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Health care providers’ perspectives on providing end-of-life psychiatric care between cardiovascular and oncological hospitals: a cross-sectional questionnaire survey


 Background: Psychological distress is a serious problem for patients with heart disease or cancer at the end of life. The aim of this study was to compare the barriers to providing end-of-life psychiatric care in cardiovascular compared to oncological settings.Methods: In this cross-sectional questionnaire survey conducted in Japan, we mailed questionnaires to physicians and nurses in 347 oncological and 427 cardiovascular hospitals in March 2018 to assess health care providers’ perspectives. First, we applied the Palliative Care Difficulties Scale and assessed end-of-life psychiatric care difficulties. Second, we asked about barriers to providing end-of-life psychiatric care in free description. Results: A total of 224 oncological and 213 cardiovascular hospitals responded to the questionnaires. The mean scores of palliative and end-of-life psychiatric care difficulties showed no significant differences between oncological and cardiovascular hospitals. Eight barriers to providing end-of-life psychiatric care were identified and were based on patients’ personal, interfamilial, clinicians’ personal, clinician-patient communication, end-of-life care, psychiatric care, systematic or environmental, and disease-specific problems. In addition, health care providers in cardiovascular hospitals were found to have a significantly higher rate of disease-specific issues compared with oncological hospitals. Conclusions: Both oncological and cardiovascular physicians and nurses have similar difficulties in providing end-of-life psychiatric care. However, health care providers of cardiovascular hospitals particularly experience heart disease-specific problems, such as unpredictability of prognosis or insufficiency of guideline development.