Primary Mental Health Competencies for Hospice and Palliative Medicine Physicians: A Delphi Study

Psychiatric and psychological care in serious illness is a core domain of hospice and palliative medicine (HPM), encompassing both normative psychosocial responses and mental health comorbidities. While social workers serve as psychosocial leaders on HPM interdisciplinary teams, commitment to supporting whole-person care remains the responsibility of the entire team. However, training and scope of practice for HPM physicians in the mental health domain are poorly standardized.

To establish and prioritize "primary mental health competencies" for specialist hospice and palliative medicine physicians using expert consensus methods.

We convened a panel of eight physicians, one social worker, two psychologists, and one nurse practitioner with expertise at the intersection of palliative care and mental health. Using group meetings and 1:1 interviews with the project leads, the expert panel generated initial competencies. A purposive voting panel of 36 palliative care physicians representing a range of practice settings and areas of career focus finalized high-priority competencies using a two-phase modified Delphi approach.

The expert panel proposed 68 competencies divided into: (A) psychological foundations of serious illness care, (B) diagnosis and management of mental health disorders in serious illness, and (C) systems-based practice. After first-round voting, 23 competencies were recirculated for a second vote. Following second-round voting, 32 competencies were included in the final list: seven from part A, 20 from part B, and five from part C.

This consensus-based, expert-led process successfully generated and prioritized essential competencies in the psychological and psychiatric aspects of palliative care for specialist physicians.