What does psychology have to offer at end of life?

Dr Jenny Strachan, Clinical Psychologist, Marie Curie Hospice, Edinburgh, United Kingdom, explains the background to her longer article published in the January/February issue of the European Journal of Palliative Care.

Dr Jenny Strachan

I came from a background in Adult Mental Health to work in Oncology and Palliative Care with perhaps the same prejudices and misconceptions as many new to the area. I expected there would be tragedy, overwhelming distress, dramatic dysfunction. And so there is, sometimes. Research suggests that up to 20 per cent of patients in a palliative care setting may meet criteria for a psychological disorder, and making specialist care available to such people is – and should be – a priority at local and national levels.

But viewed from another angle, something more than 80 per cent of patients don’t meet criteria for a mental disorder. Does psychology have nothing to offer them? Call me biased, but I can’t believe that.

The ‘science of mind and behaviour’ has many branches. Developmental psychology explores how our minds and behaviours are shaped by our early years’ experiences. Cognitive neuropsychology investigates how they are determined by the structure and functions of the brain. Social psychology considers the influence of the groups, large and small, in which we belong. I could go on.

The findings of this phenomenal body of research don’t stop applying to people simply because they approach the end of their lives. We can use what we know about psychology to understand individual patients and their families better, to guide service design, to promote a healthy workplace culture. If psychologists in palliative care stick to a narrow, ‘clinical’ interpretation of the role, that is, direct treatment of disorder, we miss an opportunity to promote and preserve the wellbeing of all our patients. Not to mention the wellbeing of fellow staff.

I believe that one of the key roles of an applied psychologist in any multidisciplinary setting is to translate that body of psychological knowledge into something relevant and useful to colleagues in their roles. The short series of articles that I am writing for the European Journal of Palliative Care (EJPC) has arisen from my ongoing mission to do just that. When the teams in my hospice meet to discuss a challenging patient or situation we often move to discussing general or abstract ideas from psychology. But we always then come back to the concrete: ‘what does this tell us about what we should do here?’ My attempts to summarise these meetings became – with a great deal of editorial support – the articles that will be published in future issues of the EJPC.

In sharing some of the ideas and strategies of a psychologist with colleagues, my intention is not to have them do my job for me, but to support them to do theirs more confidently and effectively. It’s a two-way street: having been taught by my nursing colleagues how to pick up on opioid toxicity has made me a better psychologist (this is the tip of a massive iceberg of things I have learned from nurses!).

Psychology is not a complementary therapy. It should not be thought of as an ‘extra’ that we add in for the patients who are struggling. It is the theory-driven, evidence-based study of being human, and it has something to offer us all.

Read the full article in the European Journal of Palliative Care
This post relates to a longer article, ‘Psychological ideas in palliative care: attachment theory’ by Jenny Strachan, published in the January/February 2017 edition of the European Journal of Palliative Care (vol. 24.1). If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive.

You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.

Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog. 

EJPC Palliative Care Development Award 2017 – nominations form now online.

Do you know someone who has made a major contribution to palliative care policy development? Why not nominate them for the EJPC Palliative Care Policy Development Award? Click here to nominate. Launched by the European Journal of Palliative Care in collaboration with the European Association for Palliative Care, the award is aimed at professionals working in palliative care worldwide who have made a substantial contribution to policy development through research, clinical practice or as policy activists. The 2017 Award will be presented at the 15th World Congress of the EAPC   in Madrid, Spain (18–20 May 2017). Deadline for applications: 31 March 2017.