Advance directives and advocacy in end-of-life decisions

This article examines the issue of advocacy for all adults in end-of-life decisions to help enhance the role of health care providers as partners in decision making. The ethical issues of death and dying are of particular concern for the elderly. Conflicts may prevent providers and nurses from creating a good dying experience for patients and family. Among the many issues associated with end-of-life decision making are futility, autonomy, and quality of life, a "good death," advance directives, family distress, and the culture of medicine. To overcome related barriers, involved health care providers can promote advocacy by offering choices in end-of-life care and providing an environment of listening and communication. Initiating and maintaining dialogue on this difficult subject will provide better care to patients and families.     

Observations on the first year of Oregon's Death with Dignity Act.

Using data from the files of Compassion in Dying, we describe 34 individuals who approached Compassion wanting to use the Death with Dignity Act and who died during the first year of the Act's implementation. Of these 34, 10 died using medication prescribed under the Act. Using first-hand data from the dying individuals, their families, and their health care teams, we provide comparisons between predicted outcomes and actual experiences, discuss important elements of the physician–patient relationship, and describe several averted suicides and homicides. We also review changes in end-of-life care in Oregon and provide recommendations about issues in need of further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emergency medical services for children: Beyond lights and sirens.

This article describes the history of emergency medical services for children and identifies important mental health issues. It discusses the roles of psychologists in such services, including intervening with children and their families during times of crisis, helping others who are providing the physical care of children to mitigate rather than exacerbate children's emotional distress, and attending to the emotional needs of health care providers who treat children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician-assisted dying: Review of issues and roles for health psychologists.

The authors review the recent empirical and theoretical literature on physician-assisted dying (PAD) since implementation of the Oregon Death With Dignity Act (ODDA) in 1997. The authors provide a brief overview of end-of-life practices; consider ethical and practical issues regarding PAD; outline governments' acts and health care organizations' current codified principles regarding PAD, including the American Psychological Association's goal to increase the visibility of psychology in end-of-life issues; examine recent data pertinent to ODDA implementation and psychologists' attitudes regarding PAD; and outline potential roles for health psychologists responding to requests for PAD and implementing PAD (where it is legal). Health psychologists can assume at least 4 roles regarding PAD: (a) policy advocates, (b) educators, (c) practitioners, and (d) researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An introduction to psychologists treating medically ill patients: Competent practice and seeking credentials in organized health care settings for routine or incidental practice.

Psychology has been recognized as a health care science and profession, and psychologists have been working clinically with medically ill patients and within organized health care settings and hospitals for decades. The potentially daunting environment of organized health care should be seen by psychology as an opportunity to further develop and expand its scope of practice. With knowledge of that environment's rules, regulations, ethics, bylaws, and traditions, the clinically competent psychologist who is first seeking to practice in hospitals should succeed alongside psychologists with busy practices who are already exclusively or occasionally within an organized health care setting or medical facility. This article reviews issues of competency, credentialing, privileges, bylaws, and practice expansion to guide psychologists toward a successful hospital practice with medically ill patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crisis in training pediatric psychologists.

Examines the shortage in the US of personnel who are trained in child mental health care that results in underservice to children, youth, and families. Doctoral programs offering specialty training are in short supply, as are pediatric psychology training programs. In addition, many clinical psychology programs are ill-equipped to offer curriculae for the development of skills and knowledge bases required by child psychologists. It is concluded that a training conference is needed to communicate the issues involved in this mental health provider crisis if children are to have access to psychological services. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaboration between psychologists and family physicians: Implementing the biopsychosocial model.

Training in primary care medicine in the past decade has included more attention to the psychosocial issues of patients. With this shift, psychologists have new opportunities to collaborate with medical providers to provide comprehensive health care to medical patients and their families. Systems theory and biopsychosocial medicine provide compatible theories to underpin this collaboration. Suggestions are made for overcoming the considerable barriers to implementation of this model, and examples of creative collaboration are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists and hospice: Where we are and where we can be.

Since the early days of the hospice movement, the role of psychologists in hospice care has been discussed. This study is based on questionnaire responses from hospice programs randomly drawn from those who were members of the National Hospice and Palliative Care Organization. The results clearly demonstrate the need for psychology's role in hospice, but there is much to do to clarify and develop this role. Although psychologists have much to offer in the hospice field and end-of-life care in general, this study found that there are not many psychologists actively working in these settings. Suggestions are made for how psychologists can become more involved in the provision of hospice and other end-of-life care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Observations on the Politics of Multidisciplinary Health Research.

In multidisciplinary health research, psychologists work as equals with other professionals to investigate health issues from a broad perspective. However, the domain of such research--the health care system--is frequently outside the psychologist's habitual territory. This article examines the role of psychologists in this line of work and the politics relating to their success. Discussion focuses on how the psychologist presents him/herself as being able to improve and add to the research, the importance of personal and professional credibility, professional language, and other practical concerns. Although multidisciplinary health research is becoming a more established activity for psychologists, few precedents currently exist for defining the psychologist's position. So every study adds not only to the body of knowledge of health but also to the character and identity of psychology as a discipline. Attention to the interpersonal and political aspects of health research is critical to the development of the field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing the societal contribution of organized psychology.

Encourages greater political involvement by psychologists and offers commentary on the experiences of 25 psychologists who have recently served on Capitol Hill. The current and potential contribution of psychology to a selected series of policy areas, including child health issues, care for the elderly, functional illiteracy, and criminal justice, is discussed. Also examined are the role and associated responsibilities of psychologists with regard to the health care field. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Completing advance directives for health care decisions: Getting to yes.

The concept of advance directives for health care decision making has been judicially condoned, legislatively promoted, and systematically implemented by health care institutions, yet the execution rate of advance directives remains low. Physicians should discuss with their patients advance care planning generally and end-of-life issues specifically, preferably when patients are in good health and not when they face an acute medical crisis. The physician–hospital relationship poses particular challenges for the optimal implementation of advance directives that must be addressed. Hospital administrators must improve education of patients and physicians on the value of such documents as well as internal mechanisms to ensure better implementation of directives. Health insurance plans may be better able to ensure optimal gathering and implementation of directives. Patients must become more familiar and more comfortable with advance care planning and the reality of death and dying issues. Full acceptance of the value of directives ultimately rests on achieving full participation of all involved—providers, patients, families, and payors—in this most profound process. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Building Systems of Care for Children With Chronic Health Conditions.

Objective: To describe the leadership role that rehabilitation psychologists can play in improving the health care delivery system for children with special health care needs (CSHCN). Setting: Midwest academic health center and surrounding communities. Participants: Children with chronic health conditions and disabilities and their families. Intervention: A model research demonstration project designed to promote family-centered, comprehensive, coordinated, and community-based care for CSHCN. The project aims to enhance environmental supports for CSHCN and their families in 2 ways: (a) by improving the ability of primary care providers to deliver effective chronic care management and (b) by integrating this improved clinical practice into an enhanced Medicaid managed care service delivery system for persons with chronic illness and disabilities. Conclusions: Psychologists have the potential to improve the quality of life of CSHCN and their families by intervening not only through direct services but also by promoting positive changes in the larger health care environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospice the adjective, not the noun: The future of a national priority.

Reviews the development of the hospice movement and examines some current policy issues relating to hospice care, such as who is eligible for such care. Two issues related to who can receive hospice services are explored: the requirement for a lay primary caregiver and the diagnosis requirement for admission. Possible roles for psychologists as providers and researchers are considered, and the cognitive and personality behaviors of hospice patients are discussed. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pet loss: Issues and implications for the psychologist.

The subject of pet loss has received little attention within the field of psychology, which is surprising given the millions of people who form strong attachments with their pets and experience the death of a pet at some point during their lifetime. The primary purpose of this article is to show why it is important for psychologists to understand how significant pets can be in the lives of their clients and to be sensitive to clients' grief in response to the death of a pet. We discuss special considerations related to the effect of pet loss on families, children, and the elderly. In addition, we examine how psychologists can play an important role in helping people cope with the emotional impact of pet loss through grief counseling, consultation with animal health care professionals, and outreach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A step in the right direction: A resource for collaboration on health-related issues.

Reviews the book, Health-related disorders in children and adolescents edited by L. Phelps (see record 1998-07780-000). This edited text provides an overview of 96 medical conditions that place children at risk of developing psychological or educational problems. The central feature of this book is that it is intended as a reference tool for professionals who collaborate with medical professionals. Increasingly, there have been many vehicles for school psychologists to collaborate with medical professionals, including comprehensive school health care programs and school-based health clinics, and community-based coordinated services that provide children and youth comprehensive care. In this regard, school psychologists are likely to encounter increasing numbers of children who experience health disorders, along with more traditional areas of practice including mental health and educational issues. Although not a purely medically oriented text, Phelps has taken a perspective that school psychologists work within the context of a multidisciplinary team of professionals who are likely to provide services for these children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologist–physician partnership in a medical specialty screening clinic.

Describes the development of a headache screening clinic in which psychologists participate with neurologists in the initial patient evaluation, using brief screening questionnaires and interviews. The majority of patients assessed in this clinic experienced clinically significant emotional distress, although only a minority of these patients felt a need for psychological intervention. By combining psychological screening with initial medical evaluation, emotionally disturbed individuals who present with physical complaints can be rapidly identified and their defensiveness about referral for psychological/psychiatric intervention can be minimized. Psychologists' psychometric screening instruments and their interviewing skills can contribute significantly to optimal utilization of health care services. Three case examples are given. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological assessment of candidates for solid organ transplantation.

The role of psychologists, who can assist in preparing clients for transplant surgery and support them postsurgery to sustain the complex maintenance protocol, is outlined. An overview of specific procedures used in the psychological evaluation and treatment of solid organ transplant patients, a discussion of general issues involved in treating these patients, and case vignettes are provided. As transplants become more common, the need for additional psychologists as part of multidisciplinary treatment teams increases. Because many patients live great distances from the transplant center, community psychologists may be enlisted to treat organ transplant patients and to collaborate with psychologists on transplant teams. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the psychologist in determining competence for assisted suicide/euthanasia in the terminally ill.

This paper discusses the history of assisted suicide/euthanasia and public attitudes in Canada; discusses depression in the terminally ill and the potential role of the psychologist in the assisted suicide/ euthanasia process; and specifically addresses the importance of determining competence in terminally ill patients. One area in which the services of psychologists have not been used to their fullest potential is in the care of the terminally ill, particularly in helping them make end-of-life decisions. It is very important that individuals making end-of-life decisions be assessed for mental disorders in order to ensure they are able to make competent decisions. If assisted suicide and euthanasia were to become legalized, psychologists should be involved in the assessment process in order to determine competency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral "Medicine" and the Collaboration Model of Knapp and Vandecreek.

Knapp and Vandecreek's (1981) article provided a helpful outline of some ethical and legal considerations of the health psychologist. Their recommendations regarding "physician collaboration" (p. 679) in the psychological management of physiological health concerns lead to practical problems that require further ethical and legal inquiry. Some concerns arising from efforts to apply the collaboration model are considered here: interaction with physicians who are minimally sophisticated about the psychological aspects of illness; collaboration with physicians who routinely equate patient's health psychology concerns only with emotional disorder and consign these individuals to the psychologist; and whether health psychologists can select an accurate diagnosis for conditions that are not psychological in nature. Health psychologists may ultimately resolve these issues as the professional identity of behavioral "medicine" and its practitioners develops. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criteria for the evaluation of quality improvement programs and the use of quality improvement data.

This document provides a set of criteria to be used by psychologists in evaluating quality improvement programs (QIPs) that have been promulgated by health care organizations, government agencies, professional associations, or other entities. These criteria also address the privacy and confidentiality issues evoked by the intended use of patient data gathered by such QIPs. Although developed for psychologists, these criteria may be useful across health service areas and professions. Psychologists support continuous quality improvement and professional development to ensure that their patients receive the best possible care. Careful evaluation of quality improvement strategies helps ensure improved quality of care while avoiding unintended negative consequences to the patient and/or the therapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)