Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-25T04:21:39.773Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychiatry trainees’ views and educational needs regarding the care of patients with a life-limiting illness

Published online by Cambridge University Press:  20 June 2016

Benjamin C. Forster Open the ORCID record for Benjamin C. Forster [Opens in a new window] ,
Helen Proskurin ,
Brian Kelly ,
Melanie R. Lovell ,
Ralf Ilchef  and
Josephine M. Clayton
Benjamin C. Forster
Affiliation:
HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia
Helen Proskurin
Affiliation:
HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia
Brian Kelly
Affiliation:
School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia John Hunter Hospital, Newcastle, New South Wales, Australia
Melanie R. Lovell
Affiliation:
HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Ralf Ilchef
Affiliation:
Royal North Shore Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Josephine M. Clayton*
Affiliation:
HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia Royal North Shore Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
*
Address correspondence and reprint requests to: Josephine Clayton, HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Pallister House, P.O. Box 5084, Greenwich, New South Wales 2065, Australia. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

People with a life-limiting physical illness experience high rates of significant psychological and psychiatric morbidity. Nevertheless, psychiatrists often report feeling ill-equipped to respond to the psychiatric needs of this population. Our aim was to explore psychiatry trainees’ views and educational needs regarding the care of patients with a life-limiting physical illness.

Method:

Using semistructured interviews, participants’ opinions were sought on the role of psychiatrists in the care of patients with a life-limiting illness and their caregivers, the challenges faced within the role, and the educational needs involved in providing care for these patients. Interviews were audiotaped, fully transcribed, and then subjected to thematic analysis.

Results:

A total of 17 psychiatry trainees were recruited through two large psychiatry training networks in New South Wales, Australia. There were contrasting views on the role of psychiatry in life-limiting illness. Some reported that a humanistic, supportive approach including elements of psychotherapy was helpful, even in the absence of a recognizable mental disorder. Those who reported a more biological and clinical stance (with a reliance on pharmacotherapy) tended to have a nihilistic view of psychiatric intervention in this setting. Trainees generally felt ill-prepared to talk to dying patients and felt there was an educational “famine” in this area of psychiatry. They expressed a desire for more training and thought that increased mentorship and case-based learning, including input from palliative care clinicians, would be most helpful.

Significance of Results:

Participants generally feel unprepared to care for patients with a life-limiting physical illness and have contrasting views on the role of psychiatry in this setting. Targeted education is required for psychiatry trainees in order to equip them to care for these patients.

Keywords

PsychiatryPalliative careEducationInterventions
Type
Original Articles
Information
Palliative & Supportive Care , Volume 15 , Issue 2 , April 2017 , pp. 231 - 241
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Balon, R., Motlova, L.B., Beresin, E.V., et al. (2016). A case for increased medical student and psychiatric resident education in palliative care. Academic Psychiatry, 40(2), 203–206.Google Scholar
Blosh, S. & Kissane, D. (2000). Psychotherapies in psycho-oncology. An exciting new challenge. The British Journal of Psychiatry, 177, 112–116.Google Scholar
Breitbart, W., Rosenfeld, B., Pessin, H., et al. (2015). Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology, 33(7), 749–754.Google Scholar
Chochinov, H.M. & Breitbart, W. (2009). Handbook of psychiatry in palliative medicine. New York: Oxford University Press.Google Scholar
Chochinov, H.M., Kristjanson, L.J., Breitbart, W., et al. (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. The Lancet Oncology, 12(8), 753–762.Google Scholar
Dein, S. (2003). Psychiatric liaison in palliative care. Advances in Psychiatric Treatment, 9(4), 241–248.Google Scholar
Fairman, N. & Irwin, S.A. (2013). Palliative care psychiatry: Update on an emerging dimension of psychiatric practice. Current Psychiatry Reports, 15(7), 374.Google Scholar
Ferrando, S.J. (2000). Commentary: Integrating consultation–liaison psychiatry and palliative care. Journal of Pain and Symptom Management. 20(3), 235–236.Google Scholar
Ganzini, L., Fenn, D.S., Lee, M.A., et al. (1996). Attitudes of Oregon psychiatrists toward physician-assisted suicide. The American Journal of Psychiatry, 153(11), 1469–1475.Google Scholar
Irwin, S.A., Montross, L.P., Bhat, R.G., et al. (2011). Psychiatry resident education in palliative care: Opportunities, desired training, and outcomes of a targeted educational intervention. Psychosomatics, 522(6), 530–536.Google Scholar
Kahn, M.W. (2011). Palliative psychotherapy. The American Journal of Psychiatry, 168(9), 888–889.Google Scholar
Macleod, A.D.S. (2013). Palliative medicine and psychiatry. Journal of Palliative Medicine, 16(4), 340–341.Google Scholar
Macleod, S. (2011). The psychiatry of palliative medicine: The dying mind, 2nd ed. Oxford: Radcliffe Publishing.Google Scholar
Meier, D.E. & Beresford, L. (2010). Growing the interface between palliative medicine and psychiatry. Journal of Palliative Medicine, 13(7), 803–806.Google Scholar
Ng, F., Crawford, G.B. & Chur-Hansen, A. (2014). Depression means different things: A qualitative study of psychiatrists' conceptualization of depression in the palliative care setting. Palliative & Supportive Care, 21, 1–8.Google Scholar
Ogawa, A., Nouno, J., Shirai, Y., et al. (2011). Availability of psychiatric consultation–liaison services as an integral component of palliative care programs at Japanese cancer hospitals. Japanese Journal of Clinical Oncology, 42(1), 42–52.Google Scholar
Patterson, K.R., Croom, A.R., Teverovsky, E.G., et al. (2014). Current state of psychiatric involvement on palliative care consult services: Results of a national survey. Journal of Pain and Symptom Management, 47(6), 1019–1027.CrossRefGoogle ScholarPubMed
Pope, C. & Mays, N. (2006). Qualitative research in health care. Chicester: John Wiley & Sons.CrossRefGoogle Scholar
Rayner, L., Price, A., Evans, A., et al. (2011). Antidepressants for the treatment of depression in palliative care: Systematic review and meta-analysis. Palliative Medicine, 25(1), 36–51.Google Scholar
Rhondali, W., Reich, M. & Filbet, M. (2012). A brief review on the use of antidepressants in palliative care. European Journal of Hospital Pharmacy–Science and Practice, 19(1), 41–44.Google Scholar
Royal Australian and New Zealand College of Psychiatrists (RANZCP) (2009). Curriculum: Advanced training fellowship. Available from https://www.ranzcp.org/Files/PreFellowship/Training/Fellowship_Training/2_fs_generalist_curriculum_v1-pdf.aspx.Google Scholar
Royal Australian and New Zealand College of Psychiatrists (RANZCP) (2010). Curriculum: Basic training psychiatry. Available from https://www.ranzcp.org/Files/PreFellowship/Training/Fellowship_Training/2_bt_curriculum_v2-pdf.aspx.Google Scholar
Shuster, J.L., Breitbart, W. & Chochinov, H.M. (1999). Psychiatric aspects of excellent end-of-life care. Ad Hoc Committee on End-of-Life Care. The Academy of Psychosomatic Medicine. Psychosomatics, 40(1), 1–4.Google Scholar
Tait, G.R. & Hodges, B.D. (2009). End-of-life care education for psychiatric residents: Attitudes, preparedness, and conceptualizations of dignity. Academic Psychiatry, 33(6), 451–456.Google Scholar
Tremblay, A. & Breitbart, W. (2001). Psychiatric dimensions of palliative care. Neurologic Clinics, 19(4), 949–967.CrossRefGoogle ScholarPubMed
University of Auckland School of Psychology (2014). About thematic analysis. Available from http://www.psych.auckland.ac.nz/en/about/our-research/research-groups/thematic-analysis/about-thematic-analysis.html.Google Scholar
Wilson, K.G., Chochinov, H.M., Skirko, M.G., et al. (2007). Depression and anxiety disorders in palliative cancer care. Journal of Pain and Symptom Management, 33(2), 118–129.Google Scholar
Winer, R.A. (2013). Formalizing palliative training in psychiatry residency programs. Academic Psychiatry, 37, 444–446.Google Scholar