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11/11/2021 | 2:45 PM to 3:45 PM
WORKSHOP LIVE DISCUSSION: From Goals to Meanings: The Role of Psychotherapeutics for Psychiatrists Working with Palliative Care
Click to watch the presentation recording of this session in advance of the live discussion:
https://clp21.secure-platform.com/a/solicitations/8/sessiongallery/77
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Palliative care has become the standard of care for individuals across a spectrum of serious and life-limiting illnesses. Palliative care focuses on understanding and managing distress in physical, psychosocial, and spiritual domains, complex symptom management, and exploring patients’ values. The provision of palliative care is often steeped in individual, dyadic, and group dynamics uncovered or exacerbated by the stressors of serious illness, mortality, high stakes medical decision-making, and physical symptoms. Palliative care communication paradigms are often oriented around serious illness care foci like goals of care and prognostication, which only partially captures this complexity. Consultation-liaison psychiatrists offer palliative care clinicians and patients expertise in understanding and managing complex dynamics including psychiatric formulation, psychotherapeutic interventions, and judicious use of psychopharmacology to help contain unmanageable affect. Despite complementary skillsets between CL psychiatry and palliative care, these specialties often remain siloed due to structural barriers, biases, and limited opportunities for co-education. This panel will focus on the role of psychiatrists in utilizing psychotherapeutically-informed skills within the psychiatric-palliative care interface for the purposes of educating palliative care clinicians, improving patient care, and addressing inter-team conflict. Four psychiatrists both with and without palliative care training will each describe psychotherapeutically-informed approaches to their work with palliative care services. Dr. Jacobowski will present from the perspective of dual training in child and adolescent psychiatry and pediatric palliative care, reviewing psychiatry education commonly provided in palliative care training, yet ongoing gaps in primary psychiatric skills and knowledge for palliative physicians. She will discuss the role of the embedded psychiatrist as role model and educator with a particular focus on how psychiatric formulation and basic psychotherapeutic skills serve as an important foundation for teaching primary psychiatry skills and addressing those educational gaps. Dr. Gerwin will utilize a case-based approach to present psychiatry-palliative care collaboration in the care of hospitalized patients with serious illness from early childhood through young adulthood. She will focus on delineating psychiatry and palliative care roles in a complementary way and on how to incorporate concepts of grief, acceptance, and resilience into CL practice. Dr. Chammas will share her experience translating psychiatric/psychotherapeutic concepts such as formulation into didactics for palliative care providers. She will share challenges and strategies for translating ideas that may seem foundational or basic to psychiatrists to a palliative care audience. Dr. Shalev will discuss an initiative to develop literature aimed at helping palliative care providers to “think like psychotherapists.” He will discuss a multisite collaboration aimed at defining “psychological elements of palliative care” (PEPC) and an upcoming paper series in the Journal of Palliative Medicine focusing on high yield concepts in PEPC such as formulation, transference/countertransference, the holding environment, attachment etc. and how these concepts interpolate and modulate the palliative care encounter.
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Palliative care has become the standard of care for individuals across a spectrum of serious and life-limiting illnesses. Palliative care focuses on understanding and managing distress in physical, psychosocial, and spiritual domains, complex symptom management, and exploring patients’ values. The provision of palliative care is often steeped in individual, dyadic, and group dynamics uncovered or exacerbated by the stressors of serious illness, mortality, high stakes medical decision-making, and physical symptoms. Palliative care communication paradigms are often oriented around serious illness care foci like goals of care and prognostication, which only partially captures this complexity. Consultation-liaison psychiatrists offer palliative care clinicians and patients expertise in understanding and managing complex dynamics including psychiatric formulation, psychotherapeutic interventions, and judicious use of psychopharmacology to help contain unmanageable affect. Despite complementary skillsets between CL psychiatry and palliative care, these specialties often remain siloed due to structural barriers, biases, and limited opportunities for co-education. This panel will focus on the role of psychiatrists in utilizing psychotherapeutically-informed skills within the psychiatric-palliative care interface for the purposes of educating palliative care clinicians, improving patient care, and addressing inter-team conflict. Four psychiatrists both with and without palliative care training will each describe psychotherapeutically-informed approaches to their work with palliative care services. Dr. Jacobowski will present from the perspective of dual training in child and adolescent psychiatry and pediatric palliative care, reviewing psychiatry education commonly provided in palliative care training, yet ongoing gaps in primary psychiatric skills and knowledge for palliative physicians. She will discuss the role of the embedded psychiatrist as role model and educator with a particular focus on how psychiatric formulation and basic psychotherapeutic skills serve as an important foundation for teaching primary psychiatry skills and addressing those educational gaps. Dr. Gerwin will utilize a case-based approach to present psychiatry-palliative care collaboration in the care of hospitalized patients with serious illness from early childhood through young adulthood. She will focus on delineating psychiatry and palliative care roles in a complementary way and on how to incorporate concepts of grief, acceptance, and resilience into CL practice. Dr. Chammas will share her experience translating psychiatric/psychotherapeutic concepts such as formulation into didactics for palliative care providers. She will share challenges and strategies for translating ideas that may seem foundational or basic to psychiatrists to a palliative care audience. Dr. Shalev will discuss an initiative to develop literature aimed at helping palliative care providers to “think like psychotherapists.” He will discuss a multisite collaboration aimed at defining “psychological elements of palliative care” (PEPC) and an upcoming paper series in the Journal of Palliative Medicine focusing on high yield concepts in PEPC such as formulation, transference/countertransference, the holding environment, attachment etc. and how these concepts interpolate and modulate the palliative care encounter.
Speakers
Natalie Jacobowski
Child and Adolescent CL Psychiatrist and Pediatric Palliative Care Physician | Nationwide Children's Hospital
Dr. Jacobowski is board certified in general psychiatry, child and adolescent psychiatry, and hospice and palliative medicine and clinically practices both pediatric consultation liaison psychiatry with emphasis on psycho-oncology and pediatric palliative care. Her clinical and academic emphases are recognition and treatment of pediatric delirium, unique psychiatric and palliative needs of adolescent and young adult oncology patients, and improving psychiatric symptom recognition and treatment in pediatric palliative care through improving primary psychiatry skills in palliative care providers and increasing collaboration between the specialties.
Roslyn Gerwin
Physician | Maine Medical Center
Dr. Gerwin is Board Certified in Adult and Child & Adolescent Psychiatry. She graduated from UNE COM in 2011. She completed her Adult Psychiatry training at Berkshire Medical Center in 2014 and her CAP fellowship at Maine Medical Center in 2016. Dr. Gerwin has been the Director of Pediatric Psychiatry for the Barbara Bush Children's Hospital since 2016. Primary clinical focuses include comorbid complex medical illnesses, eating disorders, and media-based topics. Dr. Gerwin is actively involved in multidisciplinary teaching across all a variety of training levels. In her free time, she enjoys yoga, dancing, and gardening.
Daniel Shalev
Instructor in Medicine and Psychiatry | Weill Cornell Medicine
Dan Shalev MD is an instructor in medicine and psychiatry and a post-doctoral research associate in behavioral geriatrics at Weill Cornell Medicine. He completed his psychiatry residency and consultation-liaison fellowship at Columbia University and his hospice and palliative medicine fellowship at the bicampus New York Presbyterian fellowship at Cornell and Columbia. His research lies at the interface of mental health and palliative care with a focus on models of integration and end-of-life care for individuals with comorbid mental illnesses.
Danielle Chammas
Physician, UCSF Comprehensive Cancer Center's Symptom Management Service | UCSF
Danielle Chammas, MD is a palliative care physician and psychiatrist who works in the UCSF Comprehensive Cancer Center’s Symptom Management Service. After receiving her undergraduate degree from Stanford University (2005), she attained her MD at UCSF School of Medicine (2010), where she graduated as part of the Alpha Omega Alpha Honor Medical Society. She remained at UCSF for her residency in General Adult Psychiatry (2014), where she served as a Chief Resident at the SFVA Medical Center and was recognized for her commitment to teaching. She went on to complete a fellowship in Hospice and Palliative Medicine at UCSF (2015). In addition to providing clinical care, her professional and scholarly interests include the intersection of psychiatry and palliative care, the psychological dimensions of life-limiting illness, therapeutic communication, medical education, clinician wellness, and medical humanities. In her personal life, Dr. Chammas enjoys creating art, publishing children’s books, and spending quality time with her husband and three daughters (ages 6, 4, and 2).
Philip Bialer
Attending Psychiatrist | Memorial Sloan Kettering Cancer Center
Dr. Bialer completed his fellowship training as the Consultation-Liaison AIDS Fellow at the Beth Israel Medical Center in New York City. He stayed on at Beth Israel to develop the AIDS Psychiatry program. Dr. Bialer was the Chief of the Division of Consultation-Liaison Psychiatry and the C-L fellowship training director at Beth Israel from 1993-2008. While at Beth Israel, Dr. Bialer was also the director and PI of a Ryan White-funded program that provided mental health services to patients with HIV/AIDS attending MMTP and was one of five Physician-Ethicists leading the Ethics Program. Dr. Bialer is past president of Society for Liaison Psychiatry and is currently the Vice-President of the Academy of Consultation-Liaison Psychiatry where he previously served as chair of the Education Committee and chair of the 2015 Annual Meeting Committee. He is a Fellow of the Academy of C-L Psychiatry and a Distinguished Fellow of the American Psychiatric Association, as well as a Fellow of the American College of Psychiatrists.
In 2009, Dr. Bialer joined the faculty of Memorial Sloan Kettering Cancer Center as a member of the Communication Skills and Research Laboratory (Comskil) and is currently the Director of Training for that program. He is also the Associate Program Director for the C-L Psychaitry Fellowship
In 2009, Dr. Bialer joined the faculty of Memorial Sloan Kettering Cancer Center as a member of the Communication Skills and Research Laboratory (Comskil) and is currently the Director of Training for that program. He is also the Associate Program Director for the C-L Psychaitry Fellowship
Emily Sorg
Psychiatrist | Massachusetts General Hospital
Emily Sorg, MD, is an attending psychiatrist on the Consultation-Liaison Psychiatry and Psychosocial Oncology services at Massachusetts General Hospital. She is an Instructor in Psychiatry at Harvard Medical School and serves as the Associate Director for the HMS psychiatry clerkship at the MGH site. Dr. Sorg completed her medical degree at Icahn School of Medicine at Mount Sinai, her psychiatry residency training at MGH/McLean, and a fellowship in Consultation-Liaison Psychiatry at MGH. Clinical interests include psycho-oncology, disparities in mental health, psychotherapy, and medical education.
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Speakers
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