At the Kaiser Permanente San Francisco medical center, a Psychiatric Nurse Practitioner is embedded as a care team member in the outpatient Palliative Care clinic. This partnership ensures that patients with complex psychiatric histories who are facing life-limiting illnesses are connected with the psychiatry provider best equipped to provide them with specialized, excellent care.

Kaiser Permanente is an integrated health care delivery system that provides members with both primary and specialty care services across inpatient and outpatient settings. Previously, when patients seen by Palliative Care presented with significant psychiatric need, providers would refer the patient to the psychiatry department. This model did not recognize the unique needs, both medical and social, that exist for palliative care patients. Patients coping with life-limiting illness and loss of ability would have to navigate the psychiatry department themselves, and there was no linkage between the Palliative Care team and the patient’s ultimate psychiatric provider. These patients may lack the stamina, social support, or emotional resources to seek psychiatric care, navigate the department, and adhere to a treatment plan, as they are often juggling many appointments at once. Furthermore, many therapists and psychiatrists lack training and expertise to feel comfortable providing psychiatric care to patients facing the end of life.

The Psychiatric Nurse Practitioner has the expertise to address both medical and psychological concerns in the context of serious or life-limiting illness. The provider spends two days a week embedded in the collocated Palliative Care Clinic and Oncology departments, and sees patients both alongside the Palliative Care providers in shared appointments and separately.

Benefits include:

  • Increased patient satisfaction: Patients and their family members report feeling more supported by the palliative care team and by the Kaiser Permanente medical system overall.
  • Better care: Patients are getting better care, psychiatrically and emotionally.
  • Palliative care providers feel more supported: The psychiatry provider is consulted for complicated psychiatric needs, ethical concerns, and treatment decisions, and is considered an invaluable team member.
  • Better distribution of resources: Palliative care providers use their time more effectively, as their patients’ emotional and psychiatric needs are addressed. The social worker on the Palliative Care team can focus on patients that need resources she can provide, rather than being occupied by psychiatric support needs of patients.
  • Smoother transition from oncology into palliative care: The partnership with both Oncology and the Palliative Care Clinic allows the Psychiatric provider to counsel patients on accepting palliative care referrals from their oncologist. The provider is an additional resource for educating patients and families about the benefits of palliative care.
  • Decreased emergency department utilization: Patients who were frequenting the ED because of psychiatric complications and concerns that their health was deteriorating were provided with appropriate psychiatric support and stopped or reduced inappropriate visits to the ED.
  • Patients and their caregivers are more likely to access appropriate support and care: Members who may not have had the resources to navigate the psychiatry department on their own are connected with highly specialized support.


  • Loretta Wilson, MSN
  • Psychiatric Nurse Practitioner
  • Kaiser Permanente San Francisco
  • 2238 Geary Boulevard
  • San Francisco, CA, 94110