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Shalev D, Brenner K, Carlson RL, Chammas D, Levitt S, Noufi PE, Robbins-Welty G, Webb JA. Palliative Care Psychiatry: Building Synergy Across the Spectrum. Curr Psychiatry Rep 2024; 26:60-72. [PMID: 38329570 DOI: 10.1007/s11920-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE OF REVIEW Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. RECENT FINDINGS PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA.
| | - Keri Brenner
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Rose L Carlson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA
| | - Danielle Chammas
- Department of Medicine, University of California: San Francisco, San Francisco, CA, USA
| | - Sarah Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul E Noufi
- Department of Medicine, Georgetown University, Baltimore, MD, USA
| | | | - Jason A Webb
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
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Hurwitz O, Chammas D, Shalev D. Psychiatry and Palliative Care: Growing the Interface Through Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:540-545. [PMID: 36447070 PMCID: PMC10228389 DOI: 10.1007/s40596-022-01733-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/15/2022] [Indexed: 05/14/2023]
Affiliation(s)
- Olivia Hurwitz
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Redressing disparities in end-of-life care and serious mental illness through models of care and workforce development. Int Psychogeriatr 2021; 33:109-112. [PMID: 33750500 PMCID: PMC9063934 DOI: 10.1017/s1041610220001519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bouthillier ME, Vaillancourt H. Psychiatrie, soins palliatifs et de fin de vie : des univers (ir)réconciliables? Le cas de madame Sanchez. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1073546ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Contexte : En psychiatrie, la question d’offrir des soins palliatifs et de fin de vie pour ce qui serait une « condition psychiatrique terminale » ou, plus globalement, de considérer adopter une approche palliative pour des problèmes de santé mentale sévères et persistants constitue encore un tabou. Méthodologie : Cette question est abordée par l’analyse d’un cas effectuée lors d’une consultation en éthique clinique à l’aide de la méthode des scénarios d’Hubert Doucet. Il s’agit de madame Sanchez, une patiente âgée de plus de 90 ans, présentant des troubles psychiatriques, exprimant le désir de mourir par des gestes suicidaires, refusant les traitements proposés, ainsi que refusant de boire et manger. Son histoire clinique est racontée par le filtre de l’accompagnement réflexif offert en éthique clinique aux diverses parties prenantes. Résultats : L’analyse de cas, loin de répondre aux défis posés par le concept des soins palliatifs et de fin de vie en contexte psychiatrique, présente néanmoins une occasion d’en nommer les enjeux éthiques principaux : la souffrance psychique, le refus de manger et de boire ainsi que le refus de traitement, la sédation palliative et l’aide médicale à mourir, les volontés et directives médicales anticipées, ainsi que les défis clinico-organisationnels suscités par la clientèle gérontopsychiatrique. Conclusion : Les défis cliniques et éthiques demeurent nombreux pour les professionnels et les décideurs afin de répondre aux besoins de la clientèle de santé mentale très âgée. Nous appelons à un plus grand développement des connaissances sur ce thème précis.
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Affiliation(s)
- Marie-Eve Bouthillier
- Centre d’éthique du Centre intégré de santé et de services sociaux (CISSS) de Laval, Laval, Québec, Canada
- Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Hugues Vaillancourt
- Centre d’éthique du Centre intégré de santé et de services sociaux (CISSS) de Laval, Laval, Québec, Canada
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Shalev D, Nash SS, Levenson JA, Shapiro PA. Palliative Care Training for Consultation-Liaison Psychiatry Fellows: A National Survey Project. PSYCHOSOMATICS 2020; 61:336-342. [DOI: 10.1016/j.psym.2020.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
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Zuniga-Villanueva G, Ramirez-GarciaLuna JL, Weingarten K. Factors Associated With Knowledge and Comfort Providing Palliative Care: A Survey of Pediatricians in Mexico. J Palliat Care 2019; 34:132-138. [PMID: 30714468 DOI: 10.1177/0825859719827021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Lack of education and training in palliative care has been described to be one of the most important barriers to pediatric palliative care implementation. OBJECTIVE: To examine what factors determine the degree of knowledge and level of comfort Mexican pediatricians have providing pediatric palliative care. METHODS: A questionnaire that assessed palliative care concepts was developed and applied online to Mexican pediatricians, both generalists and specialists. RESULTS: A total of 242 pediatricians responded. The majority had not received palliative care education (92.6%) and felt uncomfortable discussing palliative needs with patients and families (92.1%). The mean score of the questionnaire was 6.8 (±1.4) of 10 correct answers. Knowledge in palliative care was associated with exposure to oncologic patients ( P = .01) and previous palliative care education ( P = .02) but inversely related to the pediatrician's age ( P = .01). Comfort addressing patient's palliative care needs was associated with knowledge in palliative care ( P < .01), exposure to oncologic patients ( P = .03), and previous education in palliative care ( P = .02). CONCLUSIONS: Although Mexican pediatricians have basic knowledge of palliative care concepts, they do not feel comfortable addressing palliative care needs, suggesting that the main barrier for implementing palliative care is not the lack of knowledge but rather feeling uncomfortable when addressing these issues with patients and families. Educational programs should incorporate strategies that could help physicians develop comfort in approaching palliative care patients.
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Affiliation(s)
| | | | - Kevin Weingarten
- 3 Pediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
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Trachsel M, Irwin SA, Biller-Andorno N, Hoff P, Riese F. Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks. BMC Psychiatry 2016; 16:260. [PMID: 27450328 PMCID: PMC4957930 DOI: 10.1186/s12888-016-0970-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/14/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND As a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established involvement of psychiatrists in palliative care, psychiatry does not currently explicitly provide palliative care for patients with mental illness outside the context of terminal medical illness. DISCUSSION Based on the WHO definition of palliative care, a, a working definition of palliative psychiatry is proposed. Palliative psychiatry focuses on mental health rather than medical/physical issues. We propose that the beneficiaries of palliative psychiatry are patients with severe persistent mental illness, who are at risk of therapeutic neglect and/or overly aggressive care within current paradigms. These include long-term residential care patients with severe chronic schizophrenia and insufficient quality of life, those with therapy-refractory depressions and repeated suicide attempts, and those with severe long-standing therapy-refractory anorexia nervosa. An explicitly palliative approach within psychiatry has the potential to improve quality of care, person-centredness, outcomes, and autonomy for patients with severe persistent mental illness. CONCLUSIONS The first step towards a palliative psychiatry is to acknowledge those palliative approaches that already exist implicitly in psychiatry. Basic skills for a palliative psychiatry include communication of diagnosis and prognosis, symptom assessment and management, support for advance (mental health) care planning, assessment of caregiver needs, and referral to specialized services. Some of these may already be considered core skills of psychiatrists, but for a truly palliative approach they should be exercised guided by an awareness of the limited functional prognosis and lifespan of patients with severe persistent mental illness.
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Affiliation(s)
- Manuel Trachsel
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, CH-8006, Zurich, Switzerland. .,Department of Psychiatry, Cedars-Sinai Health System, Los Angeles, CA, USA.
| | - Scott A. Irwin
- Supportive Care Services, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Health System, Los Angeles, CA USA ,Department of Psychiatry, Cedars-Sinai Health System, Los Angeles, CA USA
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, CH-8006 Zurich, Switzerland
| | - Paul Hoff
- Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Florian Riese
- Psychiatric University Hospital Zurich, Zurich, Switzerland ,URPP “Dynamics of Healthy Aging”, University of Zurich, Zurich, Switzerland
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Psychiatry trainees’ views and educational needs regarding the care of patients with a life-limiting illness. Palliat Support Care 2016; 15:231-241. [DOI: 10.1017/s1478951516000365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AbstractObjective:People with a life-limiting physical illness experience high rates of significant psychological and psychiatric morbidity. Nevertheless, psychiatrists often report feeling ill-equipped to respond to the psychiatric needs of this population. Our aim was to explore psychiatry trainees’ views and educational needs regarding the care of patients with a life-limiting physical illness.Method:Using semistructured interviews, participants’ opinions were sought on the role of psychiatrists in the care of patients with a life-limiting illness and their caregivers, the challenges faced within the role, and the educational needs involved in providing care for these patients. Interviews were audiotaped, fully transcribed, and then subjected to thematic analysis.Results:A total of 17 psychiatry trainees were recruited through two large psychiatry training networks in New South Wales, Australia. There were contrasting views on the role of psychiatry in life-limiting illness. Some reported that a humanistic, supportive approach including elements of psychotherapy was helpful, even in the absence of a recognizable mental disorder. Those who reported a more biological and clinical stance (with a reliance on pharmacotherapy) tended to have a nihilistic view of psychiatric intervention in this setting. Trainees generally felt ill-prepared to talk to dying patients and felt there was an educational “famine” in this area of psychiatry. They expressed a desire for more training and thought that increased mentorship and case-based learning, including input from palliative care clinicians, would be most helpful.Significance of Results:Participants generally feel unprepared to care for patients with a life-limiting physical illness and have contrasting views on the role of psychiatry in this setting. Targeted education is required for psychiatry trainees in order to equip them to care for these patients.
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