What role do psychologists play in palliative, neuro-palliative, or cognitive rehabilitation care?

The Role of Psychologists in Palliative, Neuro-Palliative, and Cognitive Rehabilitation Care

Psychologists play a critical role in multidisciplinary palliative care teams by providing specialized assessment, intervention, and support that significantly improves quality of life, enhances coping strategies, and addresses psychological distress for patients and their families across the disease continuum.

Core Functions of Psychologists in Palliative Care Settings

Assessment and Evaluation

• Structured psychosocial assessments should be conducted at key points throughout the care continuum: diagnosis, during treatment, end of treatment, relapse, palliative care transition, and bereavement 1
• Psychologists provide comprehensive neuropsychological evaluations that:
  • Accurately characterize cognitive changes over time
  • Assess functioning across multiple cognitive domains
  • Account for confounding factors such as cultural background, education level, sensory impairments, and psychiatric comorbidities 1
  • Help distinguish between various causes of cognitive impairment when standard mental status testing is insufficient 1

Psychological Interventions

• Psychologists help patients develop effective coping strategies, particularly when disease progression and treatment effects impair normal coping mechanisms 1
• They facilitate approach-oriented coping strategies (active coping, positive reframing, acceptance) which have been shown to improve quality of life and reduce depression symptoms 1
• Psychological interventions address:
  • Physical challenges: fatigue, pain, dyspnea, insomnia 2
  • Psychological aspects: depression, anxiety 2
  • Spiritual/existential distress: through meaning-based or dignity-based approaches 2
  • Social aspects: enhancing social support, facilitating end-of-life discussions 2

Supporting the Palliative Care Team

• Psychologists provide training and supervision to other team members in psychological skills 1
• They help interpret complex psychological presentations for the multidisciplinary team 3
• Psychologists establish boundaries between general psychological support (provided by nurses and other healthcare professionals) and specialized psychological interventions 3

Integration into Palliative Care Settings

Timing of Psychological Involvement

• Introduction to psychological support should occur before the condition is considered palliative 1
• Early integration of psychological services has demonstrated improved patient outcomes:
  • Enhanced problem-solving skills
  • Better coping with uncertainty and concerns about the future
  • Increased empowerment and support 1

Service Delivery Models

• Psychology services have been successfully integrated into both inpatient and outpatient palliative care settings 4
• Most patients receive 1-2 psychological sessions, with session length typically longer in outpatient (60 minutes) versus inpatient (40 minutes) settings 4
• Psychological services must be adapted to meet the specific requirements of palliative care:
  • Abbreviated session times
  • Flexibility regarding location of interventions
  • Minimized assessment burden
  • Accommodation for high attrition rates due to patients' physical conditions 2

Special Considerations for Different Populations

Pediatric and Adolescent/Young Adult (AYA) Patients

• Child life or psychosocial support specialists should meet patients soon after diagnosis to address concerns and assist with coping mechanisms 1
• For AYA patients at risk for non-adherence, additional psychological support should be provided 1
• Psychosocial care teams must attend to cultural diversity (language, religious values, diverse racial identities) 1

Cognitive Rehabilitation and Neuro-Palliative Care

• Neuropsychologists provide essential services for patients with cognitive impairment:
  • Tailored recommendations to compensate for areas of impairment (memory, executive functions)
  • Guidance for further assessment (home safety, driving ability)
  • Communication of findings to patients and families 1
• Access to neuropsychological services is particularly important for patients with CNS tumors to guide academic and career decisions 1
• Repeat neuropsychological evaluations help track cognitive trajectory and symptom progression over time 1

Common Pitfalls and Challenges

• Confusion regarding boundaries between psychological support and specialized psychological interventions 3
• Limited training for psychologists in palliative care approaches 5
• Underutilization of psychologists in palliative care teams despite their valuable contributions 6
• Challenges in adapting traditional psychological interventions to the unique constraints of palliative care settings 2

Practical Implementation

• Clear referral pathways for psychological support should be established throughout the care continuum 1
• Psychological services should be integrated within a multidisciplinary team approach 1
• Psychologists should receive specialized training in palliative care philosophy and approaches 5
• Psychological interventions should be tailored to the patient's functional status and changing needs 1

By incorporating psychologists into palliative care, neuro-palliative care, and cognitive rehabilitation teams, healthcare systems can provide more comprehensive care that addresses not only physical symptoms but also the psychological, social, and existential dimensions of illness, ultimately improving quality of life and reducing suffering for patients and their families.