[Symptom monitoring by patients with a psychiatric disorder in palliative care]. / Symptoommonitoring bij psychiatrische patiënten in de palliatieve fase.

BACKGROUND: Hardly any research has been conducted into systematic symptom monitoring in palliative care for patients with a psychiatric disorder. AIM: To gain insight into the usefulness of the Utrecht Symptom Diary (USD) and the symptom burden of patients with a psychiatric disorder in the palliative phase. METHOD: A pragmatic retrospective study using completed USDs by patients (USD-P) and/or caregivers (USD-Z) at the palliative unit and three clinical departments of geriatric psychiatry of GGz Centraal, from October 2011 to January 2018. Analysis was performed using completed USDs, from 3 months to 14 days before death and ≤ 14 days before death. The first measurement was used in both periods. Primary outcomes: prevalence of symptoms (score > 0) and clinical relevance of symptoms (score > 3). RESULTS: 50 USD’s from 38 patients were included, 9 USD-Ps and 41 USD-Zs were analysed. Self-reporting was usually not possible due to psychotic experiences, forms of denial, difficulty with concentration, weakness or fatique. Fatigue and loss of appetite were the most common in USD-Ps and USD-Zs. Fatigue reached most often clinically relevant intensity in USD-Ps and USD-Zs. CONCLUSION: If the patient cannot fill in the USD-P, the USD-Z can be an alternative to systematically monitor symptoms. Application of the USD-Z requires good observation and awareness of differences in interpretation between healthcare providers and patients in a target group that has difficulty in expressing complaints clearly. Psychical symptoms are reported more often as clinically relevant than psychological symptoms. Fatigue is the most frequently and most unequivocally scored by patients and healthcare providers in terms of presence and clinically relevant intensity.

Palliative care in mental health facilities from the perspective of nurses: a mixed-methods study.

WHAT IS KNOWN ON THE SUBJECT?: Nurses play an important role in monitoring and supporting patients and their relatives at the end of life. To date, there is a lack of recent empirical research on the experiences of psychiatric nurses in providing palliative care to psychiatric patients who suffer from life-threatening physical co-morbidity. The limited literature available indicates that palliative care for psychiatric patients needs to be improved. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This explorative study is unique in offering an insight into current palliative care practice for psychiatric patients and showed that one in three nurses working in Dutch mental health facilities is involved in palliative care provision. Important elements of palliative care, i.e.: care domains, multidisciplinary approach, early recognition and family care are recognized by nurses. Moreover, in palliative care for psychiatric patients there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Patient characteristics and little attention for palliative care within mental health facilities were found to hamper timely and adequate palliative care provision by nurses. WHAT ARE THE IMPLICATIONS FOR RESEARCH AND PRACTICE?: Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of this vulnerable patient group. Since mental health care is increasingly provided ambulatory, the development of palliative care for psychiatric patients outside mental health facilities should be closely monitored. ABSTRACT: Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in Dutch mental health facilities completed a survey. Nine participated in in-depth interviews. Results Thirty-six percent of nurses had experience with providing palliative care to psychiatric patients with physical co-morbidity in the past 2 years. Of all patients, 63% received physical care before death, 46% psychosocial care and 33% spiritual care. In 91% of all cases, care was provided by multidisciplinary teams. Patient characteristics and little attention to palliative care were barriers for timely and adequate palliative care. Discussion In palliative care for psychiatric patients, there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Yet there are barriers to adequate palliative care provision. Implications for practice Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of psychiatric patients. Since mental health care is increasingly provided ambulatory, palliative care for psychiatric patients outside mental health facilities should be closely monitored.