Current State of Psychiatric Involvement on Palliative Care Consult Services: Results of a National Survey

Patterson, Kelli N.; Croom, Andrea; Teverovsky, Esther; Arnold, Robert M.

doi:10.1016/j.jpainsymman.2013.06.015

Cited by 28 publications

(44 citation statements)

References 10 publications

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“…The issues identified in our survey are not unique to the UK or the hospice setting. Patterson et al’s 2014 survey of American hospital-based palliative care consult services demonstrated that most respondents (71%) would like psychiatry to be more involved with the palliative care service than they currently are, and the barriers identified were similar to our study [ 48 ]. However, the American survey found that 72% of consult services had some involvement with a psychiatrist, suggesting better engagement between psychiatry and palliative care than in the UK, where only 56% of the hospital-based palliative care physicians in our survey had direct access to psychiatry.…”

Section: Discussionsupporting

confidence: 80%

‘Worried to death’: the assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians

2017

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BackgroundAnxiety adversely affects quality of life and is common in adults with advanced life-limiting disease. There are no UK-wide guidelines on the assessment and management of anxiety in this specific population and there is little evidence regarding drug treatments. This study aimed to explore how palliative care physicians assess and manage anxiety in their patients, and to identify barriers encountered.MethodsA cross-sectional survey was undertaken of all physicians working in specialist palliative care in the UK who were members of the Association for Palliative Medicine. This was conducted in February 2014 using an online questionnaire.ResultsThe response rate was 23% (230/980) and 61% of respondents were consultants. Most did not use tools to screen for anxiety (87%) and almost all used the clinical interview to diagnose anxiety (99%). Only 8% used psychiatric criteria. Most physicians reported difficulties managing anxiety (93%). Only 33% thought they had adequate training in this area. Most had difficulty accessing psychological and/or psychiatric services (71%, 64% respectively). The majority used a combination of pharmacological and non-pharmacological treatments for anxiety. The most frequently prescribed first-line medications for patients with a prognosis of days to weeks were benzodiazepines (93%), usually lorazepam. The use of benzodiazepines over antidepressants was statistically significant (p < 0.001). For patients with a prognosis of months, antidepressants were most frequently prescribed first-line (60%), significantly more than benzodiazepines (p < 0.001). However, benzodiazepine use was still common in this prognostic group with 47% prescribing it first-line, sometimes in combination with an antidepressant.ConclusionThis is the first national survey on the assessment and management of anxiety in palliative care. Findings demonstrate the infrequent use of screening tools, variation in prescribing practice, potentially inappropriate use of benzodiazepines for patients with a prognosis of months, training gaps and poor access to psychological and psychiatric services in the UK. This highlights the need for formal training, further research into the pharmacological management of anxiety in this population and evidence-based national guidance to support clinical decision-making and service development.

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Section: Discussionsupporting

confidence: 80%

‘Worried to death’: the assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians

2017

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“…One study found that 97% (N=95) of residents surveyed agreed that they desired formalized palliative care training (13). Mutually, palliative care teams have expressed interest in having psychiatrists more involved, as only 10% of palliative care teams have a full-or part-time psychiatrist employed as a member on their team (14). As the interest in incorporating palliative care into end-of-life planning expands, there is potential for psychiatry to also expand into this growing field of medicine.…”

Section: Working As a Multidisciplinary Teammentioning

confidence: 99%

Ethical Considerations Regarding End-of-Life Planning and Palliative Care Needs in Patients With Chronic Psychiatric Disorders

Bauer¹

2016

AJP Residents' Journal

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“…3 However, palliative care for patients with SMI (see box 1 for an overview of the care structure for patients with SMI in the Netherlands) and physical health issues is still not widely implemented, and research on this topic for this patient group is scarce. [4][5][6][7][8][9][10][11] As the interplay between physical and psychiatric symptoms of patients with SMI and physical health issues makes them particularly vulnerable and complicates healthcare provision, 7 12-15 such research would be extremely relevant.…”

Section: Introductionmentioning

confidence: 99%

Severe mental illness and palliative care: patient semistructured interviews

Knippenberg

Zaghouli²,

Engels³

et al. 2020

BMJ Support Palliat Care

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ObjectivesTo explore perceptions, experiences and expectations with respect to palliative care of patients with severe mental illness (SMI) and an incurable, life-limiting chronic illness.MethodsFace-to-face semistructured interviews were conducted with 12 patients (10 of them living in a mental healthcare institution) with severe mental and physical health issues in the Netherlands. A semistructured interview guide was used to elicit perceptions of, experiences with and expectations regarding palliative care. Data were analysed using inductive content analysis.ResultsAnalysis of the data revealed eight categories: perceptions on health and health issues, coping with illness and symptoms, experiences with and wishes for current healthcare, contact with relatives and coresidents, experiences with end of life of relatives and coresidents, willingness to discuss end of life and death, wishes and expectations regarding one’s own end of life and practical aspects relating to matters after death. These categories were clustered into two separate themes: current situation and anticipation of end of life. Interviewees with SMI appeared not accustomed to communicate about end-of-life issues, death and dying due to their life-threatening illness. They tended to discuss only their current situation and, after further exploration of the researcher, the terminal phase of life. They seemed not engaged in their future palliative care planning.ConclusionsFindings of this study highlight inadequacies in advance care planning for patients with SMI. Results suggest using values, current and near wishes, and needs as a starting point for establishing a gradual discussion concerning goals and preferences for future medical and mental treatment and care.

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Current State of Psychiatric Involvement on Palliative Care Consult Services: Results of a National Survey

Abstract: There are shared objectives between psychiatry and palliative care; however, currently, co-involvement on treatment teams is quite limited. Future research is needed to identify ways to facilitate the interface of palliative care and psychiatry.

Cited by 28 publications

References 10 publications

‘Worried to death’: the assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians

‘Worried to death’: the assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians

Ethical Considerations Regarding End-of-Life Planning and Palliative Care Needs in Patients With Chronic Psychiatric Disorders

Severe mental illness and palliative care: patient semistructured interviews

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