Psychiatry in Palliative Care

DEFINITION

• Palliative Care Psychiatry
  • A subspecialty focused on mental health needs in serious, life-limiting illness, with goals of symptom relief, psychosocial support, and quality of life.[1],[2]
  • The integration of psychiatry into palliative medicine developed primarily in the oncology and advanced illness context in the late 1990s and early 2000s.
• Scope of This Guide
  • Applies to patients receiving palliative or end-of-life care who develop psychiatric symptoms in the context of medical illness.
  • Palliative care psychiatry differs from palliative psychiatry, which is a subspecialty formed in the early 2010s and focused on applying palliative approaches to treatment-refractory severe mental illness (SMI).[2]
  • This guide does not cover providing palliative care for SMI itself.
• Why It Matters
  • Psychiatric comorbidities in palliative and end-of-life care are common and associated with higher symptom burden and worse outcomes.[1],[3]
  • Early, integrated palliative care improves quality of life and mood, and in some settings has been associated with longer survival.[4]
• Palliative Care vs. Hospice
  • As per the Center to Advance Palliative Care, palliative care is appropriate at any stage of serious illness alongside disease-directed therapy; hospice is generally for a prognosis of 6 months or less when goals focus on comfort.[5]
• Who Are Experts in This Field?
  • While care is delivered in interdisciplinary teams, both palliative care physicians and psychiatrists with specialized palliative training are equipped to provide psychiatric services in palliative care.
    • Palliative care physicians typically complete training in internal medicine, while psychiatrists undergo a psychiatric residency. After their initial training, both fields complete a one-year fellowship in palliative medicine.
    • If none are available, general psychiatry and internal medicine consults may be helpful