Palliative Care for Severe and Persistent Mental Illness
01.2016 – 12.2018
Psychiatry in Palliative Care versus Palliative Care in Psychiatry
In contrast to the well-established involvement of psychiatrists in palliative care, psychiatry currently does not explicitly provide palliative care for patients with life-threatening psychiatric disorders such as severe anorexia or advanced dementia. Of the four pillars of medicine, prevention, curative care, rehabilitation, and palliative care, only the first three are well-established in psychiatric practice. Palliative concepts for persons with severe and persistent mental illness (SMI) seem to be a blind spot of psychiatry.
However, the need for symptom control is not dependent on the patient’s remaining life expectancy. While interventions that are intended to reduce individual suffering rather than to cure an underlying psychiatric disorder are common, they are rarely designated as “palliative”.
Aim and Research Questions:
At present, research in the field of palliative care for patients with SMI is lacking. The aim of the research project is to elucidate beliefs, attitudes, and practice of psychiatrists in Switzerland and the US toward the current state of palliative care in psychiatry. Based on psychiatrists’ approaches and attitudes, suggestions for an improvement of care for persons with SMI will be developed in cooperation with the relevant stakeholders.
Methods and Setting:
To address the research questions, an empirical survey study will be performed that is able to yield descriptive data on the current situation of palliative care for patients with SMI in Switzerland (German-speaking part) and the US. Based on focus groups, a survey questionnaire with Likert scales will be designed. Aside from a set of basic questions on palliative care for patients with life-threatening SMI, case vignettes based on patients with SMI will be presented, and an evaluation of different palliative care interventions in these cases would be requested. The appropriateness of the questionnaire items will be established in a pilot sample.
The sample will consist of the German-speaking members of the Swiss Society for Psychiatry and Psychotherapy (SGPP), and the Swiss Society of Psychiatric Head of Departments (SVPC). In the US, it is the aim to survey a comparable part of the members of the American Psychiatric Association. The sample size will range around 1600 in Switzerland, and 1600 in the US; in sum, approx. 3200 persons.
Relevance and Possible Impact:
The present study is highly relevant because there are many patients with severe PMI who might profit from a palliative approach, and there exists very little knowledge about palliative care approaches in psychiatry and psychiatrists’ attitudes regarding this topic. Palliative care concepts in psychiatry have the potential to improve quality of care, patient-centeredness, and autonomy for patients with PMI who are at the end of life and who represent a particularly vulnerable population.
The present project spans several issues of high societal interest (palliative care, the right to die controversy, and advance directives in the context of mental health), which is highly innovative. Consequently, the study is expected to generate controversial discussions among a wider, non-scientific public. Since this study is the first ever to gather data on how psychiatrists view the position of palliative care in their own specialty, it has the potential for establishing a completely new clinical approach and ample opportunities for follow-up research. In a possible additional step to be completed after conclusion of the current project, a scale for rating the palliative stage of patients with PMI could be developed, thereby improving quality of care for this vulnerable population.
Institut für Biomedizinische Ethik, Universität Zürich
Dr. med. Dr. phil. Manuel Trachsel
Prof. Dr. med. Dr. phil. Nikola Biller-Andorno (Zürich)Dr. med. Florian Riese,