Palliative Care for the Individual: Recognizing and Harnessing Resources to Surmount Barriers

Outcomes 1. Identify potential risk factors that may result in patients experiencing unmet supportive care needs.2. Address barriers to care and patient strengths with the goal of creating an individualized approach to patient care.Key MessageThis case involves a woman with multiple risk factors for experiencing healthcare disparities. Each was identified and addressed to better manage her symptoms. It is crucial in palliative care to recognize and address both barriers to care and patients' strengths in order to develop an individualized approach to supportive care.BackgroundMinority race and ethnicity, low socioeconomic status, mental illness, and multiple comorbidities are risk factors for patients experiencing unmet healthcare needs (1-5). By identifying and addressing risk factors and utilizing available resources palliative care can improve outcomes for vulnerable populations.CaseThe patient is a 63 year old Spanish-speaking woman from the Dominican Republic with a history including fibromyalgia, schizoaffective disorder, and stage IV colorectal cancer with metastases to the liver receiving palliative chemotherapy and immunotherapy. She presented to palliative care clinic with uncontrolled cancer-related abdominal pain and chronic musculoskeletal pain due to fibromyalgia. She was prescribed hydromorphone for cancer-related pain. Due to fibromyalgia-related pain, visiting clinic was difficult, so she followed regularly with her palliative care team via telehealth visits including a Spanish phone interpreter. The patient provided limited history during interactions and was withdrawn, requiring her son to provide collateral and help establish a relationship with the team. He noted difficulty determining if her pain was due to fibromyalgia or cancer when administering medications. Drawing from her son's advocacy and insight, the palliative care team collaborated with other providers including primary care, oncology, psychiatry, and interventional pain management, to ensure she received appropriate therapies for her non-cancer conditions. Recently the patient's cancer pain has worsened, and management is complicated by her son's newly variable work schedule limiting his assistance in coordination of care and participation in visits. Through shared decision-making with the patient and her son, she was referred for home-based palliative care, removing limitations of telehealth evaluation and allowing for continuation of consistent care.ConclusionIt is critically important to identify and overcome barriers and employ available resources in order to meet patient needs successfully. Strategies include consistent use of interpreters, coordination with caregivers, full psychosocial assessment, interdisciplinary team support, and implementing the appropriate care setting.KeywordsDiversity, Equity, Inclusion, Belonging, JusticeInterdisciplinary Teamwork / Professionalism 1. Identify potential risk factors that may result in patients experiencing unmet supportive care needs. 2. Address barriers to care and patient strengths with the goal of creating an individualized approach to patient care. This case involves a woman with multiple risk factors for experiencing healthcare disparities. Each was identified and addressed to better manage her symptoms. It is crucial in palliative care to recognize and address both barriers to care and patients' strengths in order to develop an individualized approach to supportive care. Minority race and ethnicity, low socioeconomic status, mental illness, and multiple comorbidities are risk factors for patients experiencing unmet healthcare needs (1-5). By identifying and addressing risk factors and utilizing available resources palliative care can improve outcomes for vulnerable populations. The patient is a 63 year old Spanish-speaking woman from the Dominican Republic with a history including fibromyalgia, schizoaffective disorder, and stage IV colorectal cancer with metastases to the liver receiving palliative chemotherapy and immunotherapy. She presented to palliative care clinic with uncontrolled cancer-related abdominal pain and chronic musculoskeletal pain due to fibromyalgia. She was prescribed hydromorphone for cancer-related pain. Due to fibromyalgia-related pain, visiting clinic was difficult, so she followed regularly with her palliative care team via telehealth visits including a Spanish phone interpreter. The patient provided limited history during interactions and was withdrawn, requiring her son to provide collateral and help establish a relationship with the team. He noted difficulty determining if her pain was due to fibromyalgia or cancer when administering medications. Drawing from her son's advocacy and insight, the palliative care team collaborated with other providers including primary care, oncology, psychiatry, and interventional pain management, to ensure she received appropriate therapies for her non-cancer conditions. Recently the patient's cancer pain has worsened, and management is complicated by her son's newly variable work schedule limiting his assistance in coordination of care and participation in visits. Through shared decision-making with the patient and her son, she was referred for home-based palliative care, removing limitations of telehealth evaluation and allowing for continuation of consistent care. It is critically important to identify and overcome barriers and employ available resources in order to meet patient needs successfully. Strategies include consistent use of interpreters, coordination with caregivers, full psychosocial assessment, interdisciplinary team support, and implementing the appropriate care setting.