Psychologists are uniquely positioned to play a significant role in end-of-life care, working with terminally-ill patients who are not likely to recover. Often embedded in integrated care teams, psychologists help these patients cope with fear, grief, and uncertainty. The field of palliative care is much newer than psychology and there is significant room for growth. One study found psychologists provided services to just 24% of palliative care inpatients and 19% of outpatients in a major comprehensive cancer center between 2013 and 2016 (Ann-Yi, S., et al., Journal of Pain and Symptom Management, Vol. 56, No. 3, 2018opens in new window).
According to the Center to Advance Palliative Careopens in new window, palliative care focuses on providing symptom relief and reducing stress for people with serious illnesses. While some may think of health care—including mental health services—as a dichotomy between curative and palliative care, professionals avoid this delineation. “Palliative care is a treatment philosophy that says, ‘Let’s try to increase a person’s comfort, well-being, and quality of life while decreasing pain and suffering,’” said David Feldman, PhD, a professor of counseling psychology at Santa Clara University who researches end-of-life issues.
The focus of palliative care is to improve quality of life so that patients can participate more meaningfully in the relationships and activities that matter to them. Because palliative care addresses an array of needs, care teams often involve a variety of clinicians, such as physicians, nurses, chaplains, social workers, and pharmacists. Some care teams also include psychologists, or consult with psychologists as needed.
[Related: The role of psychology in palliative care]
While some people may opt in to palliative care at the end of their lives, palliative care isn’t always synonymous with end-of-life care, said Julia Kasl-Godley, PhD, faculty at the Wright Institute in the Doctor of Psychology (PsyD) Program and a clinical supervisor at the Berkeley Cognitive Behavioral Therapy clinic. Some palliative care patients choose to incorporate curative measures, such as chemotherapy or dialysis, in their care plans. The goal, either way, is to give patients more control of their care and reduce stress, both of which are important for improving symptoms. One randomized trial found lung cancer patients receiving palliative care lived longer than those who didn’t receive it (Temel, J. S., et al., The New England Journal of Medicine, Vol. 363, No. 8, 2010opens in new window).
Typically, patients enter hospice care when health care providers determine that treatment can no longer cure or control a serious illness and patients have six months or less to live, but many people outlive their prognosis. While palliative care and hospice may involve different timelines, both include important questions about end-of-life decisions and how individuals can continue meeting their life goals and find meaning during a period of stress and suffering. This change requires a paradigm shift for all providers involved, including psychologists. “Psychologists are often trained to diagnose disorders and provide treatment that reduces symptoms or even cures the disorder,” said Feldman. “But a focus on decreasing distress and increasing quality of life in a more general sense should shift the way clinical psychologists think in these settings.”
