Psychological Issues in Palliative Care: Elissa Kozlov and Des Azizoddin

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GeriPal - A Geriatrics and Palliative Medicine Podcast 45 min 3 speakers 5 chapters transcribed 9 hours ago

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What are the main psychological challenges in palliative care highlighted by the hosts?

Eric Widera 0:00

This episode of the JerryPal Podcast is CME eligible.

Alex Smith 0:04

To claim credit, please go to the CME tab on jerrypal.org.

Eric Widera 0:09

Welcome to the JerryPout Podcast. This is Eric Wadera.

Alex Smith 0:12

This is Alex Smith. And

Eric Widera 0:14

Alex, who do we have with us today?

Alex Smith 0:15

Today we are delighted to welcome Alyssa Kozlov, who's a GERO psychologist and assistant professor in the Department of Health, Behavior, Society, and Policy at Rutgers School of Public Health, and is also director of a newly developed MPH in public population aging. It's an asynchronous online program. And uh I know Alyssa from the K 76 BCN meetings. This is like a Cadillac Career Development Award. Award for um aging researchers. I know she's a fantastic singer, so I'm sad that she's not able to join in the singing long because it doesn't work asynchronously via Zoom. Welcome to the Jerry Powell podcast, Alyssa.

Elissa Kozlov 0:53

Thank you. Happy to be here.

Alex Smith 0:55

And we're also delighted to welcome Des, as is Odin. Did I get it?

Des Azizoddin 1:01

Yeah, that was perfect. Thank you so much.

Alex Smith 1:03

She's a pain psychologist and assistant professor at the University of Oklahoma Health Sciences Center and the Stevenson Cancer Center. And she cr is a creator of the Stamp CBT app for cancer pain. Des Welcome to the JerryPaul Podcast.

Des Azizoddin 1:20

Thank you. I'm so excited to be here.

Eric Widera 1:22

So you can probably tell we're gonna be talking about mental health issues in particular mental health integration and issues in pain and in palliative care. I'll be working on that title. Before we get into this big topic, somebody has a song request for Alex.

Des Azizoddin 1:40

Yeah. I love the song Heartbeats by Jose Gonzalez. Um I think anytime I'm in kind of a funky mood or dealing with something odd or different in life, I listen to that song and it really helps me process whatever those emotions are. And I actually walk down the aisle to that song to marry my husband. So yeah, lots of big thanks. No pressure,

Elissa Kozlov 2:02

Alex. No pressure. No

Illia Polosukhin 2:03

pressure.

Elissa Kozlov 2:05

But it doesn't make me cry. You didn't do a good job.

Alex Smith 2:10

Well, I'm still playing now I have seven fingers for those of you who've been listening, uh up from six because I'm in a splint instead of a cast. So I'm now playing a little bit of guitar, but I had to retune it creatively to do this. So for those of you listening, you get my son Ren, the younger one, tenth grader, playing guitar on the audio only. And for YouTube, here we go, a little bit of heartbeats.

Unknown 2:35

One night to be confused, one night to speed up truth. We had a promise made, four hands and then away. Both under influence, we had divine scent to know what to say. Mind is a razor place. To call for hands of above To lean on wouldn't be good enough.

Eric Widera 3:22

Wonderful. Thank you, Alex.

Des Azizoddin 3:24

Love it. Thank you. Thank you.

Eric Widera 3:26

So let's dive into the topic. Alyssa, I'm gonna turn to you. So how big is this problem? How common are psychological issues like depression, anxiety in the palliative care setting? And also in if we can also talk about like cancer care settings.

Elissa Kozlov 3:42

They're really prevalent. I mean, we can talk about the the research-backed numbers, the epi the epidemiology numbers, but I also think that your listeners can just like pause and reflect and think how often do they encounter symptoms of depression, anxiety, pain, insomnia, trauma, right? Like all of these things happen so regularly at end of life. And I think our gut tells us well it's end of life right like this is sort of to be expected but it's not We shouldn't be suffering like this at the end of life. I mean, we can go into some of the numbers from one of my studies with um Clary Ankuda. We saw that around sixty percent of people were screening positive for depression in the last month before death.

Elissa Kozlov 4:29

That's a lot. That's a lot of people dying depressed.

Eric Widera 4:33

Yeah. And anxiety was really common too in that paper. Is that right?

Elissa Kozlov 4:38

Yeah. There was another paper I wrote with uh Dr. Fong Pinkquel, who uh we were seeing a lot of anxiety, uh around forty three percent of anxiety, I believe. Um It's high. It's too high.

Eric Widera 4:53

So this brings up an issue for me 'cause I don't think I'm seeing it in sixty percent of my patients as far as depression. Is it that um

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Chapters

5 chapters

1 What are the main psychological challenges in palliative care highlighted by the hosts? 0:00–14:54 2 How prevalent are depression and anxiety among patients in the last month of life? 14:54–18:46 3 What difficulties arise when screening for mental‑health distress in seriously ill patients? 18:46–29:27 4 What did the AAHPM physician survey reveal about clinicians’ comfort with mental‑health care? 29:27–42:30 5 How do psychological factors influence cancer pain and opioid use? 42:30–45:41

Speakers

3 identified

Eric Widera 6 min Alex Smith 5 min Illia Polosukhin

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Topics in this episode

anxiety 1 depression 1 Alex Smith 1 PTSD 1 VA 1 CBT 1 Brigham and Women's Hospital 1 Des 2 pain 1 Eric Wadera 1 gabapentin 1 opioids 1

Source

Recorded22 Feb 2024

Publisherrss.libsyn.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20524565

Show notes

In our podcast with palliative care pioneer Susan Block, she identified the psychological/psychiatric aspects of palliative care as the biggest are of need for improvement. As she said, when you think about the hardest patients you've cared for, in nearly all cases there was some aspect of psychological illness involved. That rings true to me. Today we talk with two psychologists who are deeply invested in addressing psychological aspects of care for people living with serious illness. Elissa Kozlov, a geropsychologist and director of a new population aging MPH at Rutgers, surveyed AAHPM members, and found that doctors reported major shortcomings in level of comfort and knowledge caring for patients with psychological illness. She conducted a systematic review and meta-analysis of 38 palliative care trials, finding that many excluded people with serious illness, and a lack of impact on psychological outcomes. Analyzing the Health and Retirement Study, she found 60% of older adults screened positive for depression in the last year of life (related study here). Des Azizoddin is a psychologist at the University of Oklahoma primarily focused on pain for people with cancer. Des delivered a plenary at this year's National Palliative Care Research Center's Foley retreat. She began by asking, "Raise your hand if you think there is a psychological component to cancer pain." All hands go up. Then, "Keep your hand up if you frequently refer patients with cancer pain to a psychologist?" All hands go down. Unfortunately, we lack the financial structures to reimburse psychologists that would incentivize widespread inclusion on palliative care teams. Because we live in the world as it is, not as it should be, Des has helped develop an app (link to pilot trial hot off the press!) to help people with cancer pain engage in cognitive behavioral therapy in bite sized 3-4 minute sessions (there are other apps available now developed in the VA, who have been leaders in the psychology/palliative care space). Des additionally studied stigma associated with opioid use among patients with cancer in the context of the opioid epidemic; depression, pain catastrophizing, recent surgery and opioid use among people with cancer. And, we talk about these issues and more (with far more nuance than I can include in this post). Kudos and credit to my son Renn, age 15, for the guitar on Heartbeats (hand still broken at time of recording).

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