Building Bridges: Integration of Psychiatry in Hospice and Palliative Medicine Fellowship Training -- Sponsored by the Psych Onc/Pall Med SIG

Abstract: Patients living with serious and life-threatening illnesses have high rates of psychiatric comorbidities (1). The medical subspecialty of Hospice and Palliative Medicine (HPM) is focused on aiding these individuals with life-limiting illnesses through symptom management, addressing goals of care, and providing psychosocial and spiritual support (1). While this work often includes the need to address psychiatric symptoms, many palliative care (PC) physicians lack formalized training in psychologic principles and psychiatric symptom management.

This general session demonstrates an innovative program in which training of psychological principles are introduced to HPM fellows, emphasizing the biopsychosocial model in a population-based approach that addresses patients’ complexities in a holistic manner. Through collaboration between psychiatry and palliative medicine, our session will highlight an education to non-psychiatrists that emphasizes both traditional methods of psychiatric care alongside a focus on spiritual wellbeing, health, and healing. We will also demonstrate the focus on our fellows’ physical, emotional and spiritual well-being through specific curricular elements directed towards their personal processing, insight and growth. Each speaker will incorporate interactive examples from our fellowship training, and attendees will take away concrete curricular elements that can be applied at their home institutions.

Dr. Ethan Silverman will review the overall fellowship structure and the current guidelines regarding psychiatric integration within HPM fellowship training. He will also discuss the formal didactics on psychiatric diagnoses commonly seen within PC, and model elements of the structured training in interviewing techniques and family meeting frameworks.

Dr. Robin Valpey will demonstrate the didactic curriculum on psychological elements of palliative care. She will outline the core psychological concepts covered in the first half of the curriculum (e.g. frame, countertransference), modeling the case-based learning approach. She then will exhibit the second half of the curriculum focused on direct application of specific therapeutic modalities and skills with demonstration of educational activities through audience engagement.

Dr. Elizabeth Hale will discuss the resiliency curriculum created to promote well-being within the HPM fellowship. Dr. Hale will utilize photos to model the interactive museum experience, engaging audience discussion in self-reflection through art. She will end with discussion and modeling of the monthly structured process group that is built into the curriculum.

Dr. Lisa Podgurski will end with a description and role-play of the monthly psychosocial rounds series that HPM fellows attend, demonstrating this forum for PC physicians and support staff to debrief and process challenging cases. She will highlight unique reflection opportunities within this series, engaging the audience with an example reflective reading.

Given the interface between psychiatry and palliative care medicine, integration and training across disciplines is increasingly important for the optimal health and healing of our patients with serious medical illness. By increasing training of the biopsychosocial model, key psychological principles, and behavioral interventions among PC physicians while promoting their spiritual wellbeing, we provide a model for our non-psychiatry colleagues to help address psychiatric issues among our most medically ill patients.