Psychiatric care in oncology and palliative medicine: new challenges and future perspectives

Integration of Psychosocial Theory into Palliative Care: Implications for Care Planning and Early Palliative Care

Palliative care improves patients' symptoms, quality of life and family satisfaction with caregiving, reduces hospital admissions and promotes alignment of medical care with the patient's needs and goals. This article proposes the utility of integrating three psychosocial theories into standard palliative care with implications for care planning, early palliative care and optimizing quality of life. First, Control Theory focuses on the complex juxtaposition of promoting agency/empowerment in patients and carers and coping with often highly uncertain outcomes. Second, Optimal Matching Theory accounts for the alignment of need and provision of care to potentiate the quality of life effects of supportive care in a complex social process involving health care providers, patients and carers. Third, Hope Theory represents a dynamic process, which is marked by variation in the qualities of hope as the patient and carer confront challenges during palliative care. Future work will be translational in nature to adapt both assessment and interventions based on this theoretically driven augmentation of palliative care as well as to evaluate whether it provides a conceptual framework that has incremental utility in palliative care planning.

Changes of consultation-liaison psychiatry practice in Italian general hospitals: A comparative 20-year multicenter study

INTRODUCTION

Conducted under the auspices of the Italian Society of Consultation Liaison Psychiatry (SIPC) the aim of this study was to describe the characteristics of Consultation Liaison Psychiatry (CLP) activity in Italy (SIPC-2-2018) over the past 20 years by comparing with data from the first Italian nation-wide study (SIPC-1-1998).

METHODS

We collected data on CLP visits of 3,943 patients from 10 Italian hospitals over a period of 1 year. Data were compared with those from the SIPC-1 1998 study (4,183 participants). Patients were assessed with the same ad hoc 60-item Patient Registration Form recording information from five different areas: Sociodemographic, hospitalization-related, consultation-related, interventions and outcome.

RESULTS

Compared with participants from the previous study, SIPC-2-2018 participants were significantly older (d = 0.54) and hospitalized for a longer duration (d = 0.20). The current study detected an increase in the proportion of referrals from surgical wards and for individuals affected by onco-hematologic diseases. Depressive disorders still represented the most frequent psychiatric diagnosis, followed by adjustment and stress disorders and delirium/dementia. Also, CLP psychiatrists prescribed more often antidepressants (Φ = 0.13), antipsychotics (Φ = 0.09), mood stabilizers (Φ = 0.24), and less often benzodiazepines (Φ = 0.07).

CONCLUSION

CLP workload has increased considerably in the past 20 years in Italy, with changes in patient demographic and clinical characteristics. A trend toward increase in medication-based patient management was observed. These findings suggest that the psychiatric needs of patients admitted to the general hospital are more frequently addressed by referring physicians, although Italian CLP services still deserve better organization and autonomy.