A palliative care approach in psychiatry: clinical implications

Strand, Mattias; Sjöstrand, Manne; Lindblad, Anna

doi:10.1186/s12910-020-00472-8

Cited by 44 publications

(62 citation statements)

References 60 publications

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“…Following a palliative approach for patients with SMI with a limited functional prognosis and lifespan can potentially prevent therapeutic neglect and/or overly aggressive care. It also has the potential to improve quality of care, person-centeredness, prognosis, and autonomy for patients with SMI ( 52 , 53 ).…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

2021

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Background: The study's main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Methods: A cross-sectional, observational study, was done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness. The Mini-Cog and a semi-structured clinical assessment of end-of-life decision-making capacity was done before a standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardized instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results: The Assessment of Capacity to Consent to Treatment scores correlated (p < 0.001) with the outcomes of the semi-structured decision-making capacity evaluation. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p < 0.001); a duration of serious mental illness of 30–39 years (p = 0025); having a diagnosis of schizophrenia spectrum disorders (p = 0.0007); and being admitted involuntarily (p < 0.0001). A main finding was that 65% of participants had decision-making capacity for end-of-life decisions, were able to express their values and engage in advance care discussions.Discussion and Conclusion: Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Many older patients with serious mental illness can engage in end-of-life discussions and can make autonomous decisions about preferred end-of-life care. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

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Section: Discussionmentioning

confidence: 99%

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

2021

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“…Instead, these brief admissions are best thought of as booster opportunities or brief respites at times when the risk of deterioration is high. As we have discussed in more detail elsewhere [ 1 , 13 , 21 ], self-admission is therefore probably best understood within a recovery model framework. In this model, a distinction is made between recovery from and recovery in a disorder [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation

Strand

Bulik

Gustafsson

et al. 2021

BMC Health Serv Res

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Background Self-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding. In self-admission, patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. Previous findings on patients with severe eating disorders indicate that self-admission reduces participants’ need for inpatient treatment, but that it does not alone lead to symptom remission. Methods The aim of this study was to evaluate if, from a service provider perspective, the resource reallocation associated with self-admission is justified. The analysis makes use of data from a cohort study evaluating the one-year outcomes of self-admission at the Stockholm Centre for Eating Disorders. Results Participants in the program reduced their need for regular specialist inpatient treatment by 67%. Thereby, hospital beds were made available for non-participants due to the removal of a yearly average of 13.2 high-utilizers from the regular waiting list. A sensitivity analysis showed that this “win-win situation” occurred within the entire 95% confidence interval of the inpatient treatment utilization reduction. Conclusions For healthcare systems relying on rationing by waiting list, self-admission has the potential to reduce the need for hospitalization for patients with longstanding eating disorders, while also offering benefits in the form of increased available resources for other patients requiring hospitalization. Trial Registration ClinicalTrials.gov ID: NCT02937259 (retrospectively registered 10/15/2016).

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“…The reluctance to integrate palliative psychiatry in existing mental healthcare structures may re ect the fact that it is too often associated with end of life, giving up, and hopelessness (2,3,7). The present ndings, and especially the views of psychiatrists in India, suggest that rst, palliative psychiatry is considered valuable across cultures as a means of improving patients' quality of life, without necessarily accepting a reduction in life expectancy, and second, rather than asking "palliative or curative?…”

Section: Implications For Clinical Practice and Future Researchmentioning

confidence: 99%

“…", we should discuss the possibility of palliative and curative, combining both approaches to offer optimal treatment to patients with SPMI. As Strand and colleagues (7) have argued, "[…] the type of interventions referred to as palliative are by no means 'novel' and 'cutting-edge'-quite the contrary, we interpret palliative care as an approach de ned by its goals and not by the use of speci c treatments" (p. 6). It seems important, then, that researchers and clinicians focus on developing a framework for clinical practice that optimally combines curative and palliative approaches for the individual patient and situation.…”

Section: Implications For Clinical Practice and Future Researchmentioning

confidence: 99%

“…The emerging eld of palliative psychiatry (or palliative care approaches in psychiatry) is increasingly attracting interest (1)(2)(3)(4)(5)(6)(7)(8)(9). Palliative psychiatry is based on accepting that some psychiatric symptoms are irremediable and offer a valuable means of improving the quality of life of patients with severe persistent mental illness (SPMI) (8-10, see also (11) for an in-depth discussion of the concept of SPMI).…”

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confidence: 99%

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Palliative Psychiatry for Patients with Severe and Persistent Mental Illness: A Survey on the Attitudes of Psychiatrists in India compared to Psychiatrists in Switzerland

Stoll

Mathew²,

Venkateswaran³

et al. 2021

Preprint

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Background Palliative psychiatry is a new approach for the care of patients with severe and persistent mental illness (SPMI). To assess the attitudes of psychiatrists in India towards palliative psychiatry for patients with SPMI and to compare these to the attitudes of psychiatrists in Switzerland. Methods In an online survey, data from 206 psychiatrists in India were collected and compared with data from a previous survey among 457 psychiatrists in Switzerland. Results Psychiatrists in India generally considered it very important to prevent suicide in SPMI patients (97.6%). At the same time, they considered it very important to reduce suffering (98.1%) and to ensure functionality in everyday life (95.6%). They agreed that palliative psychiatry is important for providing optimal care to SPMI patients without life-limiting illness (79.6%) and considered palliative psychiatry as indicated for patients with SPMI (78.2%). By contrast, curing the illness was considered very important by only 39.8 % of respondents. Relative to psychiatrists in Switzerland, psychiatrists in India were significantly more concerned about preventing suicide and less willing to accept a reduction in life expectancy, even at the expense of quality of life in patients with severe and persistent schizophrenia and recurrent major depressive disorder. At the same time, they were significantly more likely to advocate palliative psychiatry. Conclusion Most of the participating psychiatrists in India agreed that palliative psychiatry can be indicated for patients with SPMI. The comparison with psychiatrists in Switzerland highlights the need to take account of cultural differences in future studies of this kind.

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A palliative care approach in psychiatry: clinical implications

Cited by 44 publications

References 60 publications

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation

Palliative Psychiatry for Patients with Severe and Persistent Mental Illness: A Survey on the Attitudes of Psychiatrists in India compared to Psychiatrists in Switzerland

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