Psychologists

How psychologists address palliative care 

Psychologists make a difference to the lives of people with a life-limiting condition and their families by helping them to come to terms with their mortality and the changes that their diagnosis means for them.

Scope of practice

Psychologists seek to understand the role of mind and emotions on behaviours of individuals and groups. They do this by assessing and diagnosing a person’s needs and goals and developing strategies and evidence-based treatments to meet these goals, and offering guidance and support. [1,2]

Members of the Australian Psychological Society (APS) can view the APS’ Practice Guides (subscription required).

Psychologists may have roles of advanced or extended scope of practice which reflects a level of expertise within or beyond the established contemporary scope of practice. [3]

Role in palliative care

Palliative care provides a support system for people living with a life-limiting condition to live as actively as possible, with dignity, for as long as possible. It is active and supportive care that seeks to maximise quality of life. [4] It is useful well before death and not limited to care of the dying. [5]

In helping people with palliative care needs, a psychologist [5-7]:

• supports and reinforces the psychological work of other team members
• is led by the person’s symptoms and their sense of what is important to them to co-create realistic goals and expectations with the person in the face of impending death within the context of a therapeutic relationship
• understands the interrelationship between physical symptom distress and psychological distress
• is trained in listening and counselling
• assesses or screens a person for distress, inability to cope, or anxiety or depression
• allows a person to talk about any fears, worries or conflicting emotions
• can clarify misunderstandings or mis-expectations
• helps a person identify and talk about loss or grief
• helps a person with existential concerns such as the search for meaning in life, hope, sense of purpose, dignity, grief, and spirituality
• assists a person and their family to communicate and to explore relationship or emotional issues
• can help mobilise individual or family resources, to reduce feelings of isolation and loneliness
• might suggest strategies, techniques, and ways of lessening the distress, anxiety, or sadness the person and others are feeling
• helps explore the issues a person is facing so that they can find more pleasure in life, adjust to changing relations and social roles, and to changing impaired function and dependency
• acknowledges strength and achievements in the life of the person
• assists with verbal or written life review
• may introduce meditation or relaxation exercises to help ease physical and emotional pain
• provides bereavement care and support to family and carers
• contributes to the preparation of legacies and eulogies either with the person and/or the family.

Psychologists may work in palliative care as only part of their role or have a palliative care caseload with a specialist role. This may be as a member of a multidisciplinary team or a sole practitioner.

The RACGP aged care clinical guide (Silver Book 2019) recognises the role of allied health professionals in team care arrangements for a proactive person-centred approach to palliative care. [8] Palliative Care Australia also recognises the importance of access to information and support from a diverse range of allied health services for patients, families and carers. [9]

The role of allied health in palliative care is to provide the person with as much therapy time as possible. The goal of allied health in palliative care is around maintaining and improving functional ability. There may be a blurring of roles across allied health professions in palliative care more than in other care contexts.

Allied Health workers provide care in all practice settings. For further information on the specific area of practice go to Practice Settings.

Practice support

Useful evidence-based information and resources on rehabilitative palliative care are available from Hospice UK.

Using Evidence

Although psychologists are familiar with evidence and evidence-based practice through their training and continuing professional development (CPD), keeping up to date can be time-consuming.

CareSearch provides the tools to help find and use evidence. This includes PubMed searches on a multitude of topics and sections dedicated to Searching for Evidence and Using Evidence in Practice.

For support in applying evidence in practice, check out the Journal Club Basics page on CareSearch which provides information on the benefits of and practical pointers in setting up or joining a journal club.

Guidelines

Codes and guidelines to provide guidance to the psychology profession developed by The Psychology Board of Australia are freely accessible.

Guidelines specific to psychology and palliative care in Australia have not been published. However, the Palliative Care Service Development Guidelines 2018 (331kb pdf) provides an overview of psychology (as part of allied health) in palliative care. [9]

Resources for Patients, Carers and Families

Psychologists have an important role in supporting patients, carers and their families with information. The CareSearch Resources for Patients and Carers provides links to useful information including fact sheets and printable resources that psychologist can download and share.

Education

The National Palliative Care Strategy 2018 lists as a priority the ability of medical, nursing and allied health graduates to identify and address people’s palliative care needs (Priority 2.1, p15). [10] This is highlighted in the Essential Elements of the National Consensus Statement: essential elements for safe and high-quality end-of-life care which also recognises the importance of the role of an interdisciplinary team. [11]

Courses

CareSearch lists a collection of Palliative Care eLearning resources for allied health for independent learning.