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End-of-life care in schizophrenia: a systematic review

Published online by Cambridge University Press:  19 June 2020

Joshua M. Baruth ,
Jacqueline B. Ho ,
Sohail I. Mohammad  and
Maria I. Lapid
Joshua M. Baruth
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Jacqueline B. Ho
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Sohail I. Mohammad
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Maria I. Lapid*
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
*
Correspondence should be addressed to: Maria I. Lapid, Mayo Clinic, Department of Psychiatry and Psychology, 200 First Street SW, Rochester, MN55905, USA. Phone: +1 (507) 284 4159; Fax: +1 (507) 284 4158. Email: Lapid.Maria@mayo.edu.
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Abstract

Objective:

Schizophrenia is a severe and persistent mental illness with profound effects on patients, families, and communities. It causes immense suffering on personal, emotional, and socioeconomic levels. Individuals with schizophrenia have poorer health outcomes and die 10–20 years younger than the general population. Economic costs associated with schizophrenia are substantial and comprise 2.5% of healthcare expenditures worldwide. Despite psychosocioeconomic impacts, individuals with schizophrenia are subject to inequitable care, particularly at end of life. A systematic review was conducted to examine disparities in end-of-life care in schizophrenia and identify factors that can be targeted to enhance end-of-life care in this vulnerable population.

Design:

A comprehensive search was conducted using the databases Ovid MEDLINE(R), Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus from 2008–2018. Keywords included schizophrenia, palliative, end-of-life, and hospice. Two authors independently reviewed titles and abstracts; disagreements were resolved by consensus.

Results:

The search identified 123 articles; 33 met criteria: 13 case reports, 12 retrospective studies, 5 literature reviews, and 3 prospective studies. Articles were divided into major themes including healthcare disparities, ethics, and palliative care. Palliative care was the most frequent theme comprising >50% of the articles, and there was considerable thematic overlap with ethics and palliative care. Almost half the articles (45%) were related to schizophrenia and comorbid cancer.

Conclusions:

Increased awareness of potential healthcare disparities in this population, creative approaches in multidisciplinary care, and provision of adequate palliative services and resources can enhance end-of-life care in schizophrenia.

Keywords

palliativehospiceserious and persistent mental illnesspsychotic disorderdisparityquality-of-life
Type
Review Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 2: Issue Theme: Schizophrenia and Depression in Older Adults , February 2021 , pp. 129 - 147
Copyright
© International Psychogeriatric Association 2020

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