Child and Adolescent Psychiatry and Palliative Care

Abstract

hild and adolescent psychiatrists have an important role in educating and helping the emerging field of C palliative care. Their knowledge of development, psychotherapy, family structures, psychopharmacology, and medical culture is key to allowing palliative care to reach its goal of holistic treatment of patients. Because child and adolescent psychiatrists have medical training, they can incorporate the complex biopsychosocial picture of this severely ill population into their diagnostic evaluations. Furthermore, their medical understanding of prognostication can help provide more complete psychosocial interventions and treatment recommendations. Without this expertise, palliative care providers can misinterpret behaviors and lose opportunities to treat important elements of suffering. To understand how child and adolescent psychiatrists can be helpful in the evolution of psychosocial treatment in palliative care, it is useful to review the development of the specialty. In the United States, a patient eligible for hospice care must conform to a Medicare definition that mandates that a patient have no longer than 6 months. Because patients with illnesses such as congestive heart failure, dementia, and various types of cancer have protracted courses rather than acute fatal outcomes, the difficult, if not impossible, requirement to predict survivability has created a gap in health care between hospice care and cure-focused treatment. Palliative care fits into this uncertain space defined by the World Health Organization as “an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illnesses through the prevention and relief of suffering by early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.” Most providers practicing this field of medicine evolved from internal medicine physicians who were originally the primary care providers for these patients. In 2006, palliative care became a board-certified subspecialty, and since 2012, palliative care providers must complete a 1-year Accreditation Council for Graduate Medical Education fellowship. A large majority of these providers continue to have a background in internal medicine and family medicine. Pediatric palliative care followed adult palliative care. The World Health Organization defined it as total care of the child’s body, mind, and spirit that also involves giving support to the family. Pediatric palliative care begins at diagnosis, with the objective of alleviating a child’s physical, psychological, and social distress using a broad, multidisciplinary approach. Pediatric palliative care differs from its adult counterpart by the interplay of illness with the developmental spectrum of childhood, unclear trajectories of