As many as 15 to 20 percent of terminally ill patients are depressed about their illness, but only a fraction are referred to mental health treatment, according to Barry Rosenfeld, PhD, of Fordham University. In fact, he says, "physicians are not often able to accurately identify depression," and "those who do identify depression either see it as a normal reaction not necessitating care or are reluctant to burden patients with additional medication and treatment."
Rosenfeld made his comments at a July 18 congressional briefing on end-of-life care, sponsored by APA and the Society for the Psychological Study of Social Issues (SPSSI). Presenters spoke of the need for increased research funding, more attention to the needs of culturally diverse groups, more training for providers and access to mental health services so that the elderly, terminally ill and their loved ones may better cope with issues near the end of life.
Among those calling for more support for end-of-life care at the briefing was Sen. Ron Wyden (DOre), who is co-sponsoring the Conquering Pain Act. Among other provisions, the act would:
Require government-funded medical providers to inform patients that their pain will be managed.
Mandate a report from the Surgeon General on the state of pain management and accessibility of mental health services.
Require insurers to provide policies that allow access to pain management.
Award training grants for clinicians.
Speaker James L. Werth Jr., PhD, of The University of Akron, said the act's provisions will set the foundation for health-care workers and patients to better cope with the psychosocial issues around death, such as communication among physicians, families and patients, the well-being of a caregiver and the general experience of dying.
Psychologists know too well that the lack of care has numerous consequences, says Werth. For people near the end of their lives, the onset of depression and other psychological and interpersonal issues affects their decision-making ability, their family lives as well as their physical well-being. Depression may result in hasty decisions by patients to refuse palliative care that can improve quality of life as they go through the dying process. Families of terminally ill patients also may become exhausted and suffer physically and emotionally.
APA's briefing statement said psychologists can make "significant contributions to improve the quality of end-of-life decision-making and care by actively engaging these issues in the context of practice, education, research and public policy." SPSSI has made a similar commitment to improving the quality of care at the end of life through funding several initiatives, including this briefing, a policy advocate whose work is dedicated to this issue and a conference in February 2002.