Protecting our Elders and Developing Equitable Policies During Public Health Emergencies: Ethical Recommendations.

Purpose of the Review: Experiences of patients, families, healthcare workers and health systems during the COVID-19 pandemic and recent national focus on racial justice have forced a reconsideration of policies and processes of providing care in crisis situations when resources are scarce. The purpose of this review is to present recent developments in conceptualizing ethical crisis standards. Recent findings: Several recent papers have raised concerns that "objective" scarce resource allocation protocols will serve to exacerbate underlying social inequities. Older adults and their formal and informal caregivers suffered from intersecting planning failures including lack of adequate stockpiling of personal protective equipment, failure to protect essential workers, neglect of long-term care facilities and homecare in disaster planning and de-prioiritization in triage algorithms. Summary: Revision of disaster planning guidelines is urgent. The time is now to apply lessons learned from COVID-19 before another disaster occurs. We present several suggestions for future plans.

Improving the Care of Diverse Patient Populations: Let's Advance the Dialogue for Strategies to Address and Navigate the Elephant in the Room (P05)

Outcomes 1. Understand the development of cultural humility by completing a real-time self-assessment of implicit biases 2. Demonstrate recognition of individual implicit biases and exercise cultural curiosity via use of 1 or 2 components of the 5 “R”s tool, which includes cultural humility, mindfulness and compassion 3. Recognize 1 or 2 strategies intended to improve understanding of the cultural values and preferences of those from other cultures Cultural beliefs shape perceptions of illness, prognosis, and suffering and inform preferences for palliative and end-of-life care. Cultural identification encompasses many things: age, gender identity, ethnicity, ability, language, sexual orientation, religion, nationality, and socioeconomic status. Cultural identification and beliefs of patients often differ from those of their clinicians. This range of beliefs, values, and preferences in the clinician-patient relationship creates potential for discord, mistrust, and diminished quality of care. Studies suggest that clinicians and patients and families find interactions where cultural discordance exists challenging. Cultural humility has been found to enhance trust, increase the likelihood of clinically competent care, and increase satisfaction. Increasing clinicians’ cultural humility has been suggested as a mechanism for reducing healthcare disparities. Profound disparities in care have been exposed and exacerbated by the COVID-19 pandemic, which may relate to differences in cultural beliefs and mistrust in the healthcare system. Intentionally recognizing, evaluating, and addressing implicit bias and cultural humility, as well as honoring cultural values and preferences, are strategies that promote access to equitable, high quality, patient-centered care. This session will provide practical strategies and tools for clinicians caring for culturally diverse patients and their families. It will include facilitator-guided experiential learning within small groups using videos, role play, and discussion. Participants will learn and practice strategies to explore cultural beliefs, values, and preferences of those with serious illness and the impact on care preferences;develop shared understanding and exercise respect for individuals regardless of potential cultural-discordant dynamics;and enhance clinician resilience by understanding one's own implicit biases and practicing cultural humility strategies. The session will challenge individual beliefs and assumptions to facilitate personal and professional growth and will increase awareness of implicit biases, enhance confidence, and improve comfort in communication while promoting respect for those from cultural communities discordant with our own.

Protecting our Elders and Developing Equitable Policies During Public Health Emergencies: Ethical Recommendations

Purpose of the Review Experiences of patients, families, healthcare workers and health systems during the COVID-19 pandemic and recent national focus on racial justice have forced a reconsideration of policies and processes of providing care in crisis situations when resources are scarce. The purpose of this review is to present recent developments in conceptualizing ethical crisis standards. Recent findings Several recent papers have raised concerns that “objective” scarce resource allocation protocols will serve to exacerbate underlying social inequities. Older adults and their formal and informal caregivers suffered from intersecting planning failures including lack of adequate stockpiling of personal protective equipment, failure to protect essential workers, neglect of long-term care facilities and homecare in disaster planning and de-prioiritization in triage algorithms. Summary Revision of disaster planning guidelines is urgent. The time is now to apply lessons learned from COVID-19 before another disaster occurs. We present several suggestions for future plans.

Can you hear me now?: Improving palliative care access through telehealth.

Telehealth has been increasingly used to expand healthcare access over the last two decades. However, this had not been the case for palliative care (PC), because telehealth was considered nontraditional and impractical due to the sensitive nature of conversations and a "high touch" philosophy. Motivated by limited PC access to rural and underserved populations and positive PC telehealth studies, clinical PC telehealth models have been developing. However, nearly overnight, the COVID-19 pandemic accelerated the use and uptake of telehealth across health care and especially in PC. As a result, clinicians, administrators, and others agree that telehealth is "here to stay," and will likely maintain widespread use and refinement beyond rural areas. The purpose of this review is to describe exemplar PC telehealth programs in research and clinical practice, including pros and cons, lessons learned, and future directions for the ongoing development and expansion of PC via telehealth across diseases and the lifespan.