Hospice care of the psychotic patient

Craun, Marlys J.; Watkins, Margaret; Hefty, Amy

doi:10.1177/104990919701400409

Cited by 4 publications

(22 citation statements)

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“…Treatment for one illness may influence the other, including medication interactions, as identified in an intervention study by Picot et al (2015) and a case study analysis by Terpstra et al (2014). Changes during decline in health may influence the physical as well as the psychological state and cause complications, including changes in drug metabolism (Craun et al, 1997; Picot et al, 2015; Terpstra et al, 2014). In the discussion of end-of-life care for people with posttraumatic stress disorder, Feldman (2017) reminds readers that “[t]he treatment of psychosocial issues at the end-of-life is not a straightforward extension of evidence-based approaches for physically healthy individuals” (p. 117), and emphasizes attention to the complex nature of the illness experience for people with SPMI and the importance of making decisions for care with an understanding of this context.…”

Section: Resultsmentioning

confidence: 99%

“…Psychiatric symptoms lend their own complexity to palliative care, such as delusions, psychosis, denial of illness (both psychiatric and physical), and social withdrawal or apathy, all of which can hinder or obstruct participation in care (Craun et al, 1997; Griffith, 2007a, 2007b; Kelly & Shanley, 2000; Moini & Levenson, 2009; Rice et al, 2012). Although severity of psychiatric symptoms varies widely, active psychiatric illness can prevent people with SPMI from identifying changes in physical health, seeking out diagnosis, and participating in treatment (Moini & Levenson, 2009; Rice et al, 2012; Terpstra et al, 2014; Webber, 2012).…”

Section: Resultsmentioning

confidence: 99%

“…Although severity of psychiatric symptoms varies widely, active psychiatric illness can prevent people with SPMI from identifying changes in physical health, seeking out diagnosis, and participating in treatment (Moini & Levenson, 2009; Rice et al, 2012; Terpstra et al, 2014; Webber, 2012). Psychiatric symptoms often result in special care needs such as requiring quiet space or increased time for explanations and assessments, which may not be possible in some facilities (Baker, 2005; Craun et al, 1997; Geppert et al, 2011; McNamara et al, 2018; Woods et al, 2008). Psychiatric symptoms may influence healthcare behaviors and help-seeking patterns for people with SPMI, making it difficult to assess, collaborate on, and provide care (Jerwood et al, 2018; Moini & Levenson, 2009; Terpstra et al, 2014; Woods et al, 2008).…”

Section: Resultsmentioning

confidence: 99%

“…Additional complexities reported in the literature seem to result from social disadvantages experienced by people with SPMI, including stigma, discrimination, isolation, and poverty (Baker, 2005; Bloomer & O'Brien, 2013; Candilis et al, 2004; Craun et al, 1997; Morgan, 2016). Alienation from friends and family members places people with SPMI at a disadvantage in palliative care settings that rely on lay caregivers, such as community-based hospice care (Baker, 2005; Craun et al, 1997). Special populations, such as those who are homeless or incarcerated, are reported to experience additional complexities from systems that are not prepared to care for them (Baker, 2005; Wright et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

“…Lack of awareness of mental or physical health issues, particularly because one condition may obscure or compound the other, also limits access to palliative care (Webber, 2012). In some cases, the symptoms of psychiatric illness such as active hallucinations, disordered self-care, or negative symptoms such as not being forthcoming with information or exhibiting a flat affect may result in healthcare provider avoidance of caring for patients with SPMIs (Craun et al, 1997; Davie, 2006; Moini & Levenson, 2009; Terpstra et al, 2014; Woods et al, 2008). Healthcare providers may be subject to internalized stigma that can result in access to care issues for patients with SPMIs (Cai et al, 2011; Chochinov et al, 2012; McGrath & Jarrett, 2007).…”

Section: Resultsmentioning

confidence: 99%

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A scoping review of palliative care for persons with severe persistent mental illness

Donald

Stajduhar

2019

Pall Supp Care

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ObjectivePeople with severe persistent mental illness (SPMI) experience a greater burden and severity of chronic disease, late diagnosis, and premature death compared with the general population. Those with SPMI also receive fewer medical treatments, poor quality of care, and are less likely to receive palliative care. A systematic scoping review was undertaken to determine the extent, range, and nature of research activity about people with SPMI requiring palliative care, and to identify gaps and opportunities for future research.MethodA systematic scoping review was undertaken in September 2017 and updated in May 2018 to map literature on this topic, determine the extent and range of what has been published, and report the findings. This five-stage framework was conducted by (1) identifying the research question; (2) identifying relevant studies; (3) determining study selection; (4) charting the data; and 5) collating, summarizing, and reporting the results. A narrative approach to analysis was used to synthesize and interpret findings. A search of multidisciplinary healthcare databases resulted in 46 included articles.ResultFour major themes were identified from the included studies: complexity of care; limited access to care (both through systems and healthcare providers); competence and autonomy; and the potential for relationships between mental health and palliative care.Significance of resultsThis review reveals a highly vulnerable population with complex needs that are not reliably being met by the healthcare system and providers. Research in this area must continue to develop using rigorous qualitative and quantitative study designs, and interventions should be developed and tested based on existing knowledge to inform care. The voices of people with SPMI in need of palliative care must be represented in future studies to address gaps. To expand a body of literature addressing mainly individuals, system perspectives and sociocultural analysis can bring much to contextualizing the experience of living with SPMI in the palliative phase of care. Adoption of a palliative approach, which promotes the principles of palliative care across nonspecialized care settings provided by nonspecialist palliative providers, has the potential to increase access to high-quality palliative treatment for people with SPMI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A scoping review of palliative care for persons with severe persistent mental illness

Donald

Stajduhar

2019

Pall Supp Care

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Patients with both cancer and psychosis—to what extent do they receive specialized palliative care

Bergqvist,

Hedskog,

Hedman

et al. 2024

Acta Psychiatr Scand

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BackgroundSchizophrenia and advanced cancer are complex conditions that impact life expectancy. This study aimed to examine the receipt of specialized palliative care (SPC) in patients with metastatic cancer and a coexisting diagnosis of psychosis compared to patients with cancer only. Secondary objectives included analyzing differences in emergency visits and place of death in relation to receipt of SPC.Patients and MethodsThis retrospective, observational registry study utilized health care consumption data from the Stockholm Regional Council. We included 23,056 patients aged >18 years who died between 2015 and 2021 with a diagnosis of metastatic cancer, hematologic malignancy, or malignant brain tumor in the Stockholm Gotland region. Among them, 320 patients had a concomitant diagnosis of psychosis.ResultsPatients with cancer and psychosis were less likely to receive SPC compared to patients with cancer only (61% vs. 74%, p < 0.001). Additionally, they were, on average, four and a half years younger at the time of death (68.5 years vs. 73.1 years, p < 0.0001), more likely to reside in nursing homes (25% vs. 11%, p < 0.0001), and had a higher prevalence of low area‐based socioeconomic status (46% vs. 32%, p < 0.0001). Receipt of SPC was associated with reduced frequency of emergency visits and a higher probability of place of death to be at home or in a care facility outside the acute hospital.ConclusionsPatients with a coexisting diagnosis of psychosis and metastatic cancer have a lower probability of receiving SPC. Receipt of specialized palliative care was associated with reduced number of unplanned emergency visits and a lower risk for death at an acute hospital. Efforts are needed to ensure equitable provision of SPC for patients with cancer and psychosis.

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Palliative Care for People with Severe Persistent Mental Illness: A Review of the Literature

Woods

Willison²,

Kington³

et al. 2008

Can J Psychiatry

136

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A systematic overview of the literature on palliative care for people with severe persistent mental illness (SPMI) was conducted to inform clinical practice, research, and education. Empirical studies and nonempirical papers were included. Few empirical studies exist. There is even less information about the palliative care needs of, or the nature of palliative care provided to, people with SPMI. Mental health, primary care, and palliative care providers need to partner with people who have SPMI in developing and providing palliative care. The field of palliative care for people with SPMI is wide open and in need of methodologically sound studies that will help define the issues that exist for this vulnerable population. Recognizing the similarities between mental health and palliative care should lead to collaborative ventures and discussions in an attempt to address common and parallel issues.

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Hospice care of the psychotic patient

Cited by 4 publications

References 0 publications

A scoping review of palliative care for persons with severe persistent mental illness

A scoping review of palliative care for persons with severe persistent mental illness

Patients with both cancer and psychosis—to what extent do they receive specialized palliative care

Palliative Care for People with Severe Persistent Mental Illness: A Review of the Literature

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