Mental Health Integration and Delivery in the Hospice and Palliative Medicine Setting: A National Survey of Clinicians

Context Mental health comorbidities among individuals with serious illness are prevalent and negatively impact outcomes. Mental healthcare is a core domain of palliative care, but little is known about the experiences of palliative care clinicians delivering such care. Objectives This national survey aimed to characterize the frequency with which palliative care providers encounter and manage common psychiatric comorbidities, evaluate the degree of mental health integration in their practice settings, and prioritize strategies to meet the mental health needs of palliative care patients. Methods A e-survey distributed to the American Academy of Hospice and Palliative Medicine membership. Results 708 palliative care clinicians (predominantly physicians) were included in the analysis. Mood, anxiety, and neurocognitive disorders were frequently encountered comorbidities that many respondents felt comfortable managing. Respondents felt less comfortable with other psychiatric comorbidities. 80% of respondents noted that patients' mental health status impacted their comfort delivering general palliative care at least some of the time. Mental health screening tool use varied and access to specialist referral or to integrated psychiatrists/psychologists was low. Respondents were unsatisfied with mental health training opportunities. Conclusion Palliative care clinicians play a crucial role in addressing mental health comorbidities, but gaps exist in care. Integrated mental health care models, streamlined referral systems, and increased training opportunities can improve mental healthcare for patients with serious illness. Key Message This national survey study characterizes the experiences of hospice and palliative medicine (HPM) in addressing mental health. Our results highlight that HPM clinicians encounter and manage high levels of mental health needs, but that they lack structural supports like referral resources, integrated specialist clinicians, and training opportunities. Key Words Psychiatric palliative care, psychosocial palliative care, mental health, consultation-liaison psychiatry, depression, anxiety