The final stages of the clinical training explored how to deal with the most distressed or complex patients and how to recognize when levels of distress or complexity were beyond that which a primary care physiotherapist can reasonably manage and when to refer to other services either directly or via the GP.
However, it is well known that many patients are unable to assess their own QoL and complete a QoL measure because of cognitive impairment, difficulties in communication, symptom-related distress, or complexity of QoL measure.
The lead psychiatrist (BK) will provide clinical oversight of the programme, participate in staff training and direct clinical evaluation and treatment of patients with the highest level of distress or complexity.
Psychosocial distress increases the complexity of diagnosis, confounds therapeutic endeavours and is a major factor determining disability [ 2, 3].
We identified five themes: rigidity of service design, promoting empowerment, trust and rapport, responding to social complexities, distress at late diagnosis, and contending with discrimination and racism.
Understanding the complexities of distress and knowing who is most vulnerable is foundational to the provision of quality, palliative end-of-life care.
It is indeed a tangled web and a mosaic of experiences and even injuries, illness and distresses with many complexities.
People self-harm when they crave the primitive distraction of physical pain from the insistent complexity of emotional distress.
Rutter highlighted the other forms of deprivation found in institutional care and the complexity of separation distress; and suggested that anti-social behaviour was not linked to maternal deprivation as such but to family discord.
The twenty-three meareres are multi-dimensional, focusing on function, clinical complexity, social life, distress, and service use.
