Improving Care for People with Severe Persistent Mental Illness in the Palliative Phase




Donald, Erin E.

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Persons with severe persistent mental illness (SPMI) experience a greater burden and severity of chronic disease, late diagnosis, and premature death compared to the general population. These patients also receive fewer medical treatments, poorer quality of care, and are less likely to receive palliative care compared to the general population. Inequitable health outcomes are related to complex factors including social marginalization, stigma, lack of education and support from healthcare organizations, and siloed health services. The purpose of this study is to bring a critical theoretical perspective to understanding and improving care for the medically ill and dying with SPMI. This manuscript-based dissertation draws upon multiple lenses including a scoping review of the healthcare literature on palliative care for people with SPMI; a co-produced interpretive phenomenological analysis, in partnership with community members with lived experience of homelessness and chronic illness, investigating the appropriateness of patient-reported outcome and patient-reported experience measures for this population; and a critical analysis of historical influences on modern approaches to palliative care for people with SPMI, with an emphasis on inherited assumptions and attention to their role in present-day care. A critical synthesis of findings from these analyses informs key learnings and future recommendations for research, policy, practice, and education.



Palliative Care, Mental Illness, Nursing, Critical History