1
|
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.
Collapse
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
| |
Collapse
|
2
|
Forte DN, Stoltenberg M, Ribeiro SCDC, de Almeida IM(MO, Jackson V, Daubman BR. The Hierarchy of Communication Needs: A Novel Communication Strategy for High Mistrust Settings Developed in a Brazilian COVID-ICU. Palliat Med Rep 2024; 5:86-93. [PMID: 38415076 PMCID: PMC10898234 DOI: 10.1089/pmr.2023.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/29/2024] Open
Abstract
Context The COVID-19 pandemic presented unique challenges for health care systems. Overcrowded units, extreme illness severity, uncertain prognoses, and mistrust in providers resulted in a "pressure cooker" where traditional communication strategies were often insufficient. Objectives Building on well-studied traditional communication interventions, neurobiology principles were used to create a novel communication strategy designed in the COVID-ICU to respond to the unique communication needs of patients within the context of a high mistrust setting. Methods The hierarchy of communication needs recognizes three specific levels of communication that are essential within high-emotion and low-trust settings. The first level is to establish trust. The second level is to resonate with patients' emotions, helping to reduce arousal and improve empathy. The third level includes the more traditional content of disclosing prognostic information and shared decision-making. When facing communication challenges, clinicians are taught to move back a level and reattune to emotions and/or reestablish trust. Discussion The COVID pandemic revealed the shortcomings of a primarily cognitive communication style. The hierarchy of communication needs emphasizes trust building, and emotional resonance as prerequisites of effective cognitive discussions, resulting in more effective clinician-patient communication that more fully incorporates cultural humility and better meets the needs of diverse patient populations. Additional research is needed to further develop this strategy and evaluate its impact on patient experience and outcomes.
Collapse
Affiliation(s)
- Daniel Neves Forte
- Intensive Care Unit, Medical Emergency Department, University of São Paulo Medical School, São Paulo, Brazil
- Teaching and Research Institute, Sírio Libanês Hospital, São Paulo, Brazil
| | - Mark Stoltenberg
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Vicki Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Chammas D, Brenner KO, Gamble A, Buxton D, Byrne-Martelli S, Polisso M, Shalev D, Rosenberg LB. Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters. J Palliat Med 2024; 27:251-254. [PMID: 37449809 DOI: 10.1089/jpm.2023.0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Palliative care clinicians enhance the illness experiences of patients and their families through building therapeutic relationships. Many psychological concepts underlie a clinician's approach to a specific patient. Through high-yield tips, this article highlights ten selected psychological elements that palliative care clinicians often use to support patients. As we all (both clinicians and patients) bring our own histories and unique biographies to the work of palliative care, a more explicit focus on the psychological aspects of this work can enhance our own experience and efficacy as providers. With a thoughtful focus on the psychological aspects of how we engage with patients, palliative care clinicians can offer a more meaningful therapeutic encounter.
Collapse
Affiliation(s)
- Danielle Chammas
- Department of Medicine, Division of Palliative Medicine, University of California San Francisco, San Francisco, California, USA
| | - Keri O Brenner
- Department of Medicine, Section of Palliative Care, Stanford University School of Medicine, Stanford, California, USA
| | - Alexander Gamble
- Department of Medicine, Section of Palliative Care, Stanford University School of Medicine, Stanford, California, USA
| | - David Buxton
- Palliative Medicine AdventHealth, Orlando, Florida, USA
| | - Sarah Byrne-Martelli
- Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mike Polisso
- Department of Social Work and Case Management, Palliative Medicine, Stanford Health Care, Stanford, California, USA
| | - Daniel Shalev
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Leah B Rosenberg
- Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Datta-Barua I, Hauser J. Clinician Self-Disclosure in Palliative Care: Describing a Taxonomy and Proposing a Communication Tool. Am J Hosp Palliat Care 2023; 40:987-993. [PMID: 36734668 DOI: 10.1177/10499091231154228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
While patient self-disclosure is expected and necessary in the clinical setting, clinicians generally minimize their own self-disclosure, a practice largely guided by the boundaries of the fiduciary relationship. At the same time, many clinicians can recall a time when they made a self-disclosure to a patient, and it seemed to benefit the treatment relationship, if not the treatment itself. We reviewed literature from a variety of fields describing opinions, theories and limited data about the effects of clinician self-disclosure. Based on our findings, we posit that clinician self-disclosure has the potential to be a beneficial communication tool in palliative medicine, but like any intervention, it is not without risks. Thus, we propose a potential strategy to guide clinicians in thinking about self-disclosures.
Collapse
Affiliation(s)
| | - Joshua Hauser
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Jesse Brown VA Medical Center, Chicago, IL, USA
| |
Collapse
|
5
|
Rosenberg LB, Brenner KO, Shalev D, Jackson VA, Seaton M, Weisblatt S, Jacobsen JC. To Accompany, Always: Psychological Elements of Palliative Care for the Dying Patient. J Palliat Med 2022; 25:537-541. [PMID: 35263176 PMCID: PMC10162575 DOI: 10.1089/jpm.2021.0667] [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: 10/18/2022] Open
Abstract
Palliative care clinicians provide psychological support throughout their patients' journeys with illness. Throughout our series exploring the psychological elements of palliative care (PEPC), we suggested that the quality of care is enhanced when clinicians have a deeper understanding of patients' psychological experience of serious illness. Palliative care clinicians are uniquely poised to offer patients a grounded, boundaried, and uplifting relationship to chart their own course through a life-altering or terminal illness. This final installment of our series on PEPC has two aims. First, to integrate PEPC into a comfort-focused or hospice setting and, second, to demonstrate how the core psychological concepts previously explored in the series manifest during the dying process. These aspects include frame/formulation, attachment, attunement, transference/countertransference, the holding environment, and clinician wellness.
Collapse
Affiliation(s)
- Leah B Rosenberg
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Keri O Brenner
- Department of Medicine, Section of Palliative Care, Stanford University, Stanford, California, USA
| | - Daniel Shalev
- Department of Psychiatry and Medicine, Joan and Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Vicki A Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Juliet C Jacobsen
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Brenner KO, Logeman J, Rosenberg LB, Shalev D, Jackson VA, Seaton M, Jacobsen JC, Emanuel LL. Referral Relationship: Illuminating the Ways Palliative Care Creates a Holding Environment for Referring Clinicians. J Palliat Med 2022; 25:185-192. [PMID: 35020480 DOI: 10.1089/jpm.2021.0527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Palliative care supports referring colleagues in multiples ways. This support to referring colleagues is not often explored in the literature, yet the psychological concept that best describes it is the holding environment. The holding environment is the relational space palliative care offers referring clinicians for processing emotions and information. Using the case of Gloria, a patient living with cancer, this article discusses ways palliative care creates a holding environment for her referring oncologist, Dr. Ko. As palliative care clinicians, we create this relational space for referring clinicians when we change the dynamic, accompany the clinician, recognize challenges, establish expectations, and share a clinical second look. This article is the sixth in a series exploring the psychological elements of palliative care.
Collapse
Affiliation(s)
- Keri O Brenner
- Department of Medicine, Section of Palliative Care, Stanford University School of Medicine, Stanford, California, USA
| | - Jessica Logeman
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leah B Rosenberg
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Vicki A Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Juliet C Jacobsen
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Linda L Emanuel
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| |
Collapse
|