Is death our business? Philosophical conflicts over the end-of-life in old age psychiatry

McKellar, Duncan; Ng, Felicity; Chur‐Hansen, Anna

doi:10.1080/13607863.2015.1031636

Cited by 7 publications

(33 citation statements)

References 18 publications

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“…Among the quantitative studies, 12 studies (across 13 publications) were retrospective cohort studies, 84,[88][89][90][91][92]95,97,98,100,101,107,108 seven studies (across eight publications) were descriptive surveys 83,[85][86][87]93,94,96,111 and nine studies (across 11 publications) used a qualitative design. 32,37,99,[102][103][104][105][106]109,112,113 Among the qualitative studies, five studies (across seven publications) were described as using a non-specific qualitative descriptive approach, [102][103][104][105][106]112,113 two utilised grounded theory, 37,109 one used ethnography 99 and one used phenomenology. 32 Specific methods used to collect qualitative data included interviews (n = 6, 32,37,102-106,109 across eight publications), focus groups (n = 1 112 ), a combination of interviews and focus groups (n = 1…”

Section: Study Designs and Methodsmentioning

confidence: 99%

“…Data were retrieved from 10 countries: the USA (n = 12, across 13 publications 32,[83][84][85][86][87][88][89][90][91][92][93][94] ), Canada (n = 4, across five publications [95][96][97][98][99] ), New Zealand (n = 1 100 ), Taiwan (Province of China) (n = 1 101 ), Australia (n = 4, across six publications [102][103][104][105][106][107] ), France (n = 1 108 ), Belgium (n = 1 109 ), the Netherlands (n = 2 [109][110][111] ), the UK (n = 3 37,112,113 ) and the Republic of Ireland (n = 1 114 ).…”

Section: Country Of Researchmentioning

confidence: 99%

“…The settings in which research studies were undertaken were described as follows: specialist palliative care services; 100 palliative care consultation services; 93 acute and psychiatric care; 85,108 Veterans Administration medical centres/nursing homes; 83,88,90 all medical care covered by one insurance company; 101 acute care; 91,92,96 all hospital and community based palliative care (n = 2 studies, across three publications); 95,97,107 homeless/vulnerably housed; 99,113 shelter-based hospice for the homeless; 98 general practices and psychiatric practices; 114 nursing/care homes; 84,111 mental health and hospice/ palliative care services 32,94,112 including community, residential homes, supported accommodation and psychiatric hostels; 106 mental health services (hospital and/or community based) (n = 5 studies, across eight publications); 86,87,[102][103][104][105]109,111 hospices; 37 and not stated. 89…”

Section: Settingsmentioning

confidence: 99%

“…The remaining 12 studies (across 14 publications) were conducted with HCPs who worked with patients with SMI at EoL 32,37,85,93,94,[102][103][104][105][106][110][111][112]114 and these included mental health HCPs, 85,[102][103][104] EoL HCPs, 37 mental health and EoL HCPs, 32,94,106,112 psychiatrists 105,114 and general practitioners (GPs). 114 Terminal or chronic condition/s or cause of death A large number of research studies (n = 16, across 19 publications 32,37,[83][84][85][86][87]93,94,99,100,[102][103][104][105]109,111,112,114 ) explored the perspectives of HCPs who cared for those with SMI at EoL and as a result did not refer to any specific terminal or chronic condition. The remaining studies reported cause of death (n = 6 studies across seven publications…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…Twenty-six policy and guidance documents 22,30,55,120, and 18 research outputs 32,85,88,[91][92][93][94][97][98][99]103,105,106,108,110,[112][113][114] contribute to this theme, which addresses the broad shape and structure of the EoL and mental health care systems. Material is organised under four subthemes: policy and guidance; separate commissioning, management and organisation; partnership; and no right place to die.…”

Section: Structure Of the Systemmentioning

confidence: 99%

See 4 more Smart Citations

End-of-life care for people with severe mental illness: the MENLOC evidence synthesis

Hannigan

Edwards

Anstey

et al. 2022

Health Soc Care Deliv Res

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Background People with severe mental illness have significant comorbidities and a reduced life expectancy. This project answered the following question: what evidence is there relating to the organisation, provision and receipt of care for people with severe mental illness who have an additional diagnosis of advanced incurable cancer and/or end-stage lung, heart, renal or liver failure and who are likely to die within the next 12 months? Objectives The objectives were to locate, appraise and synthesise relevant research; to locate and synthesise policy, guidance, case reports and other grey and non-research literature; to produce outputs with clear implications for service commissioning, organisation and provision; and to make recommendations for future research. Review methods This systematic review and narrative synthesis followed international standards and was informed by an advisory group that included people with experience of mental health and end-of-life services. Database searches were supplemented with searches for grey and non-research literature. Relevance and quality were assessed, and data were extracted prior to narrative synthesis. Confidence in synthesised research findings was assessed using the Grading of Recommendations, Assessment, Development and Evaluation and the Confidence in the Evidence from Reviews of Qualitative Research approaches. Results One hundred and four publications were included in two syntheses: 34 research publications, 42 case studies and 28 non-research items. No research was excluded because of poor quality. Research, policy and guidance were synthesised using four themes: structure of the system, professional issues, contexts of care and living with severe mental illness. Case studies were synthesised using five themes: diagnostic delay and overshadowing, decisional capacity and dilemmas, medical futility, individuals and their networks, and care provision. Conclusions A high degree of confidence applied to 10 of the 52 Grading of Recommendations, Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research summary statements. Drawing on these statements, policy, services and practice implications are as follows: formal and informal partnership opportunities should be taken across the whole system, and ways need to be found to support people to die where they choose; staff caring for people with severe mental illness at the end of life need education, support and supervision; services for people with severe mental illness at the end of life necessitate a team approach, including advocacy; and the timely provision of palliative care requires proactive physical health care for people with severe mental illness. Research recommendations are as follows: patient- and family-facing studies are needed to establish the factors helping and hindering care in the UK context; and studies are needed that co-produce and evaluate new ways of providing and organising end-of-life care for people with severe mental illness, including people who are structurally disadvantaged. Limitations Only English-language items were included, and a meta-analysis could not be performed. Future work Future research co-producing and evaluating care in this area is planned. Study registration This study is registered as PROSPERO CRD42018108988. Funding This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 4. See the NIHR Journals Library website for further project information.

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Section: Study Designs and Methodsmentioning

confidence: 99%

Section: Country Of Researchmentioning

confidence: 99%

Section: Settingsmentioning

confidence: 99%

Section: Participant Characteristicsmentioning

confidence: 99%

Section: Structure Of the Systemmentioning

confidence: 99%

See 3 more Smart Citations

End-of-life care for people with severe mental illness: the MENLOC evidence synthesis

Hannigan

Edwards

Anstey

et al. 2022

Health Soc Care Deliv Res

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The Human Rights of Older People With Mental Health Conditions and Psychosocial Disability to a Good Death and Dying Well

Peisah

Sampson

Rabheru

et al. 2021

The American Journal of Geriatric Psychiatry

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Towards a palliative care approach in psychiatry: do we need a new definition?

2018

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Psychiatry today is mainly practised within a curative framework. However, many mental disorders are persistent and negatively affect quality of life as well as life expectancy. This tension between treatment goals and the actual illness trajectory has evoked a growing academic interest in ‘palliative psychiatry’, namely the application of a palliative care approach in patients with severe persistent mental illness. Recently, Trachsel et al presented a working definition of palliative psychiatry. This first official attempt to capture the concept is based on WHO’s widely accepted definition of palliative care but modified and limited to include only severe persistent psychiatric illness. While this is a welcome step in the discussion on palliative care approaches in psychiatry, it also opens up for new questions. One of the most evident is whether psychiatry actually needs its own definition of palliative care or, put differently, whether there is something about mental disorders that differs so radically from other medical conditions that it calls for a separate definition. We acknowledge the need to discuss the goals of psychiatric care in patients with severe persistent psychiatric illness. However, we question whether a separate definition of palliative care exclusive to psychiatry is the right way to go. In this paper, we discuss why.

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Is death our business? Philosophical conflicts over the end-of-life in old age psychiatry

Cited by 7 publications

References 18 publications

End-of-life care for people with severe mental illness: the MENLOC evidence synthesis

End-of-life care for people with severe mental illness: the MENLOC evidence synthesis

The Human Rights of Older People With Mental Health Conditions and Psychosocial Disability to a Good Death and Dying Well

Towards a palliative care approach in psychiatry: do we need a new definition?

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