Psychosocial Dimensions of Care
What the exam tests
Distress screening, anxiety and depression, grief and bereavement, coping styles, communication, cultural and spiritual care, sexuality and fertility, caregiver burden, and ethical decision-making.
Distress screening
Distress is the "sixth vital sign." Screen at every visit with a validated tool such as the NCCN Distress Thermometer; a score of 4 or more prompts further evaluation and referral to social work, psychology, chaplaincy, or psychiatry.
Depression versus grief
Normal grief comes in waves, is triggered by reminders, and coexists with positive memories. Major depression persists for two weeks or more with anhedonia, hopelessness, worthlessness, guilt, and sleep or appetite change. Always ask directly about suicidal ideation when hopelessness or depression appears, and refer.
Coping and communication
Coping may be problem-focused or emotion-focused; assess meaning-making and the patient's preferred role in decisions. Ask about information preferences and family involvement rather than assuming them from culture, age, or religion. Address fertility preservation before gonadotoxic therapy, and raise body image and sexual health proactively - patients rarely bring them up first.
Caregivers and bereavement
Screen for caregiver strain and financial toxicity. Anticipatory grief is normal and not pathological. Bereavement support continues after death; hospice programs typically follow families for about a year.
Traps
Assuming an older adult does not want to discuss feelings; assuming a "positive attitude" improves survival; missing caregiver burden; labeling anticipatory grief as depression.
Rule of thumb
Screen with the distress tool, act on a score of 4 or more, and always ask directly about suicidal thoughts when hopelessness or depression is present.