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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lee W, DiGiacomo M, Draper B, Agar MR, Currow DC. A Focus Group Study of Palliative Physician and Consultation-Liaison Psychiatrist Perceptions of Dealing with Depression in the Dying. J Palliat Care 2022; 37:535-544. [PMID: 36083631 PMCID: PMC9465534 DOI: 10.1177/08258597221121453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To ascertain palliative physicians’ and
consultation-liaison psychiatrists’ perceptions of depression care processes in
patients with very poor prognoses, exploring key challenges and postulating
solutions. Methods: A qualitative focus group study involving three
1-h online focus groups (2 palliative medicine and 1 psychiatry) were conducted
between November-December 2020. Fellows and trainees were recruited from
Australian and New Zealand Society of Palliative Medicine (n = 11) and Royal
Australian and New Zealand College of Psychiatrists (n = 4). Data underwent
conventional qualitative content analysis. Results: Participants
perceived depression care to be complex and challenging. Perceived barriers
included: inadequate palliative care psychiatry skills with variation in
clinical approaches; lack of supportive health infrastructure (poor access to
required interventions and suboptimal linkage between palliative care and
psychiatry); lack of research support; and societal stigma. Suggested solutions
included integrating care processes between palliative care and psychiatry to
improve clinician training, establish supportive health systems and promote
innovative research designs. Conclusions: Developing clinician
training, supportive health systems and innovative research strategies centering
on integrating palliative care and psychiatry care processes may be integral to
optimising depression care when providing care to people with very poor
prognoses.
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Affiliation(s)
- Wei Lee
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia.,St Vicent's Clinical School, University of New South Wales, Sydney, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Brian Draper
- School of Psychiatry, 7800University of New South Wales, Sydney, Australia
| | - Meera R Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, 8691University of Wollongong, Wollongong, Australia
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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] [What about the content of this article? (0)] [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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Gieselmann A, Vollmann J. [A palliative concept for psychiatry? Conceptional considerations on advantages and limits of a close cooperation between palliative care and psychiatry]. Nervenarzt 2020; 91:385-90. [PMID: 32078696 DOI: 10.1007/s00115-020-00883-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND A closer collaboration between psychiatry and palliative medicine is increasingly being discussed. This raises the question in which areas this collaboration already exists and which benefits it has for patient care. OBJECTIVE To ethically analyze the results of the application of palliative care concepts in psychiatry. MATERIAL AND METHODS Empirically informed conceptual and ethical analysis. RESULTS Palliative care and psychiatry share several basic principles. A collaboration between these disciplines already exists in certain areas. In relation to patients with persistent severe mental illnesses, this collaboration is limited to an awareness among professionals of certain concepts of palliative medicine. CONCLUSION A collaboration between psychiatry and palliative medicine can improve the quality of care, although this must vary across different patient groups.
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Burmann SN, Neukirchen M, Ostgathe C, Beckmann M, Schwartz J, Scheer K, Klco-Brosius S, Hense J, Teufel M, Tewes M. Knowledge and Self-Efficacy Assessment of Residents and Fellows Following Palliative Care Unit Rotation: A Pilot Study. Am J Hosp Palliat Care 2019; 36:492-499. [PMID: 30621437 DOI: 10.1177/1049909118823181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In Germany, some units of specialized palliative care (SPC) offer a 6- to 12-month rotation for resident physicians (RPs) and fellows from different specialties. OBJECTIVE This pilot study aimed to evaluate feasibility of assessing palliative care knowledge (PCK) and palliative care self-efficacy (PCSE) using a paper-based questionnaire. METHODS Palliative care knowledge and PCSE were assessed by introducing a score, followed by a descriptive analysis (determination of frequency, mean, median, and range) using nonparametric tests (χ2 test, Mann-Whitney U test). RESULTS We assessed 17 RPs following SPC rotation and 16 board-certified specialists (BCSs) who had no experience in SPC from 3 German comprehensive cancer centers. Resident physicians were predominantly enrolled in residency programs of hematology and oncology (n = 6), anesthesiology (n = 6), and psychosomatic medicine (n = 3). Resident physicians rotated between year 1 and 8 of residency. Fifteen RPs (88%) had elected this rotation and 72% preferred 12-month duration. The total PCK score of PCK was 27 (RPs) and 24 (BCSs; P = .002). Mean PCSE scores were 46 (RPs) and 39 (BCSs; P = .016). Of 71% of RPs, only 27% of BCSs knew how support of hospice service was initiated ( P = .004). Participants rated the items as comprehensible (n = 24; 73%), relevant (n = 25; 76%) and the questionnaire as adequately long (n = 23; 70%). CONCLUSION An improved PCK and PCSE were observed in physicians who rotated through an SPC unit; this resulted in an increased tangibility of local palliative care and hospice services. The questionnaire was comprehensible, relevant in terms of content, and adequate in length for a prospective multicenter survey.
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Affiliation(s)
- Sven Niklas Burmann
- 1 Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Neukirchen
- 2 Department of Palliative Medicine, Medical Faculty, Heinrich-Heine-University, Duesseldorf University Hospital, Moorenstrasse, Duesseldorf, Germany
| | - Christoph Ostgathe
- 3 Department of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mingo Beckmann
- 4 Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, Essen, Germany
| | - Jacqueline Schwartz
- 2 Department of Palliative Medicine, Medical Faculty, Heinrich-Heine-University, Duesseldorf University Hospital, Moorenstrasse, Duesseldorf, Germany
| | - Karin Scheer
- 5 Hospice Care, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stephanie Klco-Brosius
- 6 West German Cancer Center, DAGGIST Consortium, University Hospital Essen, Essen, Germany
| | - Joerg Hense
- 1 Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Teufel
- 4 Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, Essen, Germany
| | - Mitra Tewes
- 1 Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
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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: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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