7 Getting mental health medicines right when it matters at the end of life: a regional survey of palliative and psychiatry professionals

Le résumé fourni par la source

Introduction 84 million people in the EU are affected by a mental health disorder with the prescription of psychiatric medications increasing internationally by 4% over a 12-year period. Professionals will care for dying patients who are prescribed these medications and it is paramount that these are carefully managed. However, access to psychiatric services for advice at this time will vary across countries and there is no evidence to guide professionals. Palliative and Psychiatry professionals have collaborated to address this gap. Methods Palliative and Psychiatry professionals across the Wessex region, were surveyed to explore the management of psychiatric medications at the end of life. Scenarios surrounding patients with psychiatric diagnoses in their last days and weeks of life were included. Additional questions addressed respondents’ confidence in these scenarios. Results 46 Palliative (57%) and Psychiatry (43%) professionals responded to the survey. Management of patients in the last days of life differed between professionals; with psychiatry more likely to wean anti-depressants and stop mood stabilisers. Palliative professionals were more likely to consider switching from an oral to an injectable anti-psychotic. The professionals’ decision to switch, stop or wean a psychiatric medication was guided by several factors: psychiatric history, relapse/withdrawal risk, drug half-life, and drug toxicity. Professionals felt less confident in managing a patient in the last weeks of life. Professionals expressed a desire to improve inter-specialty working and the need to develop guidance. Conclusion This has emphasised the complexity of managing patients on psychiatric medications at the end of life; management is varied, and professionals lack confidence; both factors influenced by the lack of guidance. The optimal management of psychiatric medications at the end of life should be an international research priority to determine best practice and guide professionals in countries where psychiatric services are less established, and support may be lacking.

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