Due to the incredible advances in psychological / psychiatric palliative care, Domain 3 was substantially changed in the 4th edition. The importance of having palliative care trained social workers on the interdisciplinary team is highlighted in relation to the need to facilitate the assessment and treatment of the patient and family's responses to a serious illness as well as ongoing mental health needs.
Recognizing that most palliative care teams do not have a mental health specialist on the team, the importance of establishing relationships and processes for referrals and care coordination with psychiatrists or other mental health specialists is emphasized throughout Domain 3.
The palliative care team can use the NCP Guidelines (see below for specifics) to identify opportunities to address the following consensus criteria for quality palliative care:
The IDT has processes to care for patients with comorbid mental health disorders, including access to mental health specialists
Someone on the team can recognize and respond to common responses to a serious illness:
Post-traumatic stress disorder
Substance use disorder and withdrawal symptoms
The team also has someone who can recognize complex psychiatric issues
Serious and persistent mental illness
Have the ability to support people experiencing compassion fatigue, moral distress, grief, loss, and bereavement
A grief assessment and reassessment of anticipatory grief, including "the risk of prolonged grief disorder starting at diagnosis and throughout the illness trajectory" (NCP Guidelines, 4th ed)
The importance of providing comprehensive palliative care whether or not the "psychological or psychiatric concern was pre-existing or distinct from the serious illness"(NCP Guidelines, 4th ed)
Throughout Domain 3 and all the domains, the importance of providing comprehensive care to perinatal palliative care families, children, teens, and young adults and their family members.
Evidence of Practice and Action Plan
Domain 3 provides an opportunity to review your preparedness to respond to a range of emotional and mental health issues to see what needs to be done to be in alignment with the NCP Guidelines.
As you can see in the example below, your “evidence of practice” doesn’t have to be extensive. The goal is to find areas to improve the care you provide patients and families. The evidence of meeting the criteria doesn’t preclude the need to take additional steps to better align with the NCP Guidelines.
Assessing your program in relation to the NCP Guidelines 4th ed., doesn’t have to be completed all at once. Your team can review each domain one at a time, reviewing a few guidelines each week. Or you can divvy up the guidelines and ask each person to do a review to bring back to the team.
National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care, 4th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018. https://www.nationalcoalitionhpc.org/ncp.