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A scoping review of palliative care for persons with severe persistent mental illness

Published online by Cambridge University Press:  19 March 2019

Erin E. Donald  and
Kelli I Stajduhar
Erin E. Donald*
Affiliation:
Institute on Aging and Lifelong Health and School of Nursing, University of Victoria, Victoria, BC, Canada
Kelli I Stajduhar
Affiliation:
Institute on Aging and Lifelong Health and School of Nursing, University of Victoria, Victoria, BC, Canada
*
Author for correspondence: Erin E. Donald, Ph.D.(c), R.N., Institute on Aging and Lifelong Health and School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia V8W 2Y2, Canada. E-mail: donalde@uvic.ca
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Abstract

Objective

People with severe persistent mental illness (SPMI) experience a greater burden and severity of chronic disease, late diagnosis, and premature death compared with the general population. Those with SPMI also receive fewer medical treatments, poor quality of care, and are less likely to receive palliative care. A systematic scoping review was undertaken to determine the extent, range, and nature of research activity about people with SPMI requiring palliative care, and to identify gaps and opportunities for future research.

Method

A systematic scoping review was undertaken in September 2017 and updated in May 2018 to map literature on this topic, determine the extent and range of what has been published, and report the findings. This five-stage framework was conducted by (1) identifying the research question; (2) identifying relevant studies; (3) determining study selection; (4) charting the data; and 5) collating, summarizing, and reporting the results. A narrative approach to analysis was used to synthesize and interpret findings. A search of multidisciplinary healthcare databases resulted in 46 included articles.

Result

Four major themes were identified from the included studies: complexity of care; limited access to care (both through systems and healthcare providers); competence and autonomy; and the potential for relationships between mental health and palliative care.

Significance of results

This review reveals a highly vulnerable population with complex needs that are not reliably being met by the healthcare system and providers. Research in this area must continue to develop using rigorous qualitative and quantitative study designs, and interventions should be developed and tested based on existing knowledge to inform care. The voices of people with SPMI in need of palliative care must be represented in future studies to address gaps. To expand a body of literature addressing mainly individuals, system perspectives and sociocultural analysis can bring much to contextualizing the experience of living with SPMI in the palliative phase of care. Adoption of a palliative approach, which promotes the principles of palliative care across nonspecialized care settings provided by nonspecialist palliative providers, has the potential to increase access to high-quality palliative treatment for people with SPMI.

Keywords

Palliative careEnd-of-lifeMental healthSevere mental illnessHealthcare delivery
Type
Review Article
Information
Palliative & Supportive Care , Volume 17 , Issue 4 , August 2019 , pp. 479 - 487
Copyright
Copyright © Cambridge University Press 2019 

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