Palliative Care for Patients with Mental Illness

2019 ◽  
pp. 503-512
Author(s):  
John D. Chovan ◽  
Betty D. Morgan
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
Special Needs ◽  
Ethical Decision Making ◽  
Healthcare Providers ◽  
Interdisciplinary Teams ◽  
Underserved Population ◽  
Persistent Mental Illness ◽  
Life Threatening ◽  
Persons With Schizophrenia

This chapter describes the challenges and special needs for persons living with severe and persistent mental illness as they face chronic and life-threatening illnesses. Healthcare providers, especially those working on palliative care interdisciplinary teams, will learn the magnitude of this underserved population; their circumstances; the special needs of the persons with schizophrenia, bipolar disorder, and personality disorders; and those aspects of their mental illness that limit access to and delivery of appropriate healthcare throughout the trajectory of their illnesses. Techniques for caring for and communicating with patients and their families are offered, as are ethical decision-making advice regarding refusal of treatment, capacity and competence, advance directives, and interpersonal issues.

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

2019 ◽  
Vol 17 (04) ◽  
pp. 479-487 ◽  
Author(s):  
Erin E. Donald ◽  
Kelli I Stajduhar
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
Scoping Review ◽  
Research Question ◽  
Healthcare Providers ◽  
Premature Death ◽  
Future Research ◽  
Research Activity ◽  
Complex Needs ◽  
Persistent Mental Illness

AbstractObjectivePeople 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.

scholarly journals Acceptability of palliative care approaches for patients with severe and persistent mental illness: a survey of psychiatrists in Switzerland

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Manuel Trachsel ◽  
Martina A. Hodel ◽  
Scott A. Irwin ◽  
Paul Hoff ◽  
Nikola Biller-Andorno ◽  
...  
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
Persistent Mental Illness

Case series of introducing palliative care consultation in psychiatry

2020 ◽  
Vol 34 (5) ◽  
pp. 680-683 ◽  
Author(s):  
Thorleif Etgen
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
Case Series ◽  
Future Research ◽  
First Year ◽  
Problem Solution ◽  
Actual Case ◽  
Persistent Mental Illness ◽  
Palliative Care Consultation ◽  
Care Consultation

Background: The significance of palliative care consultation in psychiatry is unclear. Actual case series: Analysis of the introduction of palliative care consultation in a large psychiatric hospital. Possible courses of action: Continue without offering, survey the need for or offer palliative care consultation, and analyse its introduction. Formulation of a plan: Palliative care consultation was established and details including patient age, department, diagnosis, main problem, solution and discharge were analysed during the first 2 years. Outcome: Two consultations in the first year and 18 consultations in the second year were requested (18 geriatric, 2 addiction, 0 general, clinical social and forensic psychiatry) involving two domains: delirium associated with dementia or another condition (75%) and mental illness (e.g. alcoholic psycho-syndrome, psychosis, suicidal tendency, schizophrenia, depression) and cancer (25%). Recommendations of consultations were realized in 95%. Lessons from the case series: Implementation of palliative care consultation in psychiatry is one possible method of how to introduce palliative care in a field of medicine with lack of palliative care. View: Future research should focus on reasons for reservations about palliative care in psychiatry, include more patients with severe persistent mental illness and assess the value of palliative care consultation in resolving this problem.

scholarly journals Fully-integrated medical home for people with severe and persistent mental illness: A description and outcome analysis of a Medicare Advantage Chronic Special Needs Program

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Robert Myers
Keyword(s):  
Mental Illness ◽  
Special Needs ◽  
Medical Home ◽  
Social Needs ◽  
Community Treatment ◽  
Outcome Analysis ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Persistent Mental Illness ◽  
Management Approaches

People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.

Nursing Research

2019 ◽  
pp. 855-860
Author(s):  
Terrah Foster Akard ◽  
Karen Hyden ◽  
Mary Jo Gilmer
Keyword(s):  
Palliative Care ◽  
Healthcare Providers ◽  
Nursing Research ◽  
Ongoing Research ◽  
Care Research ◽  
Research Areas ◽  
Current State ◽  
Research Organizations ◽  
Life Threatening ◽  
Care Nursing

Palliative care nursing research aims to improve care for patients with life-threatening conditions and their families and includes physical, emotional, social, and spiritual domains. This chapter will help guide nurses and other healthcare providers in understanding the current state of nursing research and future directions. Published articles, information from leading palliative care and research organizations, and authors’ ongoing research were used to describe selected components of palliative care nursing research including (a) goals of palliative care research, (b) benefits and challenges in palliative care research, (c) priority research areas in palliative care, (d) palliative care funding source, and (e) preparation of a research proposal. Nurses are in ideal roles not only to provide palliative care at the bedside, but also to serve as leaders in research to advance the science of palliative care.

scholarly journals Fully-integrated medical home for people with severe and persistent mental illness: A description and outcome analysis of a Medicare Advantage Chronic Special Needs Program

2018 ◽  
Vol 10 (2) ◽  
pp. 48-52
Author(s):  
Robert Myers
Keyword(s):  
Mental Illness ◽  
Special Needs ◽  
Medical Home ◽  
Social Needs ◽  
Community Treatment ◽  
Outcome Analysis ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Persistent Mental Illness ◽  
Management Approaches

People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.

Psychiatric issues in palliative care: Recognition of delirium in patients enrolled in hospice care

2008 ◽  
Vol 6 (2) ◽  
pp. 159-164 ◽  
Author(s):  
Scott A. Irwin ◽  
Sanjai Rao ◽  
Kimberly A. Bower ◽  
Joanna Palica ◽  
Sanjay S. Rao ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Retrospective Chart Review ◽  
Interdisciplinary Teams ◽  
Significant Problem ◽  
Term Care ◽  
Prevalence Estimates ◽  
Life Threatening ◽  
Hospice And Palliative Care ◽  
The Impact

ABSTRACTObjectives:Delirium is prevalent, difficult to assess, under-recognized, and undertreated in hospice and palliative care settings. Furthermore, it is associated with significant morbidity and mortality. Under-recognition of delirium results in under-treatment and increased suffering. The intent of this study was to retrospectively evaluate the recognition of delirium in a large cohort of hospice patients by interdisciplinary hospice care teams.Methods:A retrospective chart review of 2,716 patients receiving hospice care was conducted in order to determine the baseline rate of recognition of delirium in patients with advanced, life-threatening illnesses by front-line hospice clinicians. Documentation of “delirium” as either a diagnosis or problem was used as an estimate of how often these disorders were considered significant issues by the treating interdisciplinary team.Results:Of the patients receiving home/long-term care, 17.8% (386/2168) had delirium documented as a diagnosis or significant problem. The presence of recognized delirium in this setting was associated with significant differences in marital status, ethnicity, hospice diagnosis, and age. Total length of hospice care was also significantly longer. Of patients receiving inpatient care, 28.3% (614/548) had delirium documented as a diagnosis or significant problem. Recognized delirium in this setting was associated with significant differences in gender, ethnicity, hospice diagnosis, and length of inpatient stay.Significance of results:If documentation is representative of the care that the interdisciplinary teams provide, delirium of any kind appears to be under-recognized in this population. In fact, it is on the low end of prevalence estimates in the literature. Improved delirium assessment is needed in order to minimize the impact of delirium on patients living with advanced, life-threatening illnesses and their caregivers.

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