End-of-life care for people with severe and persistent mental illness and a life-limiting disease: An umbrella review

Abstract

Background: Although there is sufficient evidence that disparities in health care access and provision contribute to poor physical health outcomes in people with a severe and persistent mental illness (SPMI), very little is known about the quality of end-of-life (EoL) care and palliative sedation in these people. Methods: A comprehensive and systematic literature search in PubMed, Embase, Web of Science, Scopus, and CINAHL electronic databases (from inception to November 2023) was conducted, without language restriction, for reviews on the EoL-care and/or palliative sedation for people with SPMI. Critical appraisal of the selected reviews was performed. Data were analyzed according to 4 principles of biomedical ethics. Results: Ten reviews were included. From the analysis, it became clear that people with SPMI are at risk of suboptimal EoL-care. Stigma among healthcare professionals, lack of integrated care policies, absence of advanced care planning, and insufficient expertise and training in palliative care of psychiatrists have been identified as key challenges to the provision of adequate EoL-care for people with SPMI. No data were found about palliative sedation. Conclusions: To optimize palliative and EoL-care for SPMI patients and a life-limiting disease, a policy of coordinated and integrated mental and physical healthcare is needed. Moreover, education and training initiatives to reduce stigma and discrimination among all healthcare workers and to enhance palliative care skills in psychiatrists should be offered. Finally, more research is needed on EoL and particularly on palliative sedation for people with SPMI. © 2025 Cambridge University Press. All rights reserved.