LISTEN ACKNOWLEDGE RESPOND
“MIND THE GAP”
PSYCHOLOGICAL SCREENING AND
ASSESSMENT
Responding to the Mental Health concerns
of people living with an advanced chronic and terminal illness
and their family and care givers
The LAR project has been funded by the Commonwealth
Government under the Public Health Chronic Disease and
Palliative Care Program.
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Assessment and Screening – effective and appropriate
Must be ethical
• Maleficence : do no harm;
• Beneficence: to do what is good
Needs to take into account:
• the person’s specific diagnosis and stage of illness
• the person’s age
• the person’s stage of development
• the person’s stage of life
• the person’s family and social connections
• other experiences or stressors the person may have had
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Evaluation of interventions
Understand Goals of Care: Pre-terminal chronic palliative care
This work attempts to restore meaning to that ultimate phase of the life of these patients.
Patient choices about their care should be the centre of any decision about
their final days, weeks and months of life, not the determination of a
medical tool
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People relate that they are most fearful of:
loss of mental faculties,
loss of control,
loss of independence,
being a burden on family, and
loss of dignity,
……ahead of fear of physical pain.
In every study, fear of death itself was rated last.
People were not afraid of dying, they were afraid of the dying process.
Cartwright, CM, Robinson, GW, Steinberg, MA., Williams, GM., Najman, JM., & Tyler, WB., 1998
End-of-life decision-making: Perspectives of Northern Territory doctors, nurses and community members,
Report, University of Queensland and Norther Territory University
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“For people living with advanced illness ‘taking charge’ represents
a central priority.
The right to exercise choice and control, even when extremely ill,
is important to patients and is often related to preserving their
dignity and maintaining normality.”
Johnston B. Can self-care become an integrated part of end of life care?
Implications for palliative nursing. International Journal of Palliative Nursing.
2010; 16 (5):212-4
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Treatment V/s Time
If a person has 400 days to live (or less)
When, how and why of MH treatment planning
• What is ethical?
• What can make a difference?
• How do we evaluate effectiveness?
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Assessment tools
What to screen for and how to assess?
•DASS –Depression, Anxiety and Stress Scale –differentiates between each
•HADS –Hospital Anxiety and Depression Scale –excludes Stress symptoms
•PROGNOSTIC INDICATOR –no surprise question
•DISTRESS THERMOMETER –self reporting scale across 5 domains of life
http://www.caresearch.com.au/caresearch/tabid/503/Default.asp
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CASE STUDY
Discuss one or more case study. (You can also choose one of your own)
• Identify psychological / mental health issues across the Unit of care
• Discuss impact of these on the Unit of Care
• Identify MH classifications relevant to identified issue
• Choose an appropriate assessment tool
• Discuss goals of care and relevance of ethical appraisal of diagnosis and treatment
“MIND THE GAP”