Park Tanya, Hegadoren Kathy, Workun Bernadette
Faculty of Nursing, 3158University of Alberta, Edmonton, Canada.
Alberta Health Services, Edmonton, Canada.
J Palliat Care. 2022 Apr;37(2):183-189. doi: 10.1177/0825859720951360. Epub 2020 Aug 18.
Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort-particularly those with a comorbid, chronic and persistent mental illness (CPMI)-are poorly documented. We sought to explore the experiences of PEOLC providers with regard to caring for patients with mental health challenges, and gather insights into ways of improving accessibility and quality of PEOLC for these patients. Twenty providers of PEOLC, from different disciplines, took part in semi structured interviews. The data were coded and analyzed using a reflexive, inductive-deductive process of thematic analysis. The most prominent issues pertained to assessment of patients and differential diagnosis of CPMI, and preparedness of caregivers to deliver mental health interventions, given the isolation of palliative care from other agencies. Among the assets mentioned, informal relationships with frontline caregivers were seen as the main support structure, rather than the formal policies and procedures of the practice settings. Strategies to improve mental health care in PEOLC centered on holistic roles and interventions benefiting the entire palliative population, illustrating the participants saw little point in compartmentalizing mental illness, whether diagnosed or not. Continuity of care and personal advocacy can significantly improve quality of life for end-of-life patients with mental health challenges, but bureaucracy and disciplinary siloing tend to isolate these patients and their caregivers. Improved interdisciplinary connectivity and innovative, hybridized roles encompassing palliation and psychiatry are 2 strategies to address this disconnect, as well as enhanced training in core mental health care competencies for PEOLC providers.
姑息性临终关怀（PEOLC）提供者在满足有心理健康挑战患者的需求方面资源匮乏，而且这一群体的临终经历——尤其是那些患有共病、慢性持续性精神疾病（CPMI）的患者——记录很少。我们试图探究PEOLC提供者在照顾有心理健康挑战患者方面的经历，并深入了解改善这些患者获得PEOLC的机会和质量的方法。来自不同学科的20名PEOLC提供者参与了半结构化访谈。数据通过主题分析的反思性、归纳-演绎过程进行编码和分析。最突出的问题涉及患者评估和CPMI的鉴别诊断，以及鉴于姑息治疗与其他机构的隔离，护理人员提供心理健康干预的准备情况。在提到的资产中，与一线护理人员的非正式关系被视为主要的支持结构，而非实践环境中的正式政策和程序。改善PEOLC中精神卫生保健的策略以有利于整个姑息治疗人群的整体角色和干预为中心，这表明参与者认为区分精神疾病（无论是否已确诊）没有什么意义。对于有心理健康挑战的临终患者，持续护理和个人支持倡导可以显著提高生活质量，但官僚作风和学科孤立往往会使这些患者及其护理人员被孤立。改善跨学科联系以及涵盖姑息治疗和精神病学的创新混合角色是解决这种脱节问题的两种策略，同时也要加强对PEOLC提供者核心精神卫生保健能力的培训。
