Background: Psycho-existential symptoms may be overlooked in palliative care. Screening can be a helpful way to recognise these patients.

Aim: To discern the prevalence of psycho-existential symptoms identified through routine screening.

Methods: Through use of the Psycho-existential Symptom Assessment Scale (PeSAS), data were collected from 1405 patients across six palliative care services representing a mix of models of care, and the use of pencil and paper versus electronic medical records. Symptom prevalences were computed as frequencies, with the precision of measurement represented by the difference in 95% confidence intervals. A network structure was estimated through exploratory graph analysis portraying the strength of associations between individual symptoms when all other correlations are controlled for.

Results: Psycho-existential symptoms with clinically significant prevalence (scores ≥ 4/10) included anxiety 41.1%, discouragement 37.6%, hopelessness 35.8%, pointlessness 26.9%, depression 30.3%, and the wish to die 17%. A precision of measurement within 3% was found for severe ratings (score ≥ 8/10) including anxiety 10.6%, depression 10.2%, the wish to die 7.6%, and confusion 3.6%. Higher PeSAS scores were predicted by lower Karnofsky ratings and unstable/deteriorating/terminal phases of care. Network analysis revealed hopelessness as the most central symptom, pointlessness most strongly associated with the wish to die, and feeling trapped was associated with loss of control and loss of roles.

Conclusions: PeSAS screening helped the recognition of psycho-existential distress, and revealed symptom prevalences that are challenging to our efforts to ameliorate this form of suffering. Training is desirable to help clinicians grow in confidence to discuss and respond to these symptoms.