Interventions for behavioral health comorbidities in the hospice setting: a scoping review.
Lilla Brody, Karolina Sadowska, Maureen Ekwebelem, Alexis Hollingsworth, Michael Ong, Tejas Subramanian, Drew Wright, Veerawat Phongtankuel, M Carrington Reid, Milagros D Silva, Daniel Shalev
Author Information
Lilla Brody: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA; Department of Psychology, American University, Washington, DC, USA.
Karolina Sadowska: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
Maureen Ekwebelem: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
Alexis Hollingsworth: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
Michael Ong: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
Tejas Subramanian: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
Drew Wright: Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA.
Veerawat Phongtankuel: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
M Carrington Reid: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
Milagros D Silva: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
Daniel Shalev: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA; Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
BACKGROUND: Behavioral health (BH) comorbidities in hospice patients are widespread and impact important outcomes, including symptom burden, quality of life, and caregiver wellbeing. However, evidence-based BH interventions tailored for the hospice setting remain understudied. METHODS: We conducted a scoping review with the objective of mapping studies of interventions for BH comorbidities in the hospice setting. We included empirical studies among hospice patients of interventions with BH outcomes. We abstracted data on study design, intervention type, and patient characteristics. RESULTS: Our search generated 7,672 unique results, of which 37 were ultimately included in our analysis. Studies represented 16 regions, with the United Kingdom (n=13) most represented. The most frequent intervention type was complementary and alternative interventions (n=13), followed by psychotherapeutic interventions (n=12). Most of the studies were either pilot or feasibility investigations. Fifteen studies employed a randomized controlled trial design. The most frequently utilized measurement tools for BH outcomes included the Hospital Anxiety and Depression Scale and the Edmonton Symptom Assessment Scale. Seventeen studies demonstrated statistically significant results in a BH outcome measure. BH conditions prevalent among hospice patients that were the focus of intervention efforts included depression symptoms, anxiety symptoms, and general psychological distress. No study focused on trauma-related disorders or substance use disorders. CONCLUSIONS: This scoping review reveals a concerning gap in research regarding evidence-based BH interventions in hospice settings, especially in the U.S. Despite extensive utilization of hospice care services and the high prevalence of BH conditions among hospice patients, randomized controlled trials focused on improving BH outcomes remain scant. The current BH practices, like the widespread use of benzodiazepines and antipsychotics, may not be rooted in robust evidence, underscoring an urgent need for investment in hospice research infrastructure and tailored clinical trials to test behavioral approaches to mitigate mental health outcomes at the end of life.
