مقاله انگلیسی رایگان در مورد پیامدهای روانشناسی ارجاع در بخش مراقبت تسکین دهنده – الزویر 2018

Context: Psychologists can provide unique contributions to interdisciplinary palliative care. Despite research indicating high distress in palliative care cancer patients, little has been reported regarding the feasibility and practice of psychology in this setting. Objectives: To review the integration of clinical psychology practice in a palliative care department at a major comprehensive cancer center. Methods: Retrospective chart review of 1940 unique cancer patients (6451 total patient contacts) referred for psychology services provided by clinical psychologists in palliative care from 9/1/2013 to 2/29/2016. Results: Psychologists provided services to 1644 in-patients (24% of palliative care in-patients) and 296 out-patients (19% of palliative care out-patients). The majority (85%) received services in the in-patient setting. Most patients were female (57%) and white (68%) with a variety of cancer diagnoses. Adjustment disorders were the most prevalent in both settings with significant differences in other DSM-5 diagnoses by service location (p<0.0001). Psychological assessment (86%) and supportive expressive counseling (79%) were the most frequent services provided in the initial consult. Duration of initial visit was significantly longer in out-patient (median=60 minutes) compared to in-patient setting (median=40 minutes) (p<.0001). No significant differences were noted between settings regarding the median number of counseling sessions per patient; however, the majority (70%) only received 1 or 2 sessions. Over time, total patient encounters increased in the in-patient setting (p<0.0001), while session lengths in both settings significantly decreased (p<0.0001). Conclusions: Palliative care psychology services successfully integrated into an interdisciplinary palliative care department and rapidly grew in both in-patient and out-patient settings.

Introduction

Cancer patients experience significant psychological distress that fluctuates on a continuum of emotions including, sadness, fear, depression, anxiety, panic, isolation and can include existential and spiritual crisis through the course of one’s cancer experience beginning with diagnosis to end of life. 1 Prevalence rates of distress varies due to differences in operational definitions of distress and other measurement and methodological issues. 2-4 A recent large epidemiological study using a standardized clinical interview found the 4-week prevalence of mental disorders in cancer patients to be 31.8%, with the most prevalent being anxiety disorders (11.5%), mood disorders (6.5%), and adjustment disorders (11%). 5 These results are comparable to a meta-analyses showing a combined prevalence of 32% in cancer patients during acute care. 6 Rates are somewhat lower than those reported from a metaanalysis of 94 studies, 24 of which were in palliative care. Results for the palliative care meta-analysis indicated prevalence rates of 16.5% for depression, 15.4% for adjustment disorders, and 9.8% for anxiety disorders. In this meta-analysis, there were no significant differences between palliative care and non-palliative care settings, noting some combination of mood disorders to occur in 30-40% of patients. 7 Importantly, psychological distress has been associated with greater physical symptom severity, suffering, and mortality 8, 9 with research indicating that psychological and adjustment issues contribute 64% of variance in predicting suffering levels. 9 While some distress may be normal, particularly for those coping with advanced cancer, individuals with mild-to-moderate distress may have significant impairments in their day-to-day functioning and require psychological intervention, similar to those with diagnosable disorders. 10, 11 Early psychological intervention, similar to the push for early palliative care, may prevent “normal” adjustment from progressing to diagnosable disorders. For this reason, several national mandates have called for routine psychological distress screening and the integration of psychosocial care for all patients. 12-14 As noted by Holland and colleagues, 15 barriers to psychosocia care, in general, include busy out-patient clinics; the need for rapid identification of distress in busy clinic settings; poor insurance reimbursement for mental health care; and the stigma of mental health issues.