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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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Shalev D, Robbins-Welty G, Ekwebelem M, Moxley J, Riffin C, Reid MC, Kozlov E. Mental Health Integration and Delivery in the Hospice and Palliative Medicine Setting: A National Survey of Clinicians. J Pain Symptom Manage 2024; 67:77-87. [PMID: 37788757 PMCID: PMC10841817 DOI: 10.1016/j.jpainsymman.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
CONTEXT Mental health comorbidities among individuals with serious illness are prevalent and negatively impact outcomes. Mental healthcare is a core domain of palliative care, but little is known about the experiences of palliative care clinicians delivering such care. OBJECTIVES This national survey aimed to characterize the frequency with which palliative care providers encounter and manage common psychiatric comorbidities, evaluate the degree of mental health integration in their practice settings, and prioritize strategies to meet the mental health needs of palliative care patients. METHODS A e-survey distributed to the American Academy of Hospice and Palliative Medicine membership. RESULTS Seven hundred eight palliative care clinicians (predominantly physicians) were included in the analysis. Mood, anxiety, and neurocognitive disorders were frequently encountered comorbidities that many respondents felt comfortable managing. Respondents felt less comfortable with other psychiatric comorbidities. Eighty percent of respondents noted that patients' mental health status impacted their comfort delivering general palliative care at least some of the time. Mental health screening tool use varied and access to specialist referral or to integrated psychiatrists/psychologists was low. Respondents were unsatisfied with mental health training opportunities. CONCLUSION Palliative care clinicians play a crucial role in addressing mental health comorbidities, but gaps exist in care. Integrated mental health care models, streamlined referral systems, and increased training opportunities can improve mental healthcare for patients with serious illness.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY; Department of Psychiatry (D.S.), Weill Cornell Medicine, New York, NY.
| | - Gregg Robbins-Welty
- Department of Medicine (G.R.W.), Duke University School of Medicine, Durham, NC; Department of Psychiatry and Behavioral Sciences (G.R.W.), Duke University School of Medicine, Durham, NC
| | - Maureen Ekwebelem
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - Jerad Moxley
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - Elissa Kozlov
- Department of Health Behavior, Society, and Policy (E.K.), Rutgers School of Public Health, West Piscataway, NJ
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McConnell MH, Miljanovski M, Rodin G, O'Connor MF. Measuring double awareness in patients with advanced cancer: A preliminary scale development study. Palliat Support Care 2023:1-6. [PMID: 38124362 DOI: 10.1017/s1478951523001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Individuals with advanced cancer face the challenge of living meaningfully while also preparing for end of life. The ability to sustain this duality, called "double awareness," may reflect optimal psychological adaptation, but no psychometric scale exists to measure this construct. OBJECTIVES The purpose of this study was to develop a novel scale to measure double awareness in patients living with advanced cancer. METHODS Guided by best practices for scale development, this study addresses the first three of nine steps in instrument development, including domain clarification and item generation, establishment of content validity of the items, and pre-testing of the items with patients. RESULTS Instrument development resulted in a 41-item measure with two dimensions titled "life engagement" and "death contemplation." Items retained in the measure displayed face validity and were found to be both acceptable by patients and relevant to their lived experience. SIGNIFICANCE OF RESULTS The results of this scale development study will allow for full validation of the measure and future use in clinical and research settings. This novel measure of double awareness will have clinical utility and relevance in a variety of settings where patients with advanced cancer are treated.
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Affiliation(s)
| | - Melissa Miljanovski
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, The University of Toronto, Toronto, ON, Canada
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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: 0] [Impact Index Per Article: 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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Sadowska K, Fong T, Horning DR, McAteer S, Ekwebelem MI, Demetres M, Reid MC, Shalev D. Psychiatric Comorbidities and Outcomes in Palliative and End-of-Life Care: A Systematic Review. J Pain Symptom Manage 2023; 66:e129-e151. [PMID: 37003308 PMCID: PMC10330030 DOI: 10.1016/j.jpainsymman.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Although psychiatric comorbidities are common among individuals at end of life, their impact on outcomes is poorly understood. METHODS We conducted a systematic literature review of six databases following preferred reporting items for systematic reviews and meta-analyses guidelines and aimed at assessing the relationship between psychiatric comorbidities and outcomes in palliative and end-of-life care. Six databases were included in our search. This review is registered on PROSPERO (CRD42022335922). RESULTS Our search generated 7472 unique records. Eighty-eight full texts were reviewed for eligibility and 43 studies were included in the review. Clinically, psychiatric comorbidity was associated with poor quality of life, increased physical symptom burden, and low function. The impact of psychiatric comorbidity on health utilization varied, though many studies suggested that psychiatric comorbidity increased utilization of palliative care services. Quality of evidence was limited by lack of consistent approach to confounding variables as well as heterogeneity of the included studies. CONCLUSION Psychiatric comorbidity is associated with significant differences in care utilization and clinical outcome among patients at end of life. In particular, patients with psychiatric comorbidity and serious illness are at high risk of poor quality of life and high symptom burden. Our finding that psychiatric comorbidity is associated with increased utilization of palliative care likely reflects the complexity and clinical needs of patients with serious illness and mental health needs. These data suggest that greater integration of mental health and palliative care services may enhance quality-of-life among patients at end of life.
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Affiliation(s)
| | - Tina Fong
- Case Western Reserve University (T.F.), Cleveland, Ohio, USA
| | - Daniel R Horning
- Teacher's College (D.R.H.), Columbia University, New York, New York, USA
| | - Sandra McAteer
- School of Public Health (S.M.), University of Washington, Seattle, Washington, USA
| | - Maureen I Ekwebelem
- Division of Geriatrics and Palliative Medicine (M.I.E., M.C.R., D.S.), Weill Cornell Medicine, New York, New York, USA
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center (M.D.), Weill Cornell Medicine, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine (M.I.E., M.C.R., D.S.), Weill Cornell Medicine, New York, New York, USA
| | - Daniel Shalev
- Division of Geriatrics and Palliative Medicine (M.I.E., M.C.R., D.S.), Weill Cornell Medicine, New York, New York, USA; Department of Psychiatry (D.S.), Weill Cornell Medicine, New York, New York, USA.
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Nowels MA, Kalra S, Duberstein PR, Coakley E, Saraiya B, George L, Kozlov E. Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis. J Pain Symptom Manage 2023; 65:e691-e713. [PMID: 36764410 DOI: 10.1016/j.jpainsymman.2023.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress. OBJECTIVES Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers. DESIGN We searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as "palliative care." RESULTS We identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78). CONCLUSIONS Psychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.
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Affiliation(s)
- Molly A Nowels
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA; Center for Health Services Research (M.A.N.), Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.
| | - Saurabh Kalra
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Paul R Duberstein
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Emily Coakley
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Biren Saraiya
- Rutgers Cancer Institute of New Jersey (B.S.), New Brunswick, New Jersey, USA
| | - Login George
- Rutgers School of Nursing (L.G.), New Brunswick, New Jersey, USA
| | - Elissa Kozlov
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA
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Fernandes JB, Domingos J, Castro C, Simões A, Fernandes S, Almeida AS, Bernardes C, Miranda L, Risso S, Ferreira R, Baixinho CL, Silvestre M, Godinho C. Needs and expectations of family caregivers of cancer patients in palliative care: A study protocol. Front Psychol 2023; 13:1071711. [PMID: 36687876 PMCID: PMC9853914 DOI: 10.3389/fpsyg.2022.1071711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Cancer has an associated burden that continues to grow, affecting patients, family caregivers, and the individual's community. The family caregivers' unmet needs may harmfully jeopardize their well-being and the patient's health outcomes. Therefore, it is essential to understand the needs and expectations of family caregivers of cancer patients to develop and improve care practices. The present study aims to explore the needs and expectations of family caregivers of cancer patients in palliative care. This qualitative, descriptive exploratory study will use purposive sampling to recruit family caregivers and healthcare professionals from the palliative care units of two hospital centers in Lisbon and Tagus Valley. First, the Focus group will be performed until data saturation occurs. Then, a conventional thematic analysis will be applied to analyze data with the help of the coding software QDA Miner Lite database. This study's findings will help identify gaps in care and provide data that can support healthcare professionals in providing evidence-based centered care to family caregivers. It can also generate knowledge that may help stakeholders to develop a comprehensive support system for cancer survivors in palliative care and their family caregivers.
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Affiliation(s)
- Júlio Belo Fernandes
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal,*Correspondence: Júlio Belo Fernandes,
| | - Josefa Domingos
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Cidália Castro
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Aida Simões
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | | | - Ana Silva Almeida
- Department of Nursing, Centro Hospitalar de Setúbal E.P.E., Setúbal, Portugal
| | - Catarina Bernardes
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Luís Miranda
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Department of Nursing, Centro Hospitalar Barreiro Montijo E.P.E., Barreiro, Portugal
| | - Sandra Risso
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Department of Nursing, Centro Hospitalar Barreiro Montijo E.P.E., Barreiro, Portugal
| | - Rogério Ferreira
- Departamento de Saúde, Instituto Politécnico de Beja, Escola Superior de Saúde, Beja, Portugal,Comprehensive Health Research Center, Évora, Portugal
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, Lisbon, Portugal,Nursing Research, Innovation and Development Center of Lisbon (CIDNUR), Lisbon, Portugal
| | - Milene Silvestre
- Department of Nursing, Centro Hospitalar Barreiro Montijo E.P.E., Barreiro, Portugal
| | - Catarina Godinho
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
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Hoerger M. Priming the Palliative Psychology Pipeline: Development and Evaluation of an Undergraduate Clinical Research Training Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1942-1947. [PMID: 34268713 PMCID: PMC11103775 DOI: 10.1007/s13187-021-02064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 06/13/2023]
Abstract
Psychology adds value to palliative care research and practice, but palliative psychology training programs are underdeveloped, particularly prior to advanced graduate and post-doctoral training. The investigation aimed to examine the feasibility of developing an undergraduate clinical research training program focused on the application of palliative psychology to cancer care. Analyses described and examined predictors of trainee performance and post-graduate outcomes. Retrospective analyses of administrative data tracking trainee characteristics (degree programs and tracks, qualifications, and demographics), research trainee performance (satisfactory participation, training duration, scientific output, supervisor ratings, and overall performance), and post-graduate degree programs. The population included all undergraduate trainees in a cancer-focused palliative psychology research lab from inception in 2013 through 2020 at a US research-intensive university. Trainees (N = 25) typically majored in psychology (72.0%) or neuroscience (28.0%), often with second majors. The average participation in the lab was 3.4 semesters. Overall, 92.0% of trainees earned a conference abstract, 56.0% earned a publication, and 72.0% went on to a post-graduate degree program, most commonly psychology PhD, MD, or nursing programs. Trainees enrolling in psychology PhD programs were more likely than other trainees to have been on the pre-psychology PhD track (P < .001) and had higher overall research performance (P = .029), including higher supervisor ratings (P = .008) and higher scientific output (P = .019). This demonstration study provides evidence for the feasibility and beneficial impact of an undergraduate palliative psychology clinical research training program as an early component of cancer educational training. Findings support calls for the development and evaluation of novel palliative training programs worldwide.
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Affiliation(s)
- Michael Hoerger
- Departments of Psychology, Psychiatry, and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, 6400 Freret Street, 3070 Stern Hall, New Orleans, LA, 70118, USA.
- Department of Palliative Medicine & Supportive Care, University Medical Center of New Orleans, New Orleans, LA, USA.
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Pakenham K, Martin CL. Psychosocial palliative care: Patients' preferred intervention medium, target domains, and well-being priorities. Palliat Support Care 2022:1-9. [PMID: 36377378 DOI: 10.1017/s1478951522001535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although psychological distress in palliative patients has at least an equal or greater impact on the quality of life compared to physical or spiritual distress, there is limited research on contextual factors associated with psychosocial intervention accessibility and relevance. This is the first published study to explore patients' views on psychosocial intervention delivery medium preferences, key biopsychosocial target domains, and well-being priorities during the palliative and end-of-life (EOL) phases. METHODS Eighty-one palliative patients from a Specialist Palliative Care Service completed a questionnaire, which collected quantitative and qualitative data on preferred mediums for receiving psychosocial interventions, priority biopsychosocial target domains, and well-being priorities during the palliative and EOL phases. RESULTS Results showed that an individual in-person was the most preferred medium for receiving psychosocial interventions. Improving quality of life, distressing emotions, and adjusting to the palliative care context were the 3 most frequently endorsed biopsychosocial target domains. Valued living and comfortable living were the key priority well-being themes for the palliative phase, whereas being surrounded by loved ones and comfortable and dignified dying were the priority well-being themes for the EOL phase. SIGNIFICANCE OF RESULTS Findings highlight psychosocial interventions as an essential part of a holistic approach to patient-centered care throughout both the palliative and the EOL phases. Results can inform the refinement of existing and the development of new psychosocial interventions, particularly those that target emotional distress, adjustment, and quality of life. Furthermore, in-person treatment delivery remains essential in an evolving digital world.
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Affiliation(s)
- Kenneth Pakenham
- School of Psychology, The University of Queensland Faculty of Health and Behavioural Sciences, St Lucia, QLD, Australia
| | - Christopher Lloyd Martin
- School of Psychology, The University of Queensland Faculty of Health and Behavioural Sciences, St Lucia, QLD, Australia
- Specialist Palliative Care Service, Sunshine Coast Hospital and Health Service, 2B West Terrace, Caloundra, QLD, Australia
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10
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Plys E, Vaughan CL, Kutner JS, Berk J, Kolva E. Interdisciplinary neuropalliative care: A unique and valuable clinical training experience for geropsychology trainees. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:551-563. [PMID: 34044751 PMCID: PMC8626543 DOI: 10.1080/02701960.2021.1925891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To address workforce issues in professional geropsychology, clinical training sites must offer opportunities to build skills for working with older adults and aging families. Neuropalliative care (NPC) may offer a valuable learning environment for geropsychology trainees to develop professional competencies, while positively contributing to patient care. This article describes a novel clinical rotation for an advanced geropsychology trainee in an interdisciplinary specialty NPC clinic. A co-assessment model emerged as a useful strategy for integrating the trainee into the established NPC team. Two case examples illustrate the co-assessment's ability to enhance: collaboration within the clinic; psychological care for patients and care partners; and opportunities for the trainee to build competencies related to assessment, intervention, teams, and consultation. This paper concludes with a discussion of the benefits of NPC as a clinical training rotation for geropsychology trainees, as well as practical considerations for implementation in other clinics.
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Affiliation(s)
- Evan Plys
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
- Department of Psychiatry, University of Colorado School of Medicine
| | - Christina L. Vaughan
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
- Department of Neurology, University of Colorado School of Medicine
| | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
| | - Julie Berk
- Department of Neurology, University of Colorado School of Medicine
| | - Elissa Kolva
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine
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11
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Mossman B, Perry LM, Walsh LE, Gerhart J, Malhotra S, Horswell R, Chu S, Raines AM, Lefante J, Blais CM, Miele L, Melancon B, Alonzi S, Voss H, Freestone L, Dunn A, Hoerger M. Anxiety, depression, and end-of-life care utilization in adults with metastatic cancer. Psychooncology 2021; 30:1876-1883. [PMID: 34157174 DOI: 10.1002/pon.5754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE End-of-life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end-of-life care in metastatic cancer. METHODS This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011-12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates. RESULTS Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p < 0.001) in the 30 days before death. Anxiety (OR = 1.95, p < 0.001) and depression (OR = 1.34, p = 0.038) were associated with a greater likelihood of a palliative encounter. CONCLUSIONS Patients with metastatic cancer who had an anxiety disorder were more likely to have burdensome end-of-life care, including chemotherapy, ICU visits, and inpatient hospitalizations in the 30 days before death. Depression and anxiety both increased the odds of palliative encounters. These results emphasize the importance of mental health considerations in end-of-life care.
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Affiliation(s)
- Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Laura M Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Leah E Walsh
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sonia Malhotra
- Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Section of General Internal Medicine & Geriatrics, Deming Department of Medicine, Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Ronald Horswell
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - San Chu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA.,Department of Psychiatry, School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - John Lefante
- Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Christopher M Blais
- Department of Infectious Disease, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Lucio Miele
- Department of Genetics and Louisiana Cancer Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Brian Melancon
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sarah Alonzi
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Hallie Voss
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Lily Freestone
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Addison Dunn
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA.,Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, Louisiana, USA
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12
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Clinical Effects of Chinese Herbal Decoction Combined with Basic Chemoradiotherapy and Nursing Intervention in the Treatment of Cervical Cancer and the Effect on Serum CEA, CA125, and TNF- α Levels. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1446864. [PMID: 34603461 PMCID: PMC8483916 DOI: 10.1155/2021/1446864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/08/2021] [Indexed: 01/11/2023]
Abstract
Objective This study was aimed to investigate the clinical effect of Chinese herbal decoction combined with basic chemoradiotherapy and nursing intervention in the treatment of cervical cancer and the effect on serum carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), and tumor necrosis factor-α (TNF-α) levels. Methods A total of 200 cervical cancer patients in our hospital from June 2015 to November 2018 were selected and randomly divided into a study group and a control group. The control group was given chemoradiotherapy and psychological nursing treatment, and the study group was given self-made Chinese herbal decoction on the basis of the control group. The clinical efficacy and serum CEA, CA125, and TNF-α levels were assessed. Results After treatment, the total effective rate of the study group was significantly higher than that of the control group. The levels of serum CEA, CA125, and TNF-α were decreased in the two groups after treatment, and the decrease in the study group was more significant than that in the control group. After treatment, CD3+ and CD4+ levels were increased compared with those before treatment, and the increase in the study group was also more obvious than that of the control group. The level of CD8+ was decreased compared with before treatment, and the decrease in the study group was more notable than that of the control group. The two-year cumulative survival rate of the study group was markedly higher than that of the control group. The quality-of-life of patients treated for 3 months, 1 year, and 2 years was dramatically improved compared to before treatment. The incidence of adverse reactions in the study group was lower than that of the control group. Conclusion The treatment of basic chemoradiotherapy and psychological nursing intervention combined with Chinese herbal decoction on cervical cancer patients can improve the clinical treatment effects, improve the patient's body immunity, reduce serum CEA, CA125, and TNF-α levels, prolong survival time, improve life quality, and reduce the incidence of adverse reactions, and it is worthy of clinical promotion.
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13
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Dunleavy L, Walshe C, Machin L. Exploring the psychological impact of life-limiting illness using the Attitude to Health Change scales: A qualitative focus group study in a hospice palliative care setting. Eur J Cancer Care (Engl) 2020; 29:e13302. [PMID: 32881122 DOI: 10.1111/ecc.13302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/25/2020] [Accepted: 08/07/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Practitioners are often reluctant to engage in conversations that acknowledge patient's health concerns. This can affect patient and family carer psychological well-being. The Attitude to Health Change scales, adapted from the validated Adult Attitude to Grief scale, may have potential to address the psychological impact of illness and facilitate conversations in palliative care. To explore how health and social care professionals experience using the Attitude to Health Change Scales within hospice settings. METHODS Qualitative focus groups with practitioners currently using the Attitude to Health Change scales in three UK hospices. Two researchers conducted the interviews, developed the thematic framework and independently coded the transcripts using a framework analysis approach. RESULTS Three focus groups (n = 21 practitioners). The scale was used to assess and reassess levels of vulnerability and resilience to identify the need for support and to facilitate structured in-depth conversations. Factors that influenced scale implementation included the following: practitioner personal comfort and training; patient and family carer willingness to engage with the scales and having a practitioner "champion" within the organisation. CONCLUSION This exploratory work has identified the potential value of the scales for assessment and to facilitate conversations. Further research needs to incorporate the views of patients and family carers.
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Affiliation(s)
- Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Linda Machin
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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14
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Gatta B, LeBlanc TW. Palliative care in hematologic malignancies: a multidisciplinary approach. Expert Rev Hematol 2020; 13:223-231. [PMID: 32066301 DOI: 10.1080/17474086.2020.1728248] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Palliative care is specialized health care focused on improving the quality of life amid serious illness. Patients with hematologic malignancies have significant needs that could be addressed by a multidisciplinary palliative care team, but the integration of palliative care into hematology is far behind that of solid tumor oncology.Areas covered: This article considers what is known about the palliative care needs of hematologic malignancy patients, shows how the multidisciplinary palliative care team could improve their care, and explores how barriers to this relationship might be overcome. The evidence to support this review comes from review of recent, relevant papers known to the authors as well as PubMed searches of additional relevant articles over the past 3 years.Expert opinion: Further cultivating this relationship requires us to thoughtfully integrate the multidisciplinary palliative care team to respond to each patient's specific disease and needs, and do so at the ideal time, to maximize benefits.
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Affiliation(s)
- Brittany Gatta
- Department of Medicine, Division of General Internal Medicine, Duke Center for Palliative Care, Duke University, Durham, NC, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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15
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Abstract
PURPOSE OF REVIEW To provide an update on recent studies about psychological interventions in palliative (mainly cancer) care with a focus on physical, psychological, spiritual, and social aspects. RECENT FINDINGS Some promising psychological interventions for physical challenges, such as fatigue, pain, dyspnea, and insomnia do exist, but further research is needed. Regarding psychological aspects, current reviews showed small to large effects in the reduction of depression and anxiety symptoms through cognitive behavioral-based interventions, mindfulness-based interventions, and meaning-based interventions. Meaning-based or dignity-based approaches were also used for targeting spiritual aspects or existential distress. Social aspects that play a crucial role in palliative care are addressed by social support interventions, end-of-life discussions, and advanced careplanning. All of these psychological interventions must meet the specific requirements of palliative care, namely abbreviated session time and flexibility concerning locality of interventions, a minimized questionnaire burden and a high attrition rate caused by patients' poor physical conditions or deaths. SUMMARY There is substantial research on psychological interventions in palliative care that shows promising results, but sample sizes were often small. Due to its high relevance for this growing patient group, there is a strong need for ongoing/further research.
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16
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Kozlov E, Eghan C, Moran S, Herr K, Reid MC. Palliative Care Providers' Practices Surrounding Psychological Distress Screening and Treatment: A National Survey. Am J Hosp Palliat Care 2018; 35:938-944. [PMID: 29212346 PMCID: PMC5786500 DOI: 10.1177/1049909117743960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To investigate how inpatient palliative care teams nationwide currently screen for and treat psychological distress. METHODS A web-based survey was sent to inpatient palliative care providers of all disciplines nationwide asking about their practice patterns regarding psychological assessment and treatment. Descriptive statistics were used to characterize the sample and responses, and analysis of variance was conducted to determine whether certain disciplines were more likely to utilize specific treatment modalities. RESULTS A total of N = 236 respondents were included in the final analyses. Providers reported that they encounter psychological distress regularly in their practice and that they screen for distress using multiple methods. When psychological distress is detected, providers reported referring patients to an average of 3 different providers (standard deviation = 1.46), most frequently a social worker (69.6%) or chaplain (65.3%) on the palliative care team. A total of 84.6% of physicians and 54.5% of nurse practitioners reported that they prescribe anxiolytics or selective serotonin reuptake inhibitors to patients experiencing psychological distress. DISCUSSION AND CONCLUSIONS This study revealed significant variability and redundancy in how palliative care teams currently manage psychological distress. The lack of consistency potentially stems from the variability in the composition of palliative care teams across care settings and the lack of scientific evidence for best practices in psychological care in palliative care. Future research is needed to establish best practices in the screening and treatment of psychological distress for patients receiving palliative care.
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Affiliation(s)
- Elissa Kozlov
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
| | - Claude Eghan
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
| | - Sheila Moran
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
| | - Keela Herr
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
| | - M. Carrington Reid
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
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