Creating a Dedicated Palliative Care Team for ICU Spanish Speaking Patients in Response to COVID-19.

CONTEXT: The Latinx population faced higher rates of infection and severe illness during the COVID-19 pandemic, resulting in an increased need for palliative care services. OBJECTIVES: We describe the creation and impact of a formal palliative care initiative developed for seriously ill, Spanish-speaking patients during the COVID-19 pandemic at a tertiary care academic medical center. METHODS: Patients were enrolled in the Spanish Palliative Care Initiative during a two-month period starting in April 2020. Selected patients were longitudinally followed by a rotating team of Spanish-speaking palliative care clinicians. Following the intervention, a retrospective chart review was conducted to evaluate the impact of the program. RESULTS: We enrolled 22 patients. The most frequent palliative care task completed during the initial visit was information giving (77%) and during follow-up visits were goals of care discussion (59%) and coping support (59%). Fifteen patients (68%) had a change in code status and 4 patients (18%) were discharged to hospice. CONCLUSION: The creation of a focused clinical program targeting a historically marginalized population offered opportunity for early palliative care intervention in clinical care for Spanish-speaking patients. This underscores the need for Spanish-language concordant palliative care to improve serious illness care, and end-of-life care, by providing continuity of care, spiritual care, and ICU team support.

A Practical Framework for Serious Illness Communication Developed in a Mistrust Pressure Cooker: Lessons from a COVID Intensive Care Unit in Brazil (FR204B)

Outcomes: 1. Explore a serious illness communication model grounded in establishing trust for patient populations in whom mistrust abounds 2. Discuss best practices for applying this communication framework to diverse patient populations with whom you work. During the early days of the COVID-19 pandemic, the world looked on as Brazil experienced one of the first peak waves, caring for patients when prognosis was uncertain, and infrastructure and capacity were severely insufficient. Through this lived experience of developing and running a COVID intensive care unit at a public hospital with extensive barriers to trust, we realized that many existing serious illness communication models do not account for such settings of high baseline mistrust. Grounded in literature on the basic human need of establishing trust as well as the lived experience of running a COVID intensive care unit during such unprecedented circumstances, we developed a framework for serious illness communication in settings of high mistrust. This presentation will highlight the four main components of this communication model: Establishing Trust, Tuning Emotions, Emotional Synchrony, and Cognitive Alignment. The presentation will also include case examples of how utilizing this model changed communication patterns and decision making. We will also share data surrounding patient outcomes. We will also discuss the need for more diverse communication models, both in the United States and globally to meet diverse patient needs. Particularly in healthcare settings where mistrust abounds, it is crucial for clinicians to explore patients' goals and values with cultural humility and with an emphasis on proving themselves trustworthy. Lastly, we will engage in audience discussion, applying this communication model developed in one Latin American country during a humanitarian crisis more broadly to fit the needs of a diverse patient population across multiple settings. Sharing lessons learned from our experiences developing a culturally tailored, practical, trust-enhancing serious illness communication model is one step toward dismantling our healthcare systems' inherent biases and engaging in co-creation of diverse communication models.

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.

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID.

CONTEXT: Although the importance of palliative care (PC) integration in the emergency department (ED) has long been recognized, few formalized programs have been reported, and none have evaluated the experience of ED clinicians with embedded PC. OBJECTIVES: We evaluate the experience of ED clinicians with embedded PC in the ED during the coronavirus disease pandemic. METHODS: ED clinicians completed a survey about their perceptions of embedded PC in the ED. We summarized responses to closed-ended items using descriptive statistics and analyzed open-ended items using thematic analysis. RESULTS: There were 134 ED clinicians surveyed. About 101 replied (75% response rate). Of those who had interacted with PC, 100% indicated a benefit of having PC involved. These included freeing up ED clinicians for other tasks (89%), helping them feel more supported (84%), changing the patients care trajectory (67%), and contributing to clinician education (57%) and skills (49%). Among barriers related to engaging PC were difficulty locating them (8%) and lack of time to consult because of ED volume (5%). About 98% of respondents felt that having PC in the ED was either valuable or very valuable. Open-ended responses reflected a positive impact on clinician wellness and improvement in access to high-quality goal-concordant care. Clinicians expressed gratitude for having PC in the ED and noted the importance of having readily available and easily accessible PC in the ED. CONCLUSION: ED clinicians' perception of embedded PC was overall positive, with an emphasis on the impact related to task management, enrichment of PC skills, providing support for the team, and improved care for ED patients.

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.