Kirstine Bøndergaard

Background: Patients with severe mental disorders (SMDs) face disparities in end-of-life care, yet knowledge about the quality of palliative care is limited. Aims: This study examined healthcare professionals’ perspectives on palliative care for patients with SMDs. Methods: Questionnaires were distributed to general practitioners (GPs) and specialist palliative care (SPC) professionals in the Central Region of Denmark regarding 75 deceased patients with SMDs sampled from the Danish Palliative Care Database. Data, including fixed-response and free-text answers, were analysed using descriptive statistics, chi2-tests, and thematic qualitative analysis. Results: Of 162 questionnaires, 123 were completed (76% response rate). Most trajectories were rated as good or very good quality. Free-text analysis generated three themes: Collaboration and timing, Communication and relations, and Complexity. Conclusions: Patients with SMDs generally receive high-quality palliative care, although some care pathways remain challenged regarding coordination, timing and communication around end-of-life decisions.

Background: Previous studies show ambiguous results concerning quality of palliative care among patients with severe mental disorders, defined as schizophrenia, moderate to severe depression, and bipolar disorders. Aim: To investigate quality in specialist palliative care among Danish patients with pre-existing severe mental disorders using data from the Danish Palliative Database. Design: Danish cohort study linking data from the Danish Palliative Database and hospital medical files. Setting/participants: All adult decedents in 2023 from Central Denmark Region affiliated with specialist palliative care. Hospital records were screened for severe mental disorders. Quality indicators included: Place-of-death, days from referral to death, specialist palliative care waiting time, discussion at multidisciplinary conferences and completion of symptom assessment. Results: Of 1869 patients, 80 (4.3%) had pre-existing severe mental disorders. Compared to patients without mental disorders, these patients died younger and more often from non-cancer conditions. They were less likely to complete symptom assessment (Risk Ratio (RR): 1.49 (95% CI: 1.15;1.95)). Those who also received active psychiatric treatment experienced longer waiting times for specialist palliative care (Mean ratios (MR): 3.48 (95% CI: 1.06;11.39)) and shorter palliative care pathways (MR: 0.44 (95% CI: 0.20;0.96)) than patients without active psychiatric treatment. Conclusion: Danish patients with active severe mental disorders were less likely to complete symptom assessment, had longer waiting times and shorter specialist palliative care pathways. Future efforts should focus on timely access to specialist palliative care and health professionals supporting completion of symptom assessments in this population.

Background: Specialised palliative care providers face complex challenges when caring for patients with life-limiting diseases. Despite this, a low prevalence of burnout has been observed among physicians in Danish palliative care compared to other Western countries. Given the multidisciplinary nature of palliative care, an expanded investigation was warranted. Aim: To assess burnout and its associations with demographic variables and workplace factors among all professions in Danish palliative care. Design: Cross-sectional survey study using the Copenhagen Burnout Inventory, the Danish Psychosocial Work Environment Questionnaire, and the Warr-Cook-Wall Job Satisfaction Scale. Participants: All 12 palliative care units in the Central Denmark Region participated. Of 288 invited professionals, 151 (52%) completed the survey. Respondents comprised nurses ( n = 88), physicians ( n = 17), other healthcare specialists ( n = 12), and non-healthcare professionals ( n = 34) from six hospices and six palliative care teams. Results: The prevalence of burnout was 23% overall; 28% in hospices and 14% in palliative care teams. Professionals in palliative care teams reported more weekly working hours (38 vs 34, p < 0.001), less shift work (40% vs 73%, p < 0.001), and higher meaningfulness at work (85 vs 76, p < 0.001) compared to hospice professionals. Adjusted analyses showed higher burnout among respondents with young age ( p = 0.01), children living at home ( p = 0.02), and shift work ( p < 0.03). Low burnout was associated with high meaningfulness at work ( p < 0.001), collegial trust ( p < 0.001), and job satisfaction ( p < 0.001). Conclusion: Burnout is a relevant concern in Danish palliative care, especially at hospices. The identified links to organisational and psychosocial factors suggests areas for further research and organisational attention.

Knowledge is needed about end‐of‐life care among patients with pre‐existing severe mental disorders: Schizophrenia, bipolar disorder, and depression. This study aimed to explore the experiences with end‐of‐life care for patients with severe mental disorders, their relatives, specialised palliative care nurses and physicians, and general practitioners. Twenty semi‐structured interviews were conducted and analysed using reflexive thematic analysis, hereby six interviews with patients, three with relatives, five with general practitioners, and six with specialised palliative healthcare professionals. Patients were selected with help from healthcare professionals. Four main themes were produced: thoughts about the future, healthy relations in end‐of‐life, changes in psychiatric condition in end‐of‐life, and the role of openness. Patients with severe mental disorders had wishes and fears for the future, and all participants expressed that healthy relations were crucial for patients at the end‐of‐life. However, sometimes this was challenged by prior complex relationships. It differed whether patients experienced a change in their psychiatric condition after having a terminal disease. Openness about severe mental disorders and end‐of‐life were regarded as important. Having the opportunity to openly discuss both wishes, fears, and mental disorders with healthcare professionals and having healthy relations are important for patients with severe mental disorders at the end‐of‐life. Insecurity about severe mental disorders among specialised palliative care professionals may lead to less openness about severe mental disorders. To optimise end‐of‐life care, patients need professionals to be present and available to discuss problems related to social, physical, existential, and psychiatric conditions.