title: Survivorship of severe medically unexplained symptoms in palliative care.
abstract: OBJECTIVE
  Patients who articulate their psychological distress primarily through physical symptoms (referred to as medically unexplained symptoms (MUS)) pose a challenge to the skills of most clinicians, including palliative care physicians. The philosophical underpinnings of palliative care with a stated focus on symptom management and care of the person in their psychosociospiritual context lend itself to the care of these patients. The aim of this study was to investigate the characteristics to improve identification of this patient group within palliative care.
  
  
  METHODS
  Here, we report a case series of 6 patients with severe MUS who were referred to palliative care. We use illustrative case vignettes, examine clinical and demographic characteristics and review the perspectives of the multidisciplinary team to identify the common threads.
  
  
  RESULTS
  This case series highlights the complexities and challenges that are inherent in providing assessment and care for patients with MUS that present to palliative care. Characteristics that were identified included the clustering of 'trigger' symptoms, backgrounds of multiple chronic illnesses and relationship dysfunction. Patient outcomes in this group were universally poor, including the death of 2 patients.
  
  
  CONCLUSIONS
  Knowledge of this patient group is vital given the likely increase in prevalence of MUS as palliative care broadens its focus earlier in the trajectory of illness. The strengths of palliative care, including psychosociospiritual assessment, multidisciplinary input and communication skills holds the potential to accurately identify patients with MUS and allow the opportunity for specialist psychiatric input with the hope of improving outcomes for patients and their families.
authors.affiliation: Department of Psychosocial Cancer Care, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Dwyer
authors.affiliation: Department of Psychosocial Cancer Care, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors.forename: Keryn
authors.identifier: http://orcid.org/0000-0001-7543-4362
authors.initials: K
authors.lastname: Taylor
authors.affiliation: Vincent's Hospital, Fitzroy, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Boughey
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D000071896:Medically Unexplained Symptoms; D010166:Palliative Care; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Clinical assessment; Psychological care; Social care; Survivorship