According to the World Health Organization (WHO), only 14% of individuals who would benefit from palliative care receive end-of-life care. Palliative care is a set of interventions that improve the quality of life of patients through reducing suffering and pain. Public health palliative care integrates community engagement into expanding access to end-of-life care, especially for under-resourced areas and populations.
One area of implementation of palliative care involves its relation to psychiatric treatments. Although end-of-life care discussion is more common in conversations about life-threatening illnesses, discussions surrounding palliative care for mental illnesses are less common. Palliative psychiatry raises some ethical considerations. For one, if individuals perceive palliative care as curative, there is a false interpretation that the treatment option addresses the mental illness. In considering this issue, some studies argue that specific pharmacology treatments are palliative because their goal is to reduce suffering rather than change the progression of the disease. Additionally, concerns arise about when it becomes appropriate to start palliative care for patients with mental illnesses. There is ongoing debate about whether specific pharmacological or clinical interventions are palliative versus curative, and these conversations impact patient decisions on care.
Continuing to expand palliative care, public health plays a substantial role in involving the community in the development, production, and integration of palliative care. When community individuals are engaged in public health palliative care, more culturally sensitive resources are available to the population. One study found that social support was the component that individuals valued most over physical and cognitive health. However, social support is limited in clinical settings, so palliative interventions should focus on social communication through establishing connected community networking opportunities for patients. In addition, the study found that reflective community discussions surrounding death improve the emotional status of both patients and caretakers. Thus, community engagement is essential in understanding how palliative care can improve as individuals share their needs and values.
As conversations on palliative care continue to unfold in areas of psychiatry and public health, it is important to consider the socio-economic and environmental contexts of palliative care implementation. Patient values and experiences continue to influence decisions regarding end-of-life care, so it is imperative to consider the patient’s perspective in palliative care interventions.
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