Department of Psychiatry, Columbia University, New York, NY.
Department of Psychiatry, Columbia University, New York, NY.
Psychosomatics. 2020 Jul-Aug;61(4):336-342. doi: 10.1016/j.psym.2020.02.002. Epub 2020 Feb 19.
Provision of palliative care is part of the standard of care for patients with serious, life-limiting medical illnesses. Patients in the palliative care setting have high rates of psychiatric co-morbidity. However, integration of mental health care into palliative care remains a significant gap. With appropriate training, consultation-liaison (C-L) psychiatrists are well-positioned to improve integration of mental health into palliative care.
To understand current palliative care training practices for C-L psychiatry fellows in the United States.
We invited all U.S. C-L psychiatry fellowship program directors to participate in a 17-item online structured survey aimed at understanding palliative care training in their fellowship programs.
37/61 (61%) of C-L psychiatry fellowship program directors responded to the survey. Eighty-six percent of programs provide some palliative care didactics, but the topics covered vary widely. Programs are closely split between offering a required, elective, or no clinical palliative care experiences. Only about half (45%) of programs identify formal opportunities for interaction between palliative care and C-L psychiatry fellows. Program directors identified topics such as goals-of-care discussions, systems issues in end-of-life care, and pain management as important for fellows to learn. Barriers to teaching these topics included time, lack of teaching faculty, and disciplinary siloes.
Although C-L psychiatry fellowship program directors identify a number of key teaching topics in palliative care for C-L psychiatry fellows, there are wide discrepancies in the depth and content of existing palliative care didactic and clinical experiences in C-L psychiatry fellowships.
提供姑息治疗是对患有严重、生命有限的医学疾病的患者进行护理的标准的一部分。姑息治疗环境中的患者有很高的精神共病率。然而，将心理健康护理融入姑息治疗仍然是一个重大差距。经过适当的培训，联络精神病学专家（C-L）有很好的机会将心理健康融入姑息治疗。
了解美国联络精神病学研究员在姑息治疗方面的培训现状。
我们邀请了所有美国联络精神病学 fellowship 项目主任参与一项针对其 fellowship 项目中姑息治疗培训的 17 项在线结构化调查。
37/61（61%）位联络精神病学 fellowship 项目主任对调查做出了回应。86%的项目提供了一些姑息治疗方面的教学内容，但涵盖的主题范围广泛。项目在提供必修、选修或没有临床姑息治疗经验方面几乎平分秋色。只有大约一半（45%）的项目确定了姑息治疗和联络精神病学研究员之间正式互动的机会。项目主任确定了一些重要的教学主题，如目标关怀讨论、临终关怀中的系统问题和疼痛管理。教授这些主题的障碍包括时间、缺乏教学师资和学科隔阂。
尽管联络精神病学 fellowship 项目主任确定了联络精神病学研究员在姑息治疗方面的一些关键教学主题，但在联络精神病学研究员的姑息治疗方面，现有的姑息治疗教学和临床经验在深度和内容上存在很大差异。
