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Magoon C, Jackson V, Shalev D. Serious illness communication: A gap in psychiatric care. Gen Hosp Psychiatry 2024; 89:106-107. [PMID: 38658245 DOI: 10.1016/j.genhosppsych.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Christopher Magoon
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, United States of America.
| | - Vicki Jackson
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, United States of America
| | - Daniel Shalev
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, United States of America
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Bombaci A, Di Lorenzo F, Pucci E, Solari A, Veronese S. Education needs in palliative care and advance care planning of Italian residents in neurology: an online survey. Eur J Neurol 2024:e16376. [PMID: 38826082 DOI: 10.1111/ene.16376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/05/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND AND PURPOSE Most neurological diseases have a chronic and progressive clinical course, with patients living for extended periods with complex healthcare needs. Evidence from other countries suggests that palliative care (PC) is insufficiently integrated in the care of these patients. This study aims to identify PC and advance care planning (ACP) knowledge and the perceived preparedness of Italian residents in neurology. METHODS This is a cross-sectional online survey of physicians attending the 36 Italian neurology residency programmes. RESULTS Of 854 residents, 188 (22%) participated. Their mean age was 28.4 ± 2.0 years; 49% were women; 45% were from the north, 23% from the centre and 32% from the south of Italy. Few residents (6%) reported that a teaching course in PC was part of the graduate programme, and 3% of the postgraduate programme. During their residency, 9% of participants received PC training, and 18% ACP training. Only 13% reported to have participated in the ACP process, half within their neurology residency programme. Residents considered PC support very/extremely important in all the pre-specified clinical situations, with values ranging between 78% and 96%. Over 70% of residents revealed education needs, particularly concerning ACP. CONCLUSIONS Our data confirm the need for improving PC training in the graduate and postgraduate curriculum. This, together with collaboration and joint training of neurology and PC, is essential to improve the quality and continuity of care and respond to the complex needs of people with neurological disorders causing severe disability.
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Affiliation(s)
- Alessandro Bombaci
- PhD Programme in Neuroscience, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
- Neurology Unit, IRCSS Policlinico San Donato, San Donato Milanese, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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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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Elhassan H, Robbins-Welty GA, Moxley J, Reid MC, Shalev D. Geriatric Psychiatrists' Perspectives on Palliative Care: Results From A National Survey. J Geriatr Psychiatry Neurol 2024; 37:3-13. [PMID: 37161303 PMCID: PMC10862371 DOI: 10.1177/08919887231175435] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Older adults with psychiatric illnesses often have medical comorbidities that require symptom management and impact prognosis. Geriatric psychiatrists are uniquely positioned to meet the palliative care needs of such patients. This study aims to characterize palliative care needs of geriatric psychiatry patients and utilization of primary palliative care skills and subspecialty referral among geriatric psychiatrists. METHODS National, cross-sectional survey study of geriatrics psychiatrists in the United States. RESULTS Respondents (n = 397) reported high palliative care needs among their patients (46-73% of patients). Respondents reported using all domains of palliative care in their clinical practice with varied comfort. In multivariate modeling, only frequency of skill use predicted comfort with skills. Respondents identified that a third of patients would benefit from referral to specialty palliative care. CONCLUSIONS Geriatric psychiatrists identify high palliative care needs in their patients. They meet these needs by utilizing primary palliative care skills and when available referral to subspecialty palliative care.
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Affiliation(s)
| | - Gregg A Robbins-Welty
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jerad Moxley
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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Abstract
This Viewpoint describes specific issues related to severe mental illnesses for palliative care.
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Affiliation(s)
- Kwok Ying Chan
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Desmond Y H Yap
- Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Harinder Singh Harry Gill
- Division of Haematology, Medical Oncology and Haemopoietic Stem Cell Transplantation, Department of Medicine, University of Hong Kong, Hong Kong, China
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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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Shalev D, Ekwebelem MI, Brody LA, Callahan ME, Singh N, Reid MC. Hospice and Palliative Medicine Fellowship Training in Mental Health: A Survey of Program Directors. J Pain Symptom Manage 2023; 66:310-319. [PMID: 37442531 PMCID: PMC10528591 DOI: 10.1016/j.jpainsymman.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Abstract
CONTEXT Psychological and psychiatric care is a core domain of palliative care. Despite a high burden of mental health comorbidity among individuals with serious illness, the Accreditation Council of Graduate Medical Education gives little guidance about training hospice and palliative medicine (HPM) fellows in this domain of care. Currently, there is a lack of empiric data on HPM physician fellowship training in mental health topics. OBJECTIVES To characterize HPM physician fellowship training practices in the psychological and psychiatric aspects of palliative care. METHODS A cross-sectional survey study querying HPM fellowship training directors nationally. RESULTS A total of 95 programs participated (51% response rate). A total of 98% programs offered didactics on mental health topics. Topics universally deemed as important by program directors were commonly taught, but there was variability in both the perceived importance and the didactic coverage of several topics. Only 15% of programs offered core rotations in psychiatry. Most programs offered psychiatry electives, but such electives were only rarely utilized by fellows. Interdisciplinary team (IDT) rounds infrequently included doctoral mental health clinicians. CONCLUSIONS Beyond a few commonly identified and taught key topics, there is variability in clinical and didactic exposure to mental health training among HPM fellowships. Standardizing key learning objectives and guiding educators in how to achieve these objectives could improve the preparedness of the physician workforce in HPM to meet the mental health needs of patients with serious illness.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA; Department of Psychiatry (D.S), Weill Cornell Medicine, New York, New York, USA.
| | - Maureen I Ekwebelem
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| | - Lilla A Brody
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| | - Mary E Callahan
- Department of Medicine (M.E.C), Columbia University Irving Medical Center, New York, New York, USA
| | - Navendra Singh
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
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Calagua-Bedoya EA, Ernst C, Shalev D, Bialer P. Consultation-Liaison Case Conference: Suicidal Ideation in a Patient at the End-of-Life. J Acad Consult Liaison Psychiatry 2023; 64:371-382. [PMID: 36494065 PMCID: PMC10244477 DOI: 10.1016/j.jaclp.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Psychiatric comorbidities are common among patients approaching the end of life, often necessitating the involvement of consultation-liaison psychiatrists. We present the case of a patient with advanced metastatic prostate cancer and a complicated hospital course who made suicidal remarks and requested a hastened death. This common and challenging clinical scenario requires a multidisciplinary approach. In this article, experts in consultation psychiatry, palliative care, and psycho-oncology describe helpful diagnostic and therapeutic strategies for such cases. The key learning points are the differential diagnoses in end-of-life patients endorsing suicidal ideation, the psychiatric management of oncological and palliative care patients, the implementation of a safe discharge plan, and the role of the consultation-liaison psychiatrist in hospice care.
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Affiliation(s)
| | - Carrie Ernst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai/The Mount Sinai Hospital, New York, NY
| | - Daniel Shalev
- Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Philip Bialer
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY
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Volle D. Dementia Care at the End of Life: A Clinically Focused Review. Am J Geriatr Psychiatry 2023; 31:291-303. [PMID: 36456444 DOI: 10.1016/j.jagp.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
With the geriatric population in the United States growing rapidly, the prevalence of dementia is expected to rise concomitantly. As dementia is an invariably progressive and terminal illness, planning for and managing end of life care in dementia is an important part of the overall process of dementia care. Unfortunately, this is often neglected outside of formal palliative and hospice medicine training programs and geriatric psychiatrists are left without preparation on how to manage, as well as counsel patients and families on, this important phase of dementia care. This review aims to explore the potential contributors to this historic disparity in geriatric education and care delivery, as well as its impact, while also attempting to shift the field's focus toward a palliative approach to dementia care. To begin to accomplish this, this review explores the natural illness history/disease trajectory of the various dementing illnesses, as well as the topic of prognostication as it pertains to the end of life for patients with dementia and how this information can be used in advanced care planning and symptom management.
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Affiliation(s)
- Dax Volle
- Department of Psychiatry (DV), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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Lehmann SW. Commentary to "Palliative Care Training for Geriatric Psychiatry Fellows: A National Survey Project". Am J Geriatr Psychiatry 2022; 30:511-513. [PMID: 34758924 DOI: 10.1016/j.jagp.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Susan W Lehmann
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD.
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