Reimagining the inpatient palliative care consult: lessons from COVID-19.

As the number of inpatients with advanced age and chronic conditions rises, so too does the need for inpatient palliative care (PC). Despite the strong evidence base for PC, less than 50% of all inpatient PC needs are met by inpatient consults. Over the past several months in epicenters of the COVID-19 pandemic, PC providers have responded to the increased need for PC services through innovative digital programs including telepalliative care programs. In this article, we explore how PC innovations during COVID-19 could transform the PC consult to address workforce shortages and expand access to PC services during and beyond the pandemic. We propose a 3-pronged strategy of bolstering inpatient telepalliative care services, expanding electronic consults, and increasing training and educational tools for providers to help meet the increased need for PC services in the future.

Interdisciplinary Approaches to Resilience Training in the Care of Underrepresented Populations (VT100)

Outcomes 1. Identify shared challenges of palliative care delivery in diverse patient populations in resource-limited settings 2. Illustrate a psychoeducational approach to enhancing resilience for palliative care providers working in local and global health settings with diverse patient populations in East Africa, India, and the Navajo Nation 3. Highlight resilience interventions applied to healthcare and advocacy work in the correctional system Due to rising rates of burnout, the importance of resilience training and self-care in the field of hospice and palliative medicine is a central issue for all providers.1,2 Delivering care to diverse patient populations in resource-limited settings conveys unique challenges for providers caring for patients with variable access to care.3 These settings have high rates of late presentation, challenges around financial and housing limitations often related to systemic racism, and variable ongoing access to care, particularly highlighted during the COVID-19 pandemic.4 These healthcare disparities, when encountered globally or locally by patients and caregivers, lead to moral distress and burnout for healthcare providers as they struggle with observing suffering and optimizing care in an inherently limited system.5,6 To ensure these populations receive the highest quality of care from well-functioning providers, it is critical to identify and share best practices in resilience training for providers working in these settings. We explore this issue by examining approaches to resilience training with two case studies of palliative care delivery in resource limited settings: Resilience training and structured debriefing for global health palliative care providers working in international settings in partnership with Pallium India, Mulago Hospital in Uganda, and Navajo Nation in the United States;and integrative resilience interventions in prison healthcare and advocacy work in the Louisiana and California departments of corrections. Both featured programs highlight a unique interdisciplinary approach to resilience training design and delivery, drawing on teams of physicians, psychologists, and chaplains, both locally and globally. Through these case studies, we identify innovative approaches to enhancing resilience and decreasing moral distress in resource-limited palliative care settings.

Global Palliative Care Education in the Time of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for health care providers skilled in rapid and flexible decision making, effective and anticipatory leadership, and in dealing with trauma and moral distress. Palliative care (PC) workers have been an essential part of the COVID-19 response in advising on goals of care, symptom management and difficult decision making, and in supporting distressed health care workers, patients, and families. We describe Global Palliative Education Collaborative (GPEC), a training partnership between Harvard, University of California San Francisco, and Tulane medical schools in the U.S.; and two international PC programs in Uganda and India. GPEC offers U.S.-based PC fellows participation in an international elective to learn about resource-limited PC provision, gain perspective on global challenges to caring for patients at the end of life, and cultivate resiliency. International PC colleagues have much to teach about practicing compassionate PC amidst resource constraints and humanitarian crisis. We also describe a novel educational project that our GPEC faculty and fellows are participating in-the Resilience Inspiration Storytelling Empathy Project-and discuss positive outcomes of the project.

COVID-19 Lessons: The Alignment of Palliative Medicine and Trauma-Informed Care.

As the COVID-19 pandemic wears on, its psychological, emotional, and existential toll continues to grow and indeed may now rival the physical suffering caused by the illness. Patients, caregivers, and health-care workers are particularly at risk for trauma responses and would be well served by trauma-informed care practices to minimize both immediate and long-term psychological distress. Given the significant overlap between the core tenets of trauma-informed care and accepted guidelines for the provision of quality palliative care (PC), PC teams are particularly well poised to both incorporate such practices into routine care and to argue for their integration across health systems. We outline this intersection to highlight the uniquely powerful role PC teams can play to reduce the long-term psychological impact of the COVID-19 pandemic.

Rapid Implementation of Inpatient Telepalliative Medicine Consultations During COVID-19 Pandemic.

As coronavirus disease 2019 cases increase throughout the country and health care systems grapple with the need to decrease provider exposure and minimize personal protective equipment use while maintaining high-quality patient care, our specialty is called on to consider new methods of delivering inpatient palliative care (PC). Telepalliative medicine has been used to great effect in outpatient and home-based PC but has had fewer applications in the inpatient setting. As we plan for decreased provider availability because of quarantine and redeployment and seek to reach increasingly isolated hospitalized patients in the face of coronavirus disease 2019, the need for telepalliative medicine in the inpatient setting is now clear. We describe our rapid and ongoing implementation of telepalliative medicine consultation for our inpatient PC teams and discuss lessons learned and recommendations for programs considering similar care models.