(127) Triggers for telehealth psychiatric consultation in ambulatory palliative care patients: A Two Year Case Series.

Abstract:  


Background/Significance:

In complex psychiatric and psychosocial challenges encountered by patients facing advanced medical illnesses, collaboration between palliative and psychiatric care specialists is helpful in order to optimize patient care. Acknowledging the multifaceted nature of these issues, the integration of psychiatric care offers value to palliative care through communication, comprehension of psychosocial dimensions inherent in care for the seriously ill, and recognition of the complexities associated with managing patients with concurrent mental and physical illness along with psychopharmacological interventions. Our study explores factors triggering a request for psychiatric consultations among ambulatory palliative care patients.

Methods:
Nuvance Health is a multi-hospital system in Connecticut and New York. It operates a program wherein palliative care patients are followed regularly, in situ, in the community by a licensed clinical worker who then refers appropriate patients for ambulatory psychiatric evaluation via telehealth. This retrospective study used data extracted from electronic medical records (EMRs) to investigate the referral patterns and clinical features of patients referred to the outpatient psychiatry clinic from palliative care. We also retrieved demographic information and clinical diagnoses. The study included 40 patients with an average age of 60 years with 70% female and 30% male. Referrals were sent to the clinic by social work within the outpatient clinic and based on consultations for palliative care needs. We analyzed the obtained data to determine the percentage of patients with specific psychiatric diagnoses triggering consultations.

Results:
We reviewed data in 40 unique patients through EMRs. The percentages of patients referred due to adjustment disorder 30%, major depressive disorder (MDD) 35%, and general anxiety disorder (GAD) 35% as the primary reason for consultation. Demographic data is included. The followup showed 90 percent followup telehealth visits to psychiatry. Majority of patients have cancer as primary disease for which palliative care follows. Majority of patients treated psychiatrically reported subjective improvement. As of this writing, no one in this cohort has died.

Discussion:
The results of this investigation shed light on symptom triggers for psychiatric consultations by palliative care within an ambulatory setting which are depression and anxiety. These patients may differ from inpatient palliative care/hospice and it is likely that the latter cohort may have higher symptom burden. In this cohort, our data suggests that psychiatric intervention is efficacious in that most patients followed up and reported positive results from the psychiatric encounters. The collaboration between palliative care and psychiatry is therefore deemed valuable.
Conclusion/Implications:
Our study underscores the significance of addressing psychiatric needs among ambulatory palliative care patients, with adjustment disorder, MDD, and GAD emerging as primary consultation triggers, with symptom burden likely amplified by intricate psychosocial challenges and multiple medical comorbidities.

References:
1. Irwin, S. A., & Ferris, F. D. (2008). The Opportunity for Psychiatry in Palliative Care. The Canadian Journal of Psychiatry, 53(11), 713–724. https://doi.org/10.1177/070674370805301103
2. Patterson, K. R., Croom, A. R., Teverovsky, E. G., & Arnold, R. (2014). Current State of Psychiatric Involvement on Palliative Care Consult Services: Results of a National Survey. Journal of Pain and Symptom Management, 47(6), 1019–1027. https://doi.org/10.1016/j.jpainsymman.2013.06.015


 

Presentation Eligibility: "Not previously published or presented".

Diversity, Equity, and Inclusion: Our research highlights the importance of addressing the psychiatric needs of ambulatory palliative care patients, including those belonging to marginalized groups and facing socioeconomic challenges within the community.