Patterson Kevin R, Croom Andrea R, Teverovsky Esther G, Arnold Robert
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
J Pain Symptom Manage. 2014 Jun;47(6):1019-27. doi: 10.1016/j.jpainsymman.2013.06.015. Epub 2013 Oct 2.
Palliative care consult services have emerged as an excellent resource for physicians seeking help with patients' symptoms. Symptoms include those of a psychiatric nature (e.g., depression, anxiety, delirium); however, little information is known about whether palliative care services include psychiatric input as part of multidisciplinary teams.
To explore 1) the current level of collaboration between psychiatrists and palliative care consult services across the U.S. and 2) the factors that support or restrict such involvement.
A national survey was developed and distributed electronically to program directors identified in the National Palliative Care Registry maintained by the Center to Advance Palliative Care. Analyses examined trends in psychiatry involvement with hospital-based palliative care teams.
The survey had a 59% response rate, with final analyses including surveys completed by 260 palliative care program directors (67% inclusion rate from total respondents). Seventy-two percent of respondents reported some form of involvement with a psychiatrist on their palliative care service, with only 10% of those identifying a psychiatrist as a full- or part-time member of the team. Most respondents reported that they would like psychiatrists to be more involved with the palliative care services (71%). Secondary analyses of qualitative responses identified common impediments to increased psychiatry involvement, which included financial constraints, provider interest, and perceived disciplinary disconnect.
There are shared objectives between psychiatry and palliative care; however, currently, co-involvement on treatment teams is quite limited. Future research is needed to identify ways to facilitate the interface of palliative care and psychiatry.
姑息治疗咨询服务已成为医生在处理患者症状时寻求帮助的优质资源。症状包括具有精神性质的症状（如抑郁、焦虑、谵妄）；然而，关于姑息治疗服务是否将精神科投入作为多学科团队的一部分，所知甚少。
探讨1）美国精神科医生与姑息治疗咨询服务之间当前的合作水平，以及2）支持或限制这种参与的因素。
开展了一项全国性调查，并通过电子方式分发给在由推进姑息治疗中心维护的全国姑息治疗登记处中确定的项目主任。分析研究了精神科参与医院姑息治疗团队的趋势。
调查的回复率为59%，最终分析包括260名姑息治疗项目主任完成的调查（占总受访者的67%纳入率）。72%的受访者报告其姑息治疗服务与精神科医生有某种形式的合作，其中只有10%将精神科医生确定为团队的全职或兼职成员。大多数受访者表示希望精神科医生更多地参与姑息治疗服务（71%）。对定性回复的二次分析确定了精神科参与增加的常见障碍，包括资金限制、提供者兴趣以及感知到的学科脱节。
精神科和姑息治疗之间有共同目标；然而，目前治疗团队中的共同参与相当有限。需要未来的研究来确定促进姑息治疗与精神科之间接口的方法。
