C-L Psychiatry in the Palliative Care Setting: Defining Boundaries, Overcoming Challenges, and Growing Together

The growth of palliative care over the past three decades has changed the care of patients with serious illnesses. The clinical foci of palliative care—symptom management, caregiver support, serious illness communication—have influenced the care of medically ill patients across settings. As palliative care has evolved from a largely consultative specialty limited to cancer patients towards a broader set of models serving patients with a wide array of diagnoses, the opportunities for collaboration with consultation-liaison (CL) psychiatry have grown. Such collaboration is key to ongoing improvement of serious illness care nationally: patients with serious medical illnesses have high rates of mental health comorbidity and the ethical, medical, and psychosocial challenges of caring for individuals at the end of life call for an important interdisciplinary work.

In contrast to other subspecialties of CL in which common frameworks of care are established, CL psychiatry in the palliative care setting is poorly operationalized. The challenges to providing wholly interdisciplinary care include clinical issues surrounding comorbidity, practical, logistic, and financial concerns in creating combined treatment centers, the need to tailor educational opportunities for the next generation of physicians and helping other healthcare workers adapt to this challenging domain of care.

In this workshop, four CL psychiatrists with expertise providing services in diverse palliative care settings will utilize case-based teaching to present strategies that help psychiatrists succeed in their roles with patients receiving palliative care.

CL-palliative care co-consultation: Dr. Mishkin will discuss the challenges primary teams face with the provision of palliative services for patients with psychiatric disorders, including the complexities of conflicting advice from multiple teams, staff moral distress surrounding end of life, and interfacing with surrogate decision makers. She will make recommendations about how CL psychiatrists can work alongside palliative care clinicians to provide care to medically complex patients while supporting primary teams.

CL psychiatrist as palliative care provider: Dr. Noufi will describe the current state of psychiatric involvement in palliative care services. He will discuss the clinical role of the CL psychiatrist as primary and/or specialist palliative care provider, and the advantages of this model of provision of palliative care.

Liaisonship to palliative care: Dr. Sholevar will discuss her experiences providing psychiatric consultation to a palliative care service, focusing on their needs and how they differ from consulting palliative care services and/or primary specialist medical teams.

Preparing psychiatrists to work with palliative care: Dr. Shalev will discuss training paradigms for preparing psychiatrists to work in palliative care settings, including data on current practices, training models, and future workforce needs.

The final 10 minutes will include a general Q&A with the panel.