Clinician Perspectives on Palliative Care for Older Adults With Serious Mental Illnesses: A Multisite Qualitative Study.
Daniel Shalev, Maureen Ekwebelem, Lilla Brody, Karolina Sadowska, Sanam Bhatia, Dania Alvarez, Catherine Riffin, M Carrington Reid
Author Information
Daniel Shalev: Division of Geriatrics and Palliative Medicine (D.S., M.E., L.B., K.S., C.R., M.C.R.), Weill Cornell Medicine, New York, NY; Department of Psychiatry (D.S., S.B.), Weill Cornell Medicine, New York, NY. Electronic address: das2043@med.cornell.edu.
Maureen Ekwebelem: Division of Geriatrics and Palliative Medicine (D.S., M.E., L.B., K.S., C.R., M.C.R.), Weill Cornell Medicine, New York, NY.
Lilla Brody: Division of Geriatrics and Palliative Medicine (D.S., M.E., L.B., K.S., C.R., M.C.R.), Weill Cornell Medicine, New York, NY; American University (L.B.), Washington, DC.
Karolina Sadowska: Division of Geriatrics and Palliative Medicine (D.S., M.E., L.B., K.S., C.R., M.C.R.), Weill Cornell Medicine, New York, NY.
Sanam Bhatia: Department of Psychiatry (D.S., S.B.), Weill Cornell Medicine, New York, NY.
Dania Alvarez: Human Ecology (D.A.), Cornell University, Ithaca NY.
Catherine Riffin: Division of Geriatrics and Palliative Medicine (D.S., M.E., L.B., K.S., C.R., M.C.R.), Weill Cornell Medicine, New York, NY.
M Carrington Reid: Division of Geriatrics and Palliative Medicine (D.S., M.E., L.B., K.S., C.R., M.C.R.), Weill Cornell Medicine, New York, NY.
OBJECTIVES: Approximately 5.5% of the population live with Serious Mental Illnesses (SMI). Older adults with SMI experience a high burden of serious medical illnesses and disparities in advance care planning, symptom management, and caregiver support. The objectives of this study are to explore interdisciplinary clinician perspectives on the palliative care needs of older adults with SMI and serious medical illnesses. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study utilized thematic analysis of semi-structured interviews of interdisciplinary clinicians practicing palliative care, geriatrics, or geriatric/consultation-liaison psychiatry at four hospitals within an urban health system. MEASUREMENTS: Themes related to care of older adults with serious mental illness and serious medical illness with respect to clinician experiences, challenges in care, and opportunities to improve care. RESULTS: The authors interviewed 45 clinicians. Major themes identified were: (1) Current paradigms of palliative care do not meet the needs of patients with SMI; (2) Clinicians are motivated to care for this population but require more training and interdisciplinary practice; (3) There is a need for structural integration of psychiatric and palliative care services. CONCLUSIONS: The study underscores the inadequacy of current palliative care models in meeting the unique needs of older adults with SMI. Models of integrated psychiatric and serious illness care and enhanced training are needed to improve the delivery of palliative care. Integrated care models and workforce development at the interface of serious illness care and psychiatric have the potential to improve outcomes for this vulnerable population.
