Despite the fact that psychological distress occurs in the vast majority of people with serious illness, most hospice and palliative care clinicians have little or no training in mental health. This year, the is offering a brand new, intensive all-day pre-conference workshop to better equip clinicians to address psychological distress and mental health comorbidities.
The PalliPsych mission is to contribute to the greater field of palliative care by integrating high yield knowledge and skills from psychiatry and psychology through education, training, research, and scholarship.
Devon Phillips (DP): We are very exited to be offering this special pre-conference session, 鈥�鈥� in parallel English and French sessions, at the congress this year! What is the impetus behind this program? How did it start? What learning needs are being met by this programme?
Keri Brenner (KB): One thing that compels Dan and myself to offer this training is that within the space of palliative care, about 80% of patients experience some degree of psychological distress amidst their serious illness. But simultaneously, we have data that shows that around 80% of hospice and palliative medicine clinicians report having little or no training in mental health. And 80% of fellowship programs and hospice and palliative medicine within the United States do not have one single teaching session that involves psychotherapies on how to help people cope as they're struggling with psychological distress, or any mental health comorbidities.
So that gap was a huge catalyst for Dan and myself and many others who are trained as psychiatrists within palliative care, or have a psychological background and are working in the space of serious illness, to think about 鈥渉ow do we create educational curriculum modalities that can provide this next level training for our field?鈥�. What we're offering now is the next frontier of palliative care. It is a more intensive training which involves primary psychiatric and psychological training for education on knowledge and skills. So, any palliative care and hospice clinician will feel equipped to care for patients suffering with psychological distress.
Daniel Shalev (DS):
I can add to that a little bit. Keri and I and many of our collaborators are the faculty members for the pre-conference workshop. We all have a background of psychiatry residency, or, mental health training, and then we have come to palliative care. Our observations about the learning gaps really fall into two buckets. The first is that many of the skills that we use in psychotherapy and mental health can enhance the way that we talk to people about serious illnesses, regardless of their mental health status. There are communication strategies that transcend the diagnosis and that are the basis for the second-half of the day, which is very much focused on what can we take away from psychotherapy to deliver to all of our patients who have serious illnesses to help them be able to talk about challenging topics, like mortality and care decisions. But we also realize that as palliative care clinicians, we as a discipline get tasked with doing a lot of specialty mental health, not just using good communication skills, but also actually managing a lot of complex mental health disorders or symptoms. And that's even reflected in the palliative care scope of practice guidelines.
If you look at any referral guidelines for different disease categories in palliative care like heart failure or dementia, they all include psychological symptoms as criteria for referral to palliative care. Our national consensus project quality guidelines for palliative care, which basically define our scope of practice, include an entire domain on psychological and psychiatric aspects of care. Keri and I, our passion and vision is really to think both about what are the components of mental health specialty care that could be applied to all patients to help us in our work, and, how do we upscale palliative care clinicians to meet the needs that are being asked of them by the system. These clinicians need to be working as sort of primary mental health clinicians for people with serious illnesses.
DP: Let's switch over a little bit to what people can expect who are coming to the conference. Tell me how the day is shaping up, what your focus areas will be on.
DS: We really want to give people an opportunity to have this comprehensive day that speaks to 鈥渉ow do we take care of people who have specific mental health needs鈥� and 鈥渨hat can we take away from mental health practices for all of our patients鈥�. The first half of the day is focused on the medical model of psychiatry. We will be thinking about how do we enhance our ability to diagnose common mental health conditions in our palliative care patients? How do we screen for depression, anxiety, delirium in the palliative care setting? How do we enhance our ability to use medications to treat depression and anxiety in palliative care patients. It's really taking experts at the interface of mental health and palliative care and trying to create a framework for palliative care clinicians to feel more confident diagnosing and managing common mental health conditions. I'll let Keri describe the focus in the afternoon.
KB: The second half of the day addresses the psychological aspects of caring for patients with serious illness, knowing that the vast majority of patients with serious illness experience some type of psychological distress, even if they have no formal mental health comorbidities such as major depression. We're going to talk about formulation, which is essentially trying to know the 鈥渨hy鈥� beneath the patient and family鈥檚 thoughts, behaviors and reactions, and having a way to create a hypothesis about their struggle. Oftentimes, we can utilize our own countertransference, our own emotions and reactions, thoughts, feelings, experiences, while we're in the room with the patient as a key to unlock that knowledge about what might be happening within the patient themselves. So it's about being in tune with what the patient鈥檚 family might be experiencing, as well as more attuned with what we're experiencing within ourselves. We鈥檒l look at some high yield implementation strategies and techniques that we can use at the bedside to elevate and enrich our work so we can optimize patients鈥� and families鈥� coping, as well as optimize our own sustainability and well-being as clinicians.
DP: Excellent. It sounds like an amazing day with a range of different topics that will be very practical for people. Which clinicians would benefit from attending your session?
KB: The day is truly set up for any clinician who's caring for patients with serious illness. We really try to optimize the interdisciplinary team. Within our teaching team, we have psychiatrists, palliative care doctors, psycho-oncologists, psychologists and social workers because we want to provide a comprehensive interdisciplinary lens to these important topics. Nurse practitioners, physician assistants, physicians, nurses, social workers, chaplains, all members of the interdisciplinary team can benefit.
DP: Let鈥檚 talk a little bit about the French programme. How is that going to work? What can our Francophone colleagues expect?
DP: Having simultaneous French and English sessions is going to be a great way to kick off the conference. Last thoughts are yours- what message would you like to send out to palliative care clinicians across the globe?
DS: In taking care of folks with serious illnesses, whether we're aware of it or not, we are providing mental healthcare. It's a core part of our care and the more that we're able to attend to that, the better. People shy away from this because they may feel they are not trained for this, and that鈥檚 true, and yet it's what's in front of us and it's the work that we have to do. Even if this is your least favorite part of being a palliative care clinician, I encourage people to attend.
DS: From our survey data from 15 different grand rounds in the United States that we did, 95% percent of attendees said this training was extremely valuable. The satisfaction rate was really high.
KB: I think it demonstrates that there is a hunger within our field for greater knowledge and skills in caring for patients with mental health distress. This is a way for people to feel really empowered and equipped with a primary psychiatric and psychological skill set to care for any patient that they see with serious illness. The day is highly engaging, interactive, experiential type learning to ensure that it gets applied in a high yield way to everyday practice. Our goal is that when people come to the workshop that the next day, the next week, the next month, when they're seeing patients, they will have the knowledge and skills to immediately apply those techniques in their everyday practice.
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