DOI: 10.1177/07067437261474291 ISSN: 0706-7437

A Survey of Canadian Psychiatrists’ Attitudes Towards Palliative Care Approaches for Severe and Persistent Mental Illness: Enquête sur les attitudes des psychiatres canadiens à l’égard des approches de soins palliatifs pour les troubles mentaux grave

Sarah Levitt, Lucy Panko, Kate Tsiandoulas, Micaela Forte, Lucy Costa, Daniel Z. Buchman
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Background

Palliative psychiatry, which emphasizes improving quality of life and reducing suffering for individuals with severe and persistent mental illness (SPMI), has gained recognition internationally. Canadian psychiatrists’ perspectives on palliative psychiatry remain under-explored. We adapted a survey created by Trachsel et al. on the acceptability of palliative psychiatry amongst German-speaking Swiss psychiatrists for the Canadian context to address this gap.

Method

We conducted a cross-sectional survey of Canadian psychiatrists ( n  = 69). We collected data on demographics, attitudes towards palliative care in psychiatry, and responses to 3 case vignettes describing a patient experiencing anorexia nervosa, schizophrenia, or major depressive disorder, respectively. Additional questions explored participants’ views on coercion. Participants could elaborate on their responses to the case vignettes using optional free-text boxes. We analyzed the survey data using descriptive statistics and the qualitative data using structured tabular thematic analysis.

Results

Participants broadly endorsed treatment goals focused on improving function, reducing suffering, preventing suicide, and maintaining patient autonomy, while placing less emphasis on curative approaches. Participants were divided on whether palliative care relates to end-of-life care. There was strong acceptance for a palliative approach in SPMI care. Attitudes towards prognosis and treatment futility varied by diagnosis amongst the case vignettes. Participants expressed nuanced views on coercion, highlighting ethical tensions when considering interventions contrary to patient preferences. Our qualitative analysis uncovered themes of ethical dimensions, clinical paradigms, characteristics of mental illness, considering comprehensive treatment options, psychosocial factors, and systemic factors in participants’ consideration of their responses.

Conclusions

This cohort of Canadian psychiatrists largely endorses the applicability of palliative care approaches within SPMI care. Our findings underscore the need for further research with larger samples to understand potential gaps between theoretical acceptance and practical implementation. Future research should include the perspectives of patients, families, and other interest-holders to guide the potential integration of a palliative care model into psychiatric practice.

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