End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis

Abstract

Background: People with serious mental illness have greater mortality risk than the general population. They experience health care inequalities throughout life; it is not clear if this persists to end of life. Aim: Assess the empirical evidence describing end-of-life care and place of death for people with serious mental illness. Design: A systematic review of original, peer-reviewed research, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analysed using a narrative synthesis approach. Data sources: Five online databases (Embase, PsycArticles, PsycINFO, Medline, PubMed) and additional sources were searched (without time restriction) for primary research reporting health care utilisation in the last year of life or place of death in adults with serious mental illness. Results: After full-text screening, 23 studies were included. We found studies reporting hospital admissions, emergency department care, palliative care, and general practitioner (GP) visits at end of life. We found conflicting evidence for the association between serious mental illness and end-of-life care, although different patient groups, settings and measures were used across studies. People with serious mental illness were more likely to die in care homes than the general population. There were no patterns for other places of death. Conclusions: The evidence was sparse and heterogeneous, demonstrating variability in patterns and reporting of health care use and with little consensus on where people with serious mental illness are likely to die. Given that people with serious mental illness have increased mortality risk, this gap in the knowledge around end-of-life care outcomes is concerning; this area of research needs further development.

End of life care for people with severe mental illness: Mixed methods systematic review and thematic synthesis (the MENLOC study)

“…Previous evidence reviews of end-of-life care for people with severe mental illness have either become very out-of-date, 12,14 or have been much more limited in scope, than the review reported on here. 11,13,15 With the purpose of informing future developments in all countries with developed health services which include systems of care for people with mental health needs, and systems of care for people who are dying, in this discussion we emphasise the implications of the evidence (as summarised in 10 of the 52 synthesis statements derived from both the descriptive quantitative and qualitative research) in which there is a high degree of confidence as assessed using the CERQual approach. As the summary statements assessed using the GRADE approach all attracted very low confidence these are not drawn on here.…”

Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness

“…A recent review found that individuals with SMI were more likely to die in care homes (nursing homes or supported care facilities) as opposed to those without SMI who are more likely to die at home. 19 This may be related to the fact that those with SMI are often without social supports to care for them at home at end-of-life. Patients with SMI are more likely to be hospitalized and receive care in an intensive care unit in the last month of life 19 than those without SMI.…”

“…19 This may be related to the fact that those with SMI are often without social supports to care for them at home at end-of-life. Patients with SMI are more likely to be hospitalized and receive care in an intensive care unit in the last month of life 19 than those without SMI. It is also worth noting that studies have had mixed findings related to palliative care utilization for those with SMI 19 although this remains an emerging area of focus for researchers.…”

“…Patients with SMI are more likely to be hospitalized and receive care in an intensive care unit in the last month of life 19 than those without SMI. It is also worth noting that studies have had mixed findings related to palliative care utilization for those with SMI 19 although this remains an emerging area of focus for researchers. There might be a variety of reasons why individuals with SMI may not receive palliative care that are yet to be investigated.…”

Co-Design of an Evidenced Informed Service Model of Integrated Palliative Care for Persons Living with Severe Mental Illness: A Qualitative Exploratory Study

“…While people with SMI have a high need for palliative care [ 6 ], they face inequalities in healthcare and are seen as a vulnerable population, underrepresented in health disparities research [ 7 ]. This is reflective of a “loud silence”, and neglect, when it comes to SMI and death and dying [ 8 ].…”