Oral Presentation Palliative Care Nurses Australia Conference 2020

What are the unique palliative care needs of people with a diagnosis of schizophrenia? An integrative review of the literature.   (70205)

Abby Earrey 1 2
  1. School of Nursing , University of Auckland , Auckland , New Zealand
  2. Hospital Palliative Care Team , Auckland District Health Board, Auckland , New Zealand

Background: People with a diagnosis of schizophrenia have a higher mortality than the general population and, despite advances in modern healthcare the gap is widening (Olfson et al., 2015). The causes of such are multifactorial, and often occur within a fractured health-care system. The disparities in palliative care provision for those with schizophrenia is significant and in-part, due to siloed healthcare systems, diagnostic overshadowing, lack of collaborative interventions and debate on location of care (Butler & O’Brien, 2018; Donald & Stajduhar, 2016). Research related to the palliative care needs of people with schizophrenia remains limited.

Problem statement: People with schizophrenia experience inequitable access to primary and specialist healthcare. They also experience late diagnosis of major life-limiting diseases, are often multi-morbid and with significantly reduced life expectancy.

Aim: To conduct an integrative literature review to establish the unique palliative care needs for those with schizophrenia.

Methods: From July-September 2019 a systematic review of the literature following the PRISMA guidelines was undertaken.

Findings: 969 studies were screened for eligibility and 15 papers were included in the final review. Four key themes were identified; 1. disparities in access and provison of palliative care 2. role of family; 3. compassionate care 4. the role of the healthcare system and workforce. Sub-themes evolved and highlighted complexities in symptom management assessment, location of care and death, surrogate decision making for families aswell as overall meaningful and consistent relationships. In addition, the healthcare sector has a role to challenge stigma and uphold autonomy and advocacy. Discussion: People with schizophrenia are adversely marginalised. Rates of cardiovascular and respiratory disease are high for individuals with schizophrenia and can be related to medications, socio-economic status, poor access to primary care, poor screening for chronic diseases and malignancy, and social isolation. Cancer rates for individuals with schizophrenia are similar to the general population although with poorer outcomes - late diagnosis, less chemotherapy or surgical options, poorer quality of life and survival.

Conclusion: There is a significant gap in palliative care service provision for an already under-served population despite complex and specialist health needs. People with a diagnosis of schizophrenia must receive equitable sound and compassionate care and a change in current awareness, practice and policy must occur for this to be achieved.