By Dr Kathryn Mannix
Photograph by Tricia King, Picture Yourself (CC BY-NC)
At the recent Palliative Care Nurses Australia Conference, Dr Kathryn Mannix invited delegates to reflect on one of the most important aspects of palliative care: understanding the stories people tell themselves when facing the end of life.
A retired palliative care physician, cognitive therapist, author and storyteller, Dr Mannix explored how Cognitive Behavioural Therapy (CBT) skills can help health professionals better understand and respond to psychological and existential distress.
Her message was simple yet profound: before we can help, we need to be curious:
- What happens when…?
- How do you feel about that?
- What do you notice about your body when that difficult thing happens?
Rather than rushing to solve problems or reassure patients, Dr Mannix encouraged clinicians to use collaborative curiosity; listening to understand and seek clarity, rather than solve a problem or reassure a patient to discover what lies beneath a person’s distress.
Through thoughtful questioning and attentive listening, health professionals can help patients make sense of difficult thoughts, emotions and experiences.
Many people approaching the end-of-life experience anxiety, depression, demoralisation and/or existential distress. These responses can be complex and deeply personal, shaped by a person’s values, relationships, fears and life experiences. What may appear on the surface as worry about symptoms, loss of independence or changes in appearance can often reflect deeper concerns about identity, meaning, responsibility or loss.
The skill of guided discovery explores a person’s story together rather than making assumptions about what matters most to them.
This component of cognitive behaviour therapy seeks to help an individual understand, evaluate and manage their distress by learning to observe themselves and to investigate the helpfulness/unhelpfulness of these thoughts and behaviours.
Ultimately, Dr Mannix’s presentation reminded us that palliative care is not only about managing symptoms. It is about understanding the person behind the symptoms, listening with curiosity, and creating space for stories to be told.
When we take the time to discover the real story, we are often better equipped to support what matters most.
This approach aligns closely with the principles underpinning End-of-Life Essentials’ new Assessing and Managing Patient Mental Health module which highlights the importance of screening and assessment for psychological and existential symptoms in people approaching the end of life.
Effective assessment is not simply about completing a screening tool. It requires attentiveness, compassion and validation to ensure people feel heard and understood.
