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

Abstract

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.

A palliative care approach in psychiatry: clinical implications

“…In accordance with previous research, we believe that a change of perspective from a curative to a palliative approach could help promote patient-centeredness and increase quality of life for patients with severe and enduring psychiatric disorders [3,18]. However, as we have argued elsewhere, we do not believe that there is a need for a separate definition of palliative care in psychiatry [13]. Hence, we base our discussion here on the definition of palliative care established by the WHO [13,17].…”

“…In recent years, there has been a growing academic interest in palliative approaches in severe and persistent mental illness. More specifically, the discussion has focused on whether psychiatric care could benefit from explicitly acknowledging that a curative treatment is not always possible in major psychiatric disorders, and whether a focus on symptom reduction and quality of life may sometimes be a better option, even in potentially life-threatening conditions [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. According to these ideas, clinical psychiatry could learn from palliative care in somatic medicine by adopting a similar approach to patients suffering from psychiatric conditions beyond cure.…”

“…According to these ideas, clinical psychiatry could learn from palliative care in somatic medicine by adopting a similar approach to patients suffering from psychiatric conditions beyond cure. The suggested approach is often labelled 'palliative psychiatry' and a working definition of the concept, based on the World Health Organization (WHO) definition of palliative care [17], has been presented by Trachsel and colleagues in 2016 and in subsequent papers [3,11,13].…”

“…According to the WHO, palliative care "is an approach that improves the quality of life of patients and their families facing the problem associated with lifethreatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual" [17]. This perspective is as relevant to psychiatry as it is to somatic medicine, and concerns patients with severe persistent psychiatric disorders as well as the often multifactorial conditions encountered within geriatric psychiatry [3,11,13]. Analogous to palliation in somatic medicine, a palliative care approach in psychiatry does not mean merely giving up the attempts of finding a curative treatment [3].…”

“…However, palliative care in psychiatry is a comparatively novel concept and thus, except for case studies and a survey of clinicians' attitudes, empirical research on its clinical applicability is still lacking [3,4,10,12]. Moreover, it is yet to be spelled out what specifically distinguishes palliative care from other care options in psychiatry [3,13].…”