Palliative care (from Latin root palliare «to cloak») is an interdisciplinary medical care-giving approach aimed at optimizing quality of life and mitigating or reducing suffering among people with serious, complex, and often terminal illnesses. In Gloria’s case, although her palliative care clinician had given Gloria a medical plan for acute shortness of breath, the hospice team felt she was unlikely to have a dyspnea crisis because her dyspnea was stable over several weeks. Meeting patients outside of a psychotherapeutic care setting, palliative care clinicians mostly do not have extensive psychosocial history to inform medical care.
Q: How can healthcare providers promote coping and resilience in patients receiving palliative care?
However, Canada still lacks the capacity to consistently deliver palliative care in the community, particularly in hospice, and many people in Canada still face barriers to accessing palliative care due to factors such as age, location, diagnosis, race or ethnicity, and housing instability. Quality palliative care addresses the physical, emotional, spiritual, and family impacts of serious illness, including support for caregivers and loved ones. National Hospice Palliative Care Week is a national initiative to celebrate and highlight the incredible work being done to provide quality hospice palliative care across the country, while also calling for better access to this care in every community and in every setting. These journals are a form of practice wisdom, providing insights into psychological health in palliative care.
Acceptance and commitment therapy (ACT)
Palliative psychiatry is a new approach for the care of patients with severe and persistent mental illness (SPMI) which systematically considers biological, psychological, social, and existential factors of care. Palliative care and mental health are closely linked, and addressing the mental health needs of patients with serious illnesses is essential to providing comprehensive care. Therefore, critical issues such as emotional burnout, sleep deprivation, depression and other mental health problems appear to be highly prevalent in palliative care providers.11,12 It is essential to examine and address such psychosocial challenges that are impacting primary stakeholders in palliative care, including the patients, family caregivers and health-care providers. Global evidence informs a high burden of depression, anxiety, psychological distress and other mental health problems among the palliative care populations. In other words, the main thrust of psychiatric palliative care to date has been to bring psychiatric expertise to seriously-ill patients, many of whom had not previously experienced mental illness. First, for the most part, psychiatric palliative care has focused on the emotional dimensions of suffering among patients with advanced medical illnesses, and, perhaps to a lesser degree, the management of comorbid psychiatric illness in this setting.
- We also conducted moderator analyses to compare studies that indicated psychological distress was a primary outcome vs. those with psychological distress as a secondary outcome for both patient anxiety (SMD of 0.01 for primary outcome vs. SMD of −0.03 for secondary outcome) and patient depression (SMD of 0.52 for primary outcome vs. −0.23 for secondary outcome).
- Those living in poverty have higher rates of unmanaged symptoms and may be more likely to receive care in emergency settings rather than through specialized palliative care programs.
- In 1967, palliative care was first founded for this unserved patient population by Dame Cecily Saunders.
- Specialist palliative care is one component of palliative care service delivery.
There is significant confusion between the palliative psychiatric approach to mental illness, interventions aimed at providing psychiatric care to individuals with serious illness, and interventions aimed at providing PC to individuals with mental illness and medical comorbidities. Ordinary psychiatric care rarely has curative intent, given the limitations of the current treatments available within mental health care 156, 157. First, it is difficult to define palliative psychiatric interventions in mental health care. Suffering is linked to a reduction in quality-of-life among people experiencing SMI, yet there is often little explicit attention paid to suffering within standard mental health care practices 145, 146. Furthermore, PC clinicians are dissatisfied with their access to specialty mental health referrals for their patients; fewer than half of all PC clinicians can refer patients for specialty mental health services within their institution 25•.
We need all the different members of the team, including physicians, nurses, chaplains, and social workers to successfully provide care for patients https://www.nursingcenter.com/cearticle?an=00060867-202207000-00003&Journal_ID=1444159&Issue_ID=6425796 and their families. Routine screening for anxiety and depression is a component of high-quality palliative care, and the palliative care team should be equipped to address a positive screen. Research also shows a relatively high rate of nicotine use among patients with schizophrenia, who turn to smoking because nicotine can help to ameliorate some of their psychiatric symptoms. Some people with severe mental illness who haven’t found a satisfactory treatment may turn to other substances, like alcohol or even opiates, to self-treat. For example, some patients don’t take their medication because they are distressed by the weight gain that accompanies their treatments.
To address this, researchers have proposed modifying time valuations and incorporating domain-specific or capability-based measures such as ICECAP-SCM to better capture end-of-life quality. Economic evaluations in palliative and end-of-life care face methodological challenges distinct from those in curative medicine. In contrast, low- and middle-income countries face persistent challenges including workforce shortages, limited opioid availability, and minimal policy support, leading to widespread unmet need among older populations.