Running Head: MATERIALS AND METHODS
Materials and Methods
Palliative care psychiatry is an upcoming aspect involving specialty in the field of both palliative care and psychiatry. A psychiatrist's role in the palliative care units is to help in assessing the mental and psychological component of a patient in distress (Trachsel et al., 2016). Patients in palliative care are mostly suffering from terminal illness and are at the point of dying. Such patients experience a lot of psychological suffering, and palliative care provides them with relief from pain and the stress involved in trying to recover from severe illnesses. The primary goal of a psychiatrist, in palliative care, is to use his or her expertise in the dimensions of a patient's experience including the support from family and to give a professional opinion of the patient's mental state. All patients with life-threatening illnesses have a right to receive palliative care.
The research presented is based on the roles of a psychiatrist in palliative care. It is also a study on the psychological suffering that terminally ill patients go through while in palliative care units. Financial aid is the primary factor that determines the level of psychological suffering in family members with terminal illnesses. The primary aim of this study was to determine the psychological and emotional suffering and stress levels in patients receiving palliative care and those not receiving care. The independent variables included the psychological suffering patients endured without financial aid and lack of the appropriate attention given to them in their end of life care. On the other hand, the dependent variable was the adverse effects produced due to the lack of finances to fund the palliative care services to the patients.
The success of the study was due to the participation and contribution of distinctive parties. The subjects of the research were the patients with terminal illnesses. A portion of the patients were considered due to the fact that a significant number would not be appropriate for an adequate study. Twenty patients were from different palliative care facilities. They were grouped into two categories, the first category being the control group. The control group refers to the terminally ill patients and their families who received some kind of psychiatric care. The other was the experimental group. The experimental group, on the other hand, is the portion of patients and their families who did not receive psychiatric assistance during palliative care. Other participants in the research were the psychiatrists providing expert care to the patients and their family members, insurance firms and other financial sources.
The materials that were used in the research study were gathered from different sources. Records from various palliative care facilities were obtained to determine the rate of admission in patients with terminal illness. Resources that were focused on were mainly hospitals, palliative care facilities, and homes, which families care for their loved one’s full time. Financial records from the benefactors as well as various insurance firms offering Medicare and Medicaid and other health insurances helped determine the extent of financial resources available for the services to be provided to patients with terminal illnesses. Various processes were used to gather information for the study conducted. Surveys, observations and interviewing patients, family members and relatives, physicians and the financial aids were the methods used in this study. Experiments were also conducted and the results that were obtained were analyzed by experts. Different activities took place at this time, and they were categorized differently.
As stated above, this study was conducted with the support of information and data gathered from various sources using different methods of data collection. Surveys completed by the family members of the patients, physicians, and the psychiatrist helped come up with the findings, also observing the patients' development and psychological well-being constructed the conclusion part of the study. Experiments on the cortisol levels of patients and the sympathetic nervous system gave the results of stress on patients and their family members. Roles and benefits of psychiatrists in palliative care were depicted in this section as well as the methods used to deliver palliative care services, which were also assessed.
The criteria for determining the control group and the experiment group was through evaluation of records. Patients in palliative care facilities were used as the control group since they were already under adequate care. However, the experiment group were terminally ill patients who were not receiving suitable care. The experiments, nonetheless, were performed in both groups. The cortisol experiment measured the level and outcome of stress and was conducted three times a day. That is in the morning at 0600 hrs. noon and in the evening at 1800 hrs. Experiments on the patients experiencing depression and those who were free of depression showed different levels of cortisol.
Results
Graph 1 displays the relationship between cortisol levels in a patient to the amount of time spent during treatment. Terminally ill patients who received appropriate treatments in palliative care experienced low-stress levels compared to patients who hardly obtained the adequate treatment palliative care. The graph shows that stress levels are higher in the morning and lessen throughout the day. Graph 2 summarizes the extent of the sympathetic nervous system activity in the body of a patient experiencing stress versus a patient not suffering from high stress levels. The sympathetic nervous system activity is directly related to the mental health and stress of a patient. Patients with more stress levels show more sympathetic nervous activity compared to those patients with fewer stress levels. Emotions are usually high in the morning, medium during the day and low in the evening or at night (Mondelli et al. 2010). Although patients without financial assistance to acquire palliative care experienced depression, it is evident that in the morning they experienced more tension than usual. Stress levels however declined with the course of the day. Stress levels influenced the sympathetic nervous system. Patients with high-stress levels underwent high sympathetic nervous activity compared to those patients who experienced low-stress levels.
Discussion
A psychiatrist works to assist a patient in adjusting to life in a palliative care unit provided by the hospital to admit patients spending the latter parts of their lives. Psychiatrists intervene to help patients in adapting substantially eliminating possible anxiety and depression. By attending care plan meetings, psychiatrists ascertain that the psychological point of view is represented. Psychiatrists can also share their expertise in areas of interest with students undergoing training in a hospital or particular department. Major emphasis being the importance of engaging a patient during evaluation. He or she discusses on the best approaches in delivering bad news and how to best deal with anxiety and depression disorders.
Psychiatrists serving in palliative care use several treatment approaches (Cherny & Christakis, 2011). The knowledge of biological orientation is a method that benefits to understand the patient's psychological disorder regarding the function of the nervous system biologically. Palliative care psychiatry has gone a long way in improving the quality of life for patients during different stages of terminal illness. It has offered overall relief of intractable pain and severe symptoms and has developed the patient's mental capacity in adapting and adjusting to life during final stages of an illness. Particular domains need to be put into consideration to give an informed decision on a patient's mental state. Psychiatrists work to understand these domains which are, physical pain, spiritual problems, and social issues, concerning a patient.
References
Cherny, N. I., & Christakis, N. A. (2011). Oxford textbook of palliative medicine. Oxford university press.
Mondelli, V., Dazzan, P., Hepgul, N., Di Forti, M., Aas, M., D'Albenzio, A., ... & Morgan, C. (2010). Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment. Schizophrenia research, 116(2), 234-242.
Trachsel, M., Irwin, S. A., Biller-Andorno, N., Hoff, P., & Riese, F. (2016). Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks. BMC psychiatry, 16(1), 260.
Graph 1
Cortisol level
Time of the day
Cortisol nM
gr
Graph 2
Sympathetic Nervous System activity
Sympathetic Nervous System activity
Stress
Stress