Written by Dr Emma Brook (Central Adelaide Palliative Care Service), Professor Anna Chur-Hansen (Academic Health Psychologist, University of Adelaide) and Professor Gregory Crawford (Senior Consultant in Palliative Medicine, Northern Adelaide Local Health Network, and Academic in Palliative Medicine, University of Adelaide).

Research shows that people facing terminal illness have higher levels of psychological distress, resulting in a poorer quality of life [1,2]. Consequently, it is vital that palliative care patients, whether in hospital or outpatients, and their families and friends, have sufficient access to health professionals that can adequately address their psychological needs.

We conducted a nation-wide survey over a two-month period from November 2021 to January 2022 to identify the type of psychological supports that are available in Specialist Palliative Care Services in Australia [3]. These data were compared to a similar study by Crawford in 1999, to ascertain how services have changed over time [4].

We found that there were significantly less psychiatrists, psychologists and counsellors in Specialist Palliative Care Services in 2021/22 compared to 1999, with differences of 29.4%, 23.4% and 26.1% respectively [3]. Nearly 60% of services had no access to a psychiatrist or a psychologist in 2021/22 [3]. With the national shortage of these health professionals across all areas of healthcare, this should not come as a surprise. Improvement in palliative care services will require recognition of this significant issue, and management strategies implemented across a range of disciplines.

Reasons for poor access in palliative care to psychological health professionals requires further exploration. However, our survey found that this may in part reflect a lack of understanding about how some of these health professionals can support patients, their family and friends, other members of the health care team, and the community more broadly [3]. There seems to be overlap between some professionals with regards to the interventions they provide, such as psychotherapy and counselling. If the shortage of psychologists and psychiatrists is unable to be adequately addressed, there may be a role for better training of others better represented within the service, such as social workers and volunteers [5].

Interestingly, we found that not all psychologists and psychiatrists employed in palliative care settings were reported to have special skills or interest in palliative care [3]. Working in palliative care settings requires a specific skill set: there needs to be improved training of health professionals [6,7]. This may encourage more mental health professionals to work in this important and specialised field.

Although the direct impact for palliative care patients on the shortfall of these health professionals was not examined in our study, it is known that each can contribute to and enhance patient care in different ways. As such, it is vital that ongoing advocacy and increased funding to enable these professionals to be readily employed in palliative care services is pursued.

References

1. Ann-Yi S, Bruera E, Wu J, Liu DD, Agosta M, Williams JL, Balankari VR, Carmack CL. Characteristics and Outcomes of Psychology Referrals in a Palliative Care Department. J Pain Symptom Manage. 2018 Sep;56(3):344-351. doi: 10.1016/j.jpainsymman.2018.05.022.
2. O’Malley K, Blakley L, Ramos K, Torrence N, Sager Z. Mental healthcare and palliative care: barriers. BMJ Support Palliat Care. 2021 Jun;11(2):138-144. doi: 10.1136/bmjspcare-2019-001986.
3. Brook E, Chur-Hansen A, Chan L, Crawford G. Psychological service provision in Australian Palliative Care Services. Palliat Support Care. 2023 Jul 10:1-7. doi: 10.1017/S1478951523000925. Epub ahead of print.
4. Crawford G. Depression in palliative care patients in Australia: identification and assessment [dissertation on the Internet]. Adelaide SA: Flinders University; 2007. [cited 2022 Jul 31]. Available from: https://flex.flinders.edu.au/file/fc370248-50a7-40e3-8885-385d6ee1e851/1/Thesis-Crawford-2008.pdf
5. Farabelli JP, Kimberly SM, Altilio T, Otis-Green S, Dale H, Dombrowski D, et al. Top Ten Tips Palliative Care Clinicians Should Know About Psychosocial and Family Support. J Palliat Med. 2020 Feb;23(2):280-286. doi: 10.1089/jpm.2019.0506.
6. Nakajima K, Iwamitsu Y, Matsubara M, Oba A, Hirai K, Morita T, Kizawa Y. Psychologists involved in cancer palliative care in Japan: A nationwide survey. Palliat Support Care. 2015 Apr;13(2):327-34. doi: 10.1017/S1478951514000029.
7. Fairman N, Irwin SA. Palliative care psychiatry: update on an emerging dimension of psychiatric practice. Curr Psychiatry Rep. 2013 Jul;15(7):374. doi: 10.1007/s11920-013-0374-3.

Hear more from Dr Emma Brook about the Psychological service provision in Australian Palliative Care Services study at the RePadd Seminar Series:

Psychological Service Provision in Australian Palliative Care Services