Exploring the Barriers to Buprenorphine Therapy for Cancer-Related Pain and Concurrent Opioid Use Disorder: A Case Report.

Although buprenorphine is widely accepted as a treatment option for opioid use disorder (OUD), it is underutilized as a treatment for cancer-related pain. Owing to its decreased side effect profile, various formulations (depending on FDA indication of pain versus OUD), and ability to simultaneously address OUD and pain, buprenorphine is gaining popularity in the outpatient palliative medicine setting. Despite these compelling benefits, there are significant barriers to initiating therapy. These barriers include clinician experience, insurance authorization, pharmacy supply, and stigma. We present a complicated case to describe the practical clinical experience of an attempt at low-dose initiation of buprenorphine to treat cancer-related pain in a patient with concurrent OUD and to discuss ways to start overcoming the encountered barriers.

A Call to Action: Ethics Committee Roundtable Recommendations for Addressing Burnout and Moral Distress in Oncology.

Oncologist well-being is critical to initiating and maintaining the physician-patient relationship, yet many oncologists suffer from symptoms of burnout. Burnout has been linked to poor physical and mental health, as well as increased medical errors, patient dissatisfaction, and workforce attrition. In this Call to Action article, we discuss causes of and interventions for burnout and moral distress in oncology, highlight existing interventions, and provide recommendations for addressing burnout and improving well-being at the individual and organizational levels to deliver ethical, quality cancer care.

Ethical Challenges When Caring for Orthodox Jewish Patients at the End of Life.

Dying is a deeply personal process. The personal values, goals, and experiences of a lifetime come to the forefront during the end of life and may be shaped to some degree by the religious and cultural identity of the patient and family. When patients are part of a faith-based, religious, or cultural minority group, it can be particularly challenging for the clinical care team to gain the understanding and insights needed to reconcile disparities between majority and minority values. This article uses a case study to illustrate and review ethical issues, which frequently occur and can be anticipated in the end-of-life care of patients who identify themselves as Orthodox Jews. Although the specifics are unique to this faith-based minority group, the process of identifying, educating, and developing a means to incorporate faith-based and cultural minority beliefs and values in the provision of care can be applied to other such minority groups that the clinical team may encounter in their work.

Orthodox Jewish Thought Leaders' Insights Regarding BRCA Mutations: A Descriptive Study.

PURPOSE: To examine the factors that influence Orthodox Jewish (OJ) thought leaders' perceptions of genetic counseling and testing for BRCA mutations. The specific aims of this study were to describe (1) OJ thought leaders' views on genetic counseling and testing for BRCA mutation status and (2) insights into this high-risk faith-based minority group and their beliefs about counseling and testing for BRCA mutations. METHODS: In-depth focus groups and demographic questionnaires were used in this descriptive, qualitative study, which was performed in the cancer center of a 750-bed community teaching hospital in Brooklyn, New York. Participants included 17 OJ thought leaders in a large metropolitan area in the northeastern United States. RESULTS: Four themes emerged that describe the key components of the views of OJ thought leaders regarding genetic counseling and testing for BRCA mutation carriers. There was a high level of concern about cancer, recognition that community norms shift, acknowledgment of the role of the rabbi in medical decision making, and concern about the balance between determinism and personal responsibility in utilizing this health care service. CONCLUSION: The identification of social contributors to the utilization of genetic counseling and testing, as well as identification of solutions to optimize utilization of BRCA testing, supports the philosophic premise or conceptual model that faith-based leaders are crucial to the promotion of culturally sensitive health care delivery. Incorporating faith-based leaders early in health care strategic planning and implementation can translate into communities better utilizing health-related services.