Delivering Palliative Care in Mental Health Nursing Settings: A Systematic Review.
Oladapo Akinlotan, Allen O'Connor, Ruben Seetharamdoo and 1 others
PMID 41792897WHAT IT FOUND
People with complex mental illness and dementia had very low access to palliative care, often lacked advance decisions, and needed familiar, continuous settings.
Nurses may under-rate dementia symptoms.
Key findings
01Access to palliative care for people with complex mental illness was very low compared with the general population; in New Zealand the access rate was 0.5% versus 1.72%, and they were 3.5 times less likely to access specialist palliative care.
02In long-term care in the Netherlands, few residents with dementia had advance directives (4.9%), and when patients lacked capacity, end-of-life decisions usually involved proxy decision makers.
03People with dementia admitted to inpatient palliative care had lower symptom distress but higher functional impairment than people with cardiovascular disease, lung cancer, or motor neuron disease, and nurses often underrate their symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for RNs
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What it does not show
Only nine studies met the criteria, and the review could not combine them statistically because designs, populations, and outcomes differed. Most studies were from high-income countries, so applicability to low- and middle-income settings is uncertain. Unpublished studies and grey literature were not searched, so publication bias is possible. Included evidence came from varied settings, including nursing homes, long-term care, inpatient palliative care, and psychiatric units, so it may not all describe the same mental health ward experience. Some primary studies relied on nurse reports, retrospective data, or tools not validated for dementia, which can miss symptoms or preferences. The BPD and dementia case reports describe three patients and one patient, so they cannot show what works for most patients.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this review as proof that mental health wards provide effective palliative care. It describes access and care-delivery themes, and the positive dementia-ward case report covers one patient only.