While ACGME program requirements ensure psychiatry residents are exposed to many core subspecialties of psychiatry (e.g., addiction psychiatry, consultation-liaison, geriatric psychiatry, child and adolescent psychiatry), there is no such mandated PC exposure, despite PC being a subspecialty of psychiatry. No systematic data yet exist about the nature and content of PC education for general psychiatry trainees. While 71% of geriatric psychiatry fellowships and 86% of consultation-liaison psychiatry fellowships in the US provide didactic training on PC topics, significant variability exists in these didactics 138, 139.

What Was the Psychological Intervention and Who Provided It?

Early and frequent palliative care involvement in this patient’s care was therefore necessary to ensure timely conversations around these important topics. Indeed, it became clear through repeated discussions that the patient’s decision to stop systemic therapy was an informed https://www.nursingcenter.com/cearticle?an=00060867-202207000-00003&Journal_ID=1444159&Issue_ID=6425796 choice in keeping with her cultural and spiritual beliefs, despite the known severity of her mental illnesses. The first case illustrates how patient autonomy to make medical decisions might be limited by physician perception of capacity in patients with SPMI. A 50-year-old woman presented to the outpatient palliative care clinic, referred by her hospitalist physician. Concurrent with her oncologic treatment, this woman had been admitted to an inpatient forensic psychiatric unit in Toronto, Ont, for the past 9 years. This review strongly suggests that the present state of the science of psychological research within palliative care is lacking in rigor and specificity.

For example, many palliative care services are integrated into specialty serious illness care rather than as standalone clinics, making integration of PC and psychiatry impractical. Serious illness communication, which includes understanding patients’ and caregivers’ information preferences, sharing medical information, exploring patients’ goals and values, and making medical recommendations, has been a longstanding focus of PC . Many components of PC that are not explicitly psychiatric, including existential foci such as meaning and dignity and physical symptoms such as pain, are highly interconnected to mental health . Patients and referring clinicians also recognize the role of PC services in delivering mental health care.

Conceptualizations help understand patient concerns in one large picture, including how the concerns developed, affect the patient, what factors maintain and exacerbate these concerns, what else contributes to these concerns. Such interventions can be beneficial for those suffering with existential psychosocial-spiritual concerns, which might include hopelessness, feeling like a burden, loss of dignity, death anxiety, and depression (Saracino et al., 2019). The literature has continued to show that management of spiritual, emotional, and social suffering are important to the management of physical symptoms (Breitbart et al., 2004; Gorin et al., 2012). We may guide our colleagues to assess patient readiness and preferences for conversations about end-of-life, and to allow for an open conversation about death within these boundaries. Many people who reach this milestone feel ready for death, expressing an appropriate wish to die (Nissim et al., 2009).

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.

Frame/Formulation: Recognizing the Dying Process

Indeed, universal access to palliative care and end-of-life care for patients suffering from serious mental illnesses remains an unmet goal . In conclusion, this systematic review and meta-analysis uncovered no evidence to support the idea that palliative care interventions reduce psychological distress, but we did identify conceptual and methodological problems in the literature that could be remedied. While psychological science and psychiatry have made strides in improving psychological distress symptoms, these advances have not been fully integrated into palliative care.

• For instance, during the coronavirus disease (COVID-19) pandemic, the patients, caregivers and health-care providers may have experienced unique psychosocial stressors resulting in adverse mental health outcomes.37-41 Such public health emergencies may impact palliative care services and may contribute to additional psychosocial challenges for people involved in palliative care processes.
• Almost all associations between potential stressors and mental health measures within and between t1 and t2 were significant in the expected direction (see Supplementary materials, Table S12).
• Palliative care (PC) professionals support individuals and their families facing challenges related to life-threatening illnesses, providing physical, psychological, social, and spiritual care.
• The “values” factor of psychological flexibility is strongly linked to the search for the meaning of life, with values here being considered as the compass for individuals that guide the direction of their lives.

Psychological interventions were delivered by nurses in 27.1% of the studies, social workers in 3.4%, and psychologists in 3.4%; 54.2% of the studies did not specify which team member delivered the psychological component of the intervention; 18.6% explicitly stated that the individual delivering the psychological component of the intervention received training in how to deliver it. The category of “other” included general quality of life assessments, general distress measurements, and nonvalidated scales such as “using numeric ratings from 1 to 10 to assess depression and anxiety.” The category “none” reflected studies that did not include any measures related to psychological outcomes. The present study analyzed a subset of studies from the original review (59 of 64 articles or 92.2%) that had been identified as having a psychological component delivered as part of a multicomponent palliative care intervention.22 Data were abstracted and coded from each article by 2 investigators (Elissa Kozlov, Bahar Niknejad). Palliative care is recognized in key global mandates and strategies on universal health coverage, noncommunicable diseases, and people-centred and integrated health services. Psilocybin has attracted the greatest interest with studies suggesting that it may be a useful agent in psychiatry and in palliative care.