Domain 3: Psychological and Psychiatric Aspects of Care

Mental status screenings of seriously ill patients are assessed by the IDT. Involvement is required of social workers, who will facilitate this across all care settings and with the involvement of a special-level psychologist and/or psychiatrist. Palliative care specialists and mental health care specialists may be an integral part of the IDT.

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Recognition, assessment, and treatment of common psychological issues such as depression, anxiety, delirium, hopelessness, and complex psychiatric issues such as suicidal ideation or personality disorders, are addressed.

Patients and their families receive psychological and psychiatric services directly or through referrals. The IDT is expected to manage long-term care as well as anticipate any emerging psychological and psychiatric concern.

An understanding of the pharmacologic and nonpharmacologic interventions of this domain of care is expected, and an education plan for patients and their family needs to be implemented.

Domain 4: Social Aspects of Care

This aspect addresses the environmental and social factors impacting patients’ and their families’ functioning and quality of life. The IDT interacts with patients and their families as well as with professional social workers who have expertise and experience in palliative care.

Care planning, management, and delivery are expected through an understanding of the impact of social factors on patients and their families. In this regard, awareness is expected on the implications of care for the uninsured, underinsured, undocumented, homeless, or those who are under the custody of the county or state. The IDT is also expected to provide assistance with benefit applications.

Social assessment includes, among other criteria, understanding the family structure and function, strengths, availability of support systems, financial vulnerability, nutritional needs and food insecurity, advance care planning and legal concerns, and a family’s willingness to accept resources and referrals.

Domain 5: Spiritual, Religious, and Existential Aspects of Care

“Spirituality is recognized as a fundamental aspect of compassionate, patient and family-centered palliative care […and] is expressed through beliefs, values, traditions, and practices,” the guidelines state. A professional chaplain is part of the IDT that delivers this aspect of care. The IDT is also expected to respect the wishes of patients and families when they choose not to discuss their beliefs or accept spiritual support.