outcomes (Table 218-1).

Table 218-1 Responding to a Patient's Emotional Distress

When clinicians encounter anger, they should determine whether the source of the anger is internalized (eg, related to fear, loss of control, being a burden, or a result of anticipatory grief of life goals not accomplished) or externalized (eg, directed at others including health care providers). Personal feelings of guilt or fear may ...

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