Implementation of psycho-existential symptom distress screening among Italian healthcare providers

Objectives: Existential distress is a debilitating condition in end-of-life cancer patients. The Psycho-existential Symptom Assessment Scale (PeSAS) was developed to screen psycho-existential symptoms in palliative care, but limited research has examined its use. This study aimed to implement the Italian version of the PeSAS in palliative care services and to evaluate changes in healthcare providers' (HCPs) competence after experiential training. It also aimed to estimate the frequency of psycho-existential symptoms and explore the scale structure using network analysis. Methods: Two-hour experiential workshops were conducted in 5 Italian palliative care services by a clinical psychologist specialized in psycho-oncology and palliative care. Training covered psycho-existential distress, role-play, and feedback. Pre- and post-workshop questionnaires assessed clinicians' self-efficacy in evaluating physical, psycho-existential, and suicidal symptoms, managing distress, and providing psychosocial support. Patient cross-sectional data were analyzed with descriptive statistics, t-tests, chi-square tests, and exploratory graph analysis. Results: One hundred one clinicians from 3 services participated. Significant results were found in HCPs' self-efficacy, with the largest effect in assessing suicidal symptoms (Cohen's d = 0.54), followed by managing distress (d = 0.47) and evaluating psycho-existential symptoms (d = 0.40). Of 210 patients screened, 194 were included. PeSAS scores were strongly associated with Hopelessness (strength = 1.30) and depression (1.18), while being trapped by illness (-1.64) and wishing to die (-1.12) had weaker associations. Significance of results: The Italian PeSAS is feasible for integration into palliative care. Strong associations highlight targets for interventions, while weaker associations suggest the need for additional approaches. PeSAS enhances HCPs' ability to address the psycho-existential needs in end-of-life care.