Table 2. Palliative Care Psychiatry Curriculum - Clinical Discussion Guides
Title / Year and Clinical Rotation / Learning ObjectivesBy the end of this discussion, residents will be able to… / Case Summary
The Psychiatric Consultation at the End of Life: Collaborating with Palliative Care through the Narrative Medicine Approach / PGY-II
Inpatient Psychiatry Consultation-Liaison Rotation / 1. Discuss how palliative care and psychiatry can collaborate most effectively in caring for patients at the end of life
2. Describe how to approach a patient from a narrative medicine perspective
3. Appreciate the opportunity for empathy and growth in working with patients at the end of life / 59 year old female with a history of PTSD and depression recently diagnosed with metastatic pancreatic cancer presents with end-of-life anxiety. Her medical team believes that her pain is exacerbated by her anxiety and requests consultation with psychiatry due to intractable pain despite high dose opioids and local anesthetics.
The Psychiatric Consultation at the End of Life: Diagnosis and Management of Common Psychiatric Symptoms / PGY-II
Inpatient Psychiatry Consultation-Liaison Rotation / 1. Identify the most common psychiatric symptoms seen at the end of life and cite evidence for treatment strategies
2. Differentiate existential distress and preparatory grief from a primary mental illness
3. Recognize hypoactive delirium and differentiate it from depression or grief at the end of life / 65 year old male with metastatic prostate cancer presents with symptoms of depression, anxiety, indecision and difficulty prioritizing his goals of care. He expresses fear of dying, worry about the suffering he’ll endure and the effect it will have on his family.
Caregiver and Practical Issues at the End of Life / PGY-III/IV
Geriatric Psychiatry Outpatient Rotation / 1. Identify different styles of caregiving in families and how to assess points of conflict
2. Discuss practical ways to help the patient prepare for dying including advanced directives, the POLST form, and resources for outlining last wishes
3. Describe the process for spiritual and cultural assessment of the patient at the end of life / 70 year old Ethiopian female with a history of bipolar disorder and PTSD, now diagnosed with progressive, fronto-temporal dementia referred for a geriatric psychiatry consult. Her caregiver is asking for guidance around how to make plans for the dying process while respecting the patient’s cultural narrative of illness.
Ethical Issues at the End of Life / PGY-III /IV
Geriatric Psychiatry Outpatient Rotation / 1. Describe common ethical issues with regard to refusing care at the end of life
2. Identify Washington State’s Death With Dignity Act and how to proceed when patients express interest in this optiona
3. Discuss how to identify and respect patient goals at the end of life / 65 year old male with a history of depression, previously treated with an SSRI, now presents with recently diagnosed metastatic anal carcinoma and a poor prognosis. He discusses his wish for hastened death, has filled his “death with dignity” prescription, and needs help in deciding how to proceed.
a Loggers ET, Starks H, Shannon-Dudley M, Back AL, Appelbaum FR, Stewart FM.Implementing a Death with Dignity program at a comprehensive cancer center. N Engl J Med. 2013; 11;368(15):1417-24.