Mental Health Integration and Delivery in the Hospice and Palliative Medicine Setting: A National Survey of Clinicians.
Daniel Shalev, Gregg Robbins-Welty, Maureen Ekwebelem, Jerad Moxley, Catherine Riffin, M Carrington Reid, Elissa Kozlov
Author Information
Daniel Shalev: Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY; Department of Psychiatry (D.S.), Weill Cornell Medicine, New York, NY. Electronic address: Das2043@med.cornell.edu.
Gregg Robbins-Welty: Department of Medicine (G.R.W.), Duke University School of Medicine, Durham, NC; Department of Psychiatry and Behavioral Sciences (G.R.W.), Duke University School of Medicine, Durham, NC.
Maureen Ekwebelem: Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY.
Jerad Moxley: Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY.
Catherine Riffin: Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY.
M Carrington Reid: Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY.
Elissa Kozlov: Department of Health Behavior, Society, and Policy (E.K.), Rutgers School of Public Health, West Piscataway, NJ.
CONTEXT: Mental health comorbidities among individuals with serious illness are prevalent and negatively impact outcomes. Mental healthcare is a core domain of palliative care, but little is known about the experiences of palliative care clinicians delivering such care. OBJECTIVES: This national survey aimed to characterize the frequency with which palliative care providers encounter and manage common psychiatric comorbidities, evaluate the degree of mental health integration in their practice settings, and prioritize strategies to meet the mental health needs of palliative care patients. METHODS: A e-survey distributed to the American Academy of Hospice and Palliative Medicine membership. RESULTS: Seven hundred eight palliative care clinicians (predominantly physicians) were included in the analysis. Mood, anxiety, and neurocognitive disorders were frequently encountered comorbidities that many respondents felt comfortable managing. Respondents felt less comfortable with other psychiatric comorbidities. Eighty percent of respondents noted that patients' mental health status impacted their comfort delivering general palliative care at least some of the time. Mental health screening tool use varied and access to specialist referral or to integrated psychiatrists/psychologists was low. Respondents were unsatisfied with mental health training opportunities. CONCLUSION: Palliative care clinicians play a crucial role in addressing mental health comorbidities, but gaps exist in care. Integrated mental health care models, streamlined referral systems, and increased training opportunities can improve mental healthcare for patients with serious illness.
