Primary Mental Health Competencies for Palliative Medicine Physicians: A Consensus-Prioritized List

Outcomes 1. List 5 mental health competencies in which they already have expertise.2. Identify 2 potential sources for further learning when a physician has a relative lack of expertise in a mental health competency (i.e. a licensed clinical social worker on their existing clinical team, journal articles in the palliative medicine or mental health literature, a consult-liaison psychiatrist with shared patient populations, etc). Key Message Hospice and palliative medicine physicians aim to support patients’ whole-person quality of life, but our training emphasizes physical symptoms. We used an expert panel to develop primary mental health competencies for palliative care physicians, which will undergo iterative rounds of voting from a larger stakeholder cohort for prioritization. Introduction/Context Psychological and psychiatric care is a core domain of palliative care. Palliative care clinicians manage common psychological and psychiatric symptoms and use concepts from mental health in serious illness communication. Despite growing interest in the mental health aspects of palliative care, recent data demonstrate that training in mental health for hospice and palliative medicine (HPM) physician fellows is variable. Few guidelines exist to define scope of practice and educational goals. The lack of operationalized criteria to guide training of HPM physicians is a barrier to upskilling the HPM workforce and meeting the mental health needs of patients with serious illness. Objective To delineate preliminary HPM physician competencies in the psychological and psychiatric aspects of palliative care. Methods We used a purposive sampling strategy to convene a cohort of interdisciplinary experts in various domains of mental health and palliative care including experts in palliative care social work, psychology, bereavement, geriatric psychiatry, psycho-oncology, addiction medicine, and medical education. Our expert panel collaboratively created a framework and proposed competencies, which were then iteratively refined by the first and senior authors (LP, DS) through individual meetings with each group member. Results Leveraging the input of the expert panel, an organizational framework was developed. Competencies were organized into (A) psychological foundations of serious illness (18 competencies and sub-competencies), (B) diagnosis and management of mental health disorders in serious illness (44 competencies and sub-competencies), and (C) systems-based practice (8 competencies and sub-competencies). These proposed competencies will undergo vetting by a larger stakeholder cohort to identify those deemed most important. Conclusion We present initial HPM physician competencies in psychological and psychiatric care, a highly significant but under-delineated domain of HPM practice. These competencies will undergo further vetting to identify priorities for developing educational content and to help define scope of practice. Keywords Workforce / Career Development / Scientific Research