Palliative Care Consultation Service in Psychiatric Inpatient Units, a Pilot Program and Case Report

Carsen Sulzer, MD

VA Boston Healthcare System
Palliative Care Consultation Service in Psychiatric Inpatient Units, a Pilot Program and Case Report

Scientific Abstract

Background: There is a growing body of evidence supporting the importance of collaboration between palliative care and psychiatry in caring for individuals with serious mental illness. However, there is scant literature on the utility of palliative care involvement in the treatment of those suffering from mental health disorders who are receiving treatment in the inpatient psychiatric setting. This pilot program and case report serve to demonstrate the positive impact of palliative care consultation services in the inpatient psychiatric setting.

Methods: A palliative care consultation service was developed from Sept. 2020 to Jan. 2021 at a Boston- area hospital to provide palliative care consultations for patients admitted to acute and chronic inpatient psychiatric units. Appropriate patient consultations were determined by attending psychiatrists. Here we present a patient treated through the palliative care consultation service.

Case: The palliative care consult service met with a 60 year old man with advanced stage 4 liver carcinoma experiencing severe and chronic pain while he was admitted for alcohol detoxification. Prior to admission, he was homeless with heavy daily alcohol consumption and difficulty managing in the community. He was initially hesitant to stop drinking because he used alcohol to treat his pain. This individual became amenable to considering alcohol cessation after discussing pain management, for which the palliative care service was consulted. Their recommendations were implemented with good effect; optimized pain control subsequently improved his mood, sleep, and appetite, and he ultimately continued with substance use treatment.

Conclusions: This case report begins to elucidate the potential benefits palliative care consultation may offer psychiatric patients. These findings are consistent with findings by Etgan (2020), which established the need for palliative care in the psychiatric hospitalization setting. Given the positive response, we plan to continue and expand this program moving forward. This consultation service may also serve to facilitate the establishment of palliative psychiatry for patients with severe mental illness.

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research Areas

Authors

Carsen N. Sulzer, MD, Martina Sinopoli, MD, Alesia Cloutier, DO, MS, Jordana L. Meyerson, MD, MSc