Table 2.

Final Consensus Competencies in the Category of Psychological Foundations of Serious Illness^a

Competency	Psychological Concept(s)c
A. Psychological foundations of serious illness care:
1. Demonstrate the ability to recognize and attend to a broad range of normative emotional reactions to serious illness (e.g., sadness, worry, anger, ambivalence, anticipatory grief, gratitude, sense of meaning, existential distress)	Attunement Accompaniment
2. Foundational principles in serious illness care: Principles from psychology and psychotherapy that are important in describing and optimizing the therapeutic relationship.b  a. Develop a dynamic conceptualization of each patient as an individual whose feelings, thoughts, and behaviors are informed by prior life experiences, coping strategies, elements of identity, culture, spirituality, social context, and illness experience.  b. Notice and manage how our own reactions to patients and families can influence clinical decision making, including recognizing our own implicit biases  c. Create a therapeutic environment that allows for the exploration and containment of strong emotional reactions among patients, families, and teams  d. Remain nonjudgmental when navigating medical decisions with patients and caregivers  e. Recognize the role of cultural context in influencing individual’s psychological reactions to serious illness 3. Demonstrate self-awareness of one’s own knowledge and skills and set limits appropriately (e.g. advocate for an additional consult or refer a patient to a mental health specialist).	Formulation, Clinical Attunement, Coping Countertransference Holding environment, Therapeutic accompaniment, Therapeutic alliance Mindfulness, Technical neutrality, Unconditional positive regard Cultural Formulation

^aThis category represents concepts and skills that play a role in adaptive coping with the stress of living with serious illness. All palliative care physicians should be able to recognize and support these typical patient responses and behaviors.

^bOrganizational headings are indicated in italics.

^cNote: we have listed psychological concepts as a key term to direct physicians’ further reading/learning, not as an indication that the concept is fully captured in this competency.