The role of psychological flexibility in palliative care

Elevated psychosocial distress, pain and existential dread are prevalent among those living with a palliative illness with consequential negative impacts on quality of life (QoL). Psychological flexibility (PF) is a protective factor related to better psychosocial outcomes in various adverse health contexts. This study tests the applicability of the PF framework in accounting for variability in four palliative patient outcomes (death attitudes, distress, pain and QoL) and the stability of these variables over one month. Fifty-four palliative patients and 21 of their carers completed a questionnaire at Time 1 and one month later (Time 2). Informal carers provided proxy ratings of the patient's QoL. Results indicated no change in PF or patient outcomes, and that higher Time 1 total PF significantly predicted better Time 2 outcomes across QoL, distress, and death attitudes. The acceptance PF dimension evidenced the strongest beneficial associations, whereas unexpectedly the values-based action PF dimension predicted higher death escape attitudes, and the mindfulness PF dimension failed to predict any outcome, although at the bivariate level it was related to better outcomes across QoL, death attitudes and distress. Unexpectedly, the values-based action PF dimension was correlated with worse pain outcomes. Overall, these findings support the role of PF in improving palliative patient outcomes, and prior calls for the evaluation of Acceptance and Commitment Therapy (ACT), which targets PF, in palliative care. The unexpected findings regarding the two PF dimensions of mindfulness and values-based action, suggest that these PF processes need further investigation and require fine tuning in ACT interventions to ensure sensitivity to the palliative care context. These findings are currently being utilised to inform the development and evaluation of a self-help ACT resource for palliative patients.