We've Got Your Back: Pearls for Interdisciplinary Psychological and Psychiatric Palliative Care

IF 3.5 2区医学 Q2 CLINICAL NEUROLOGY

Journal of pain and symptom management Pub Date : 2025-04-10 DOI:10.1016/j.jpainsymman.2025.02.041

William Rosa PhD MBE APRN FPCN, Keri Brenner MD MPA, Gregg Alan Robbins-Welty MD MS HEC-C, Mike Polisso LCSW APHSW-C, Emily Linderman BCC (Board Certified Chaplain), Daniel Shalev MD, Danielle Chammas MD

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Using an interprofessional and practical clinical application approach, participants will self-report the ability to identify and leverage the skills, competencies, and approaches of all members of the interdisciplinary team to confidently address the psychiatric and psychological domain in palliative care.</div></div><div><h3>Key Message</h3><div>Despite the high prevalence of psychological and psychiatric suffering in serious illness, palliative specialists continue to feel unprepared to deliver high-quality psychological and psychiatric care. 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引用次数: 0

Outcomes

1. Using a case-based approach based rooted in the best available evidence, participants will self-report the ability to assess, manage, and alleviate psychiatric and psychological suffering in the serious illness context.

2. Using an interprofessional and practical clinical application approach, participants will self-report the ability to identify and leverage the skills, competencies, and approaches of all members of the interdisciplinary team to confidently address the psychiatric and psychological domain in palliative care.

Key Message

Despite the high prevalence of psychological and psychiatric suffering in serious illness, palliative specialists continue to feel unprepared to deliver high-quality psychological and psychiatric care. Our multidisciplinary team synthesizes the best tips and practices to prepare and equip clinicians with evidence-based approaches to psychological and psychiatric care in alignment with national palliative care guidelines.

Abstract

Psychological and psychiatric care is a core palliative care domain that includes meeting the normative psychosocial needs of patients with serious illnesses and managing common mental health disorders in serious illness. This domain encapsulates skills from across disciplines including psychotherapeutic skills, psychiatric assessment, and psychopharmacology (1-3). All interdisciplinary team (IDT) members contribute to this domain of care. However, many clinicians lack opportunities to advance relevant mental health training (4,5).

Objectives

To provide expert-level clinical pearls in the psychological and psychiatric components of palliative care.

Methods

Through literature synthesis and expert consensus, our IDT will present six “clinical pearls” on advanced topics at the interface of mental health and palliative care. Content will advance from normative psychosocial needs of people with serious illnesses to assessment of mental health symptoms to psychopharmacologic and psychotherapeutic interventions in the palliative care context. Each topic will be presented through a brief case and utilize audience response polling. Speakers will highlight the unique expertise of core IDT members, including social workers, nurses, physicians, chaplains, and pharmacists within the topics.

Results

In addition to sharing key implications for the IDT team at generalist and specialist levels, we will feature six skill-oriented mini-sessions: 1. Holding is doing: Reconceptualizing holding as an active intervention that impacts processing 2. What we can't say, we act: Identifying and responding to countertransference-based practice patterns 3. Mind, meaning, or spirit: Distinguishing depression, demoralization, and existential-spiritual distress 4. Embodied distress: Recognizing medical causes of psychiatric symptoms and psychiatric causes of physical symptoms 5. Fueling the engine: Using atypical antipsychotics to potentiate antidepressants 6. Right drug, right patient: Rational selection of benzodiazepines.

Conclusion

Supporting the mental health of patients with serious illnesses is a critical component of holistic palliative care. Through interdisciplinary collaboration, all team members can identify and contribute at an expert level.

References

1. Chammas D, Brenner KO, Gamble A, et al. Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters. J Palliat Med. Published online July 14, 2023. doi:10.1089/jpm.2023.0390 2. Robbins-Welty GA, Shalev D, Riordan PA, et al. Top Ten Tips Palliative Care Clinicians Should Know About the Physical Manifestations of Psychiatric Illness and Treatment. J Palliat Med. Published online May 9, 2024. doi:10.1089/jpm.2024.0131 3. Robbins-Welty GA, Riordan PA, Shalev D, et al. Top Ten Tips Palliative Care Clinicians Should Know About the Psychiatric Manifestations of Nonpsychiatric Serious Illness and Treatments. J Palliat Med. Published online May 10, 2024. doi:10.1089/jpm.2024.0135 4. Shalev D, Chammas D, Brenner KO, Moxley JH, Reid MC, Rosenberg LB. Mind the Gap: Understanding Palliative Care Clinician Attitudes Toward Mental Health Training. Am J Hosp Palliat Care. Published online July 24, 2024:10499091241265107. doi:10.1177/10499091241265107 5. Shalev D, Robbins-Welty G, Ekwebelem M, et al. Mental Health Integration and Delivery in the Hospice and Palliative Medicine Setting: A National Survey of Clinicians. J Pain Symptom Manage. Published online October 1, 2023:S0885-3924(23)00713-3. doi:10.1016/j.jpainsymman.2023.09.025

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我们支持你：跨学科心理和精神病学姑息治疗的珍珠

Outcomes1。使用基于现有最佳证据的案例方法，参与者将自我报告在严重疾病背景下评估、管理和减轻精神和心理痛苦的能力。采用跨专业和实际的临床应用方法，参与者将自我报告识别和利用跨学科团队所有成员的技能，能力和方法的能力，以自信地解决姑息治疗中的精神病学和心理学领域。尽管在严重疾病中心理和精神痛苦的发生率很高，但姑息治疗专家仍然感到没有准备好提供高质量的心理和精神护理。我们的多学科团队综合了最佳技巧和实践，为临床医生准备和装备基于证据的心理和精神护理方法，与国家姑息治疗指南保持一致。心理和精神护理是姑息治疗的核心领域，包括满足严重疾病患者的规范心理社会需求和管理严重疾病中常见的精神健康障碍。这个领域包含了包括心理治疗技能、精神评估和精神药理学在内的跨学科技能（1-3）。所有跨学科团队（IDT）成员都为这一护理领域做出贡献。然而，许多临床医生缺乏机会推进相关的心理健康培训（4,5）。目的为姑息治疗的心理和精神病学组成部分提供专家级的临床珍珠。方法通过文献综合和专家共识，我们的IDT将在心理健康和姑息治疗的界面上提出六个“临床珍珠”。内容将从严重疾病患者的规范社会心理需求发展到心理健康症状评估，再到姑息治疗背景下的心理药理学和心理治疗干预。每个主题将通过一个简短的案例和利用观众的反应投票。演讲者将重点介绍IDT核心成员的独特专业知识，包括社会工作者、护士、医生、牧师和药剂师。除了在通才和专家层面分享IDT团队的关键意义外，我们还将举办六场以技能为导向的小型会议：持有正在做：将持有重新定义为影响处理过程的积极干预。我们不能说的，我们要做的：识别和应对基于反转移的实践模式。思想、意义或精神：区分抑郁、道德败坏和存在的精神痛苦。体现的痛苦：认识精神症状的医学原因和身体症状的精神原因为引擎加油：使用非典型抗精神病药物来增强抗抑郁药的作用。正确的药物，正确的病人：苯二氮卓类药物的合理选择。结论支持重症患者的心理健康是整体姑息治疗的重要组成部分。通过跨学科合作，所有团队成员都能在专家水平上识别和贡献。参考文献1。Chammas D, Brenner KO, Gamble A，等。关于姑息治疗的心理方面，临床医生应该知道的十大建议。《J Palliat Med》，2023年7月14日在线出版。doi: 10.1089 / jpm.2023.0390 2。Robbins-Welty GA, Shalev D, Riordan PA，等。关于精神疾病的躯体表现及治疗，姑息治疗医师应了解的十大提示。《palat Med》杂志于2024年5月9日在线发表。doi: 10.1089 / jpm.2024.0131 3。robins - welty GA, Riordan PA, Shalev D，等。姑息治疗临床医师应了解的非精神严重疾病的精神表现及治疗的十大提示。《palat Med》杂志于2024年5月10日在线发布。doi: 10.1089 / jpm.2024.0135 4。沙利夫D， Chammas D, Brenner KO, Moxley JH, Reid MC, Rosenberg LB.了解姑息治疗临床医生对心理健康培训的态度。我是临终关怀医院。在线发布于2012年7月24日：10499091241265107。doi: 10.1177 / 10499091241265107 5。肖晓东，王晓东，王晓东，等。安宁疗护与缓和医疗环境下的心理健康整合与递送：一项全国临床医师调查。J疼痛症状管理。在线发布于2023年10月1日：S0885-3924(23)00713-3。doi: 10.1016 / j.jpainsymman.2023.09.025

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来源期刊

Journal of pain and symptom management 医学-临床神经学

CiteScore

8.90

自引率

6.40%

发文量

821

审稿时长

26 days

期刊介绍： The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.