Abstract
BackgroundIncreasing attention to palliative care for the general population has led to the development of various evidence-based or consensus-based tools and interventions. However, specific tools and interventions are needed for people with severe mental illness (SMI) who have a life-threatening illness. The aim of this systematic review is to summarize the scientific evidence on tools and interventions in palliative care for this group.MethodsSystematic searches were done in the PubMed, Cochrane Library, CINAHL, PsycINFO and Embase databases, supplemented by reference tracking, searches on the internet with free text terms, and consultations with experts to identify relevant literature. Empirical studies with qualitative, quantitative or mixed-methods designs concerning tools and interventions for use in palliative care for people with SMI were included. Methodological quality was assessed using a critical appraisal instrument for heterogeneous study designs. Stepwise study selection and the assessment of methodological quality were done independently by two review authors.ResultsFour studies were included, reporting on a total of two tools and one multi-component intervention. One study concerned a tool to identify the palliative phase in patients with SMI. This tool appeared to be usable only in people with SMI with a cancer diagnosis. Furthermore, two related studies focused on a tool to involve people with SMI in discussions about medical decisions at the end of life. This tool was assessed as feasible and usable in the target group. One other study concerned the Dutch national Care Standard for palliative care, including a multi-component intervention. The Palliative Care Standard also appeared to be feasible and usable in a mental healthcare setting, but required further tailoring to suit this specific setting. None of the included studies investigated the effects of the tools and interventions on quality of life or quality of care.ConclusionsStudies of palliative care tools and interventions for people with SMI are scarce. The existent tools and intervention need further development and should be tailored to the care needs and settings of these people. Further research is needed on the feasibility, usability and effects of tools and interventions for palliative care for people with SMI.
Highlights
The World Health Organization (WHO) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” [4]
This systematic review focused on empirically based tools and interventions that can be used in palliative care for people with severe mental illness (SMI)
Two empirically based tools and one multi-component intervention are available for improving palliative care for this group
Summary
Most attention is given to palliative care for the general population, and less attention has been paid so far to specific groups, such as people with severe mental illness (SMI) [5] It is precisely this group where good and timely palliative care deserves specific attention, because it can be perceived as a vulnerable group. People with SMI are characterized by the presence of persistent psychopathology (> 2 years) and long-term impairments in functioning in multiple areas of life, such as social functioning, education and employment [6,7,8] Common diagnoses among this population include psychotic disorders, bipolar disorder, mood/anxiety disorders and severe personality disorders, often accompanied by comorbid addiction disorders [7,8,9,10]. The causes are diverse and often concern a combination of genetic vulnerability, unhealthy lifestyle and the side effects of psychotropic medication
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