دانلود رایگان مقاله انگلیسی خصوصیات و پیامدهای روانشناسی ارجاع در بخش مراقبت های تسکین دهنده - الزویر 2018

Abstract

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.

Discussion

Although psychological care of patients and caregivers have been traditionally incorporated into the palliative care model, little has been reported in the literature regarding the integration of clinical psychologists as members of the multidisciplinary palliative care team. 19 The purpose of this study was to contribute to the literature by providing descriptive data of integrating clinical psychology services into a palliative care multidisciplinary team. Palliative care psychology at a major comprehensive cancer center demonstrated a significant growth since its inception in September, 2013, which began with two licensed doctoral level psychologists, and at present, includes three licensed doctoral level psychologists and three master’s level counselors. Our palliative care team realized a significant increase in psychology services provided by the 3 licensed psychologists during this 2 ½ year time frame studied, servicing 1644 unique in-patients (24% of palliative care in-patients) and 296 unique out-patients (19% of palliative care out-patients), underscoring the value placed by the interdisciplinary team of incorporating psychological care for those patients in need. The demographics and medical characteristics were comparable to those of palliative care patients serviced at our institution, though the gender of the psychology sample was slightly higher (56.7% in our sample compared to 49-50% in a recently published sample) 20 likely reflecting the fact that women are more likely to acknowledge distress.