Annexure- 3

Roles and Responsibility of Psychosocial care providers

Psychosocial palliative care can be provided by a variety of health staff on a palliative care team, though some members are more specifically trained in this area. Here's a breakdown:

• Primary providers:These can include palliative care physicians and palliative care nurses. While managing medical aspects, they also address emotional and social concerns as part of holistic care.
• Mental health professionals: This includes psychiatrist, psychologist, counselor, and social worker. They have specialized training in providing emotional support, coping mechanisms for anxiety and depression, and addressing family dynamics during a difficult time.

In essence, any member of the palliative care team can be involved in psychosocial care, but the role of the mental health team is discussed briefly.

Psychiatrist

Assessment and Diagnosis:

• Evaluate mental health status: They assess for symptoms of anxiety, depression, adjustment disorders, or post-traumatic stress disorder (PTSD) that may be triggered by the TB diagnosis, treatment side effects, or the prospect of a serious illness.
• Identify coping mechanisms: They understand how patients are coping with the challenges of TB and illness in general.

 

Medication Management:

• Prescribe psychotropic medications: Psychiatrists are medical doctors qualified to prescribe medications that can effectively manage mental health conditions like anxiety, depression, and insomnia, which are common in palliative care patients.
• Treatment-resistant cases: They can handle complex or treatment-resistant mental health presentations that might be beyond the scope of other team members.

Diagnostic Expertise:

• Differential diagnosis: Their in-depth knowledge of mental health disorders helps differentiate between mental health conditions and physical symptoms that can mimic psychiatric issues in palliative care (e.g., fatigue due to illness vs. depression).

Severe Mental Illness Management:

• Co-occurring disorders: For patients with pre-existing severe mental illness (SMI) like schizophrenia or bipolar disorder, a psychiatrist can manage the complexities of these conditions alongside the palliative care needs.

Consultation and Collaboration:

• Guidance to other team members: Psychiatrists can provide guidance and support to other members of the palliative care team, such as nurses and social workers, in managing the psychological aspects of their patients' care.

Additional Considerations:

• Psychopharmacology expertise: A specialized knowledge of psychopharmacology is invaluable in considering potential interactions between medications used for palliative care and psychiatric medications.
• Ethical considerations: They can provide ethical guidance on complex issues that may arise in palliative care, such as decision-making capacity in the face of mental health challenges.

Collaboration:

• Work with the palliative care team: Collaborate with other members of the palliative care team, such as physicians, nurses, and social workers, to ensure a comprehensive approach to care that addresses both physical and mental health needs.

Psychologist/counselor

Assessment and Evaluation:

• Mental health evaluation: Conducting assessments to identify and diagnose mental health conditions like anxiety, depression, adjustment disorders, and post-traumatic stress disorder (PTSD) that may arise due to the illness, treatment, or existential concerns.
• Psychosocial assessment: Evaluation of broader psychosocial factors that impacting the patient's well-being, such as social support networks, coping mechanisms, and cultural influences.

Intervention and Support:

• Individual therapy: Psychologists and counselors provide individual therapy sessions using various evidence-based techniques. These sessions help patients manage their emotions, develop coping skills for stress and anxiety, and address specific mental health conditions.
• Group therapy: Depending on the availability, they may facilitate support groups for TB patients to connect with others facing similar challenges and reduce feelings of isolation.
• Family counseling: They offer counseling and support to families, helping them understand the illness, navigate communication challenges, and cope with the emotional strain of caring for a terminally ill loved one.

Social worker

Social workers are the backbone of the palliative care team, acting as champions for the patient's well-being and a bridge between the medical aspects of care and the social, emotional, and practical realities of TB illness.

Understanding the Patient's Situation:

• Unique circumstances: Social workers go beyond a basic assessment. They delve into the patient's unique living situation, family dynamics, cultural background, and spiritual beliefs. This helps tailor support and identify potential challenges specific to the patient's context.
• Impact on daily life: They assess how the illness is impacting the patient's ability to perform daily activities, manage finances, and maintain social connections. This helps identify areas where the patient might need assistance.

Addressing Practical Challenges:

• Financial difficulties: Palliative care can be expensive. Social workers explore financial assistance options like Medicare/Medicaid benefits, disability benefits, or charitable organizations to help ease the burden on patients and families.
• Housing and transportation: They assess if the patient's home environment is suitable for their needs as the illness progresses. If necessary, they can explore options for home modifications, assisted living facilities, or transportation assistance.
• Legal issues: Social workers can help patients navigate legal issues like advance directives, power of attorney, or guardianship designations, ensuring their wishes are documented and respected.

Emotional and Social Support:

• Coping with grief and loss: Palliative care involves not just the patient but also their families who are facing impending loss. Social workers provide grief counselling for both patients and families, helping them process emotions and develop healthy coping mechanisms.
• Caregiver support: Caring for a terminally ill loved one can be emotionally and physically draining. Social workers can connect caregivers with support groups, respite care services, or mental health counseling to prevent burnout.
• Social isolation: Social workers identify patients at risk of social isolation and help them connect with friends, family, or social support groups to combat loneliness and feelings of disconnection.

 

Advance Care Planning and Communication:

• Facilitating discussions: Social workers have a unique skillset to facilitate sensitive conversations about end-of-life care preferences. They create a safe space for patients and families to discuss their wishes for medical treatment, pain management, and desired place of care.
• Respecting patient autonomy: They ensure patients understand their treatment options and empower them to make informed decisions about their care in accordance with their values and beliefs.
• Mediating communication: Social workers can act as mediators in situations where there are disagreements or difficult conversations within the family regarding the patient's care.

Collaboration and Advocacy:

• Liaison between patient and team: Social workers act as a liaison between the patient, family, and the palliative care team. They relay information, address concerns, and ensure everyone is on the same page regarding the care plan.
• Advocacy for patient rights: Social workers ensure patients' rights are respected throughout their care journey. They advocate for access to appropriate care, pain management, and emotional support services.
• Community resource network: Social workers have a strong network of community resources. They can connect patients and families with essential services like grief counseling, home care nurses, or spiritual support even after the palliative care intervention ends.

In essence, social workers in palliative care go beyond just providing support. They act as facilitators, advocates, and navigators, ensuring a smooth and dignified experience for patients and their families during a challenging time.