Hernández-Marrero, P.

Pereira, S. Martins

Palliative Medicine

English

Repositório Institucional da Universidade Católica Portuguesa

Integration of Palliative Care and Psychiatry: Ethico-Clinical and Organisational Challenges Based on Professionals’ Views S. Martins Pereira1,2, P. Hernández-Marrero1,2,3 1Universidade Católica Portuguesa, CEGE: Research Center in Management and Economics, Católica Porto Business School, Porto, Portugal, 2Universidade Católica Portuguesa, Instituto de Bioética, Porto, Portugal, 3Portuguese Nurses Association for Long-Term & Palliative Care (AECCP), Lisbon, Portugal Background/aims: Linkages between palliative care (PC) and psychiatry are increasingly relevant, sharing common features (e.g., symptom control; quality of life; respect for patients’ dignity, vulnerability, autonomy). Aims: To understand the clinical, organisational, and ethical challenges of integrating PC for patients with severe persistent mental illness (SPMI) or severe chronic psychiatric conditions (SCPC). Methods: Qualitative study with in-depth interviews. Participants: Professionals working in acute and long-term psychiatric services/institutions in Portugal. Sampling procedure: Purposive and snowball until theoretical saturation. Data collection: Ongoing; up-to-date 11 professionals interviewed. Analysis: Data is being analysed using inductive thematic analysis. Results: Four main themes with sub-themes emerged: (i) Integration through liaison of psychiatry and PC (patients in PC are referred to psychiatrists to assess and manage acute psychiatric disorders or wishes to hasten death); (ii) Inequities in access of patients with SCPC to specialist PC (patients with SCPC are often neglected in their clinical complains; even when these patients have a physical life-threatening disease and PC needs requiring specialist PC, they often do not have access to this type of service especially when compared to other patients; as patients with SPMI do not have access to specialist PC, integration could be fostered through training about PC); (iii) Palliative psychiatric care (application of the core components and principles of PC to the care of patients with SPMI, particularly those who are at risk of therapeutic neglect and/or overly aggressive care; awareness of limited functional prognosis and lifespan of patients with SPMI; care focused on quality of life); and (iv) Impracticability of integration (psychiatrists do not consider PC or end-of-life care within the scope of their practice). Conclusions: The integration of PC for patients with SPMI can be an effective response for these patients and their families.   Pereira, S. M., & Hernández-Marrero, P. (2022). Integration of palliative care and psychiatry: ethico-clinical and organisational challenges based on professionals’ views. Palliative Medicine, 36(1), 65. 

Integration of palliative care and psychiatry: ethico-clinical and organisational challenges based on professionals’ views

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Integration of palliative care and psychiatry: ethico-clinical and organisational challenges based on professionals’ views

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Repositório Institucional da Universidade Católica Portuguesa