An Unauthorized Patient from Honduras Diagnosed with Rectal Cancer and the Role of Palliative Care in Preserving Life

Outcomes 1. Self-report their ability to identify common biases encountered by unauthorized patients in the healthcare setting. 2. Self-report their ability to recognize the expanded role the Interdisciplinary Palliative Care Team plays in caring for unauthorized patients facing serious illnesses. Key Message There is an increased prevalence of cancer diagnosis among the unauthorized immigrants. Unfortunately, the immigrant patient population encounters many barriers that impact its ability to achieve adequate care including those resulting from stigma and bias in the healthcare setting. The Interdisciplinary Palliative Care team can play a key role in advocacy for this vulnerable patient population. Abstract Unauthorized immigrants with cancer are at high risk for inadequate care as they face many challenges including access to routine health visits, home insecurity, limited social or family support, and pervasive stigma and bias in the healthcare setting. (1) The Interdisciplinary Palliative Care (IPC) team's role in caring for this vulnerable patient population extends beyond addressing symptoms, advanced care planning and ensuring appropriate end-of-life care. A 25-year-old unauthorized male from Honduras presented to the ED with a rectal mass, worsening pain, bleeding and significant weight loss. He was found to have a poorly differentiated adenocarcinoma of the rectum and IPC was consulted for pain management. Due to his immigration status and limited social support, some providers vocalized he should return to his home country to further pursue treatments there. The patient ultimately underwent abdominoperineal resection with end-colostomy. He continued to experience severe pain, however the surgical team discounted his complaints and insisted to transition patient off opioids. Later that week, he developed worsening pain and rectal bleed and was found to have a 12x8-cm perineal abscess. Despite concerns about patient's unemployment with no family support or secure housing in the USA, pressure for discharge planning ensued. Throughout his hospitalization, the IPC team advocated for the patient to receive adequate treatments in-hospital while addressing the biases and resulting complications experienced by the patient at hospital leadership level. After 6 months of being hospitalized and receiving 4/5 cycles of cancer-directed-treatments, the patient was able to secure housing due to philanthropic support. The stigma and biases experienced by unauthorized patients can lead to delay in appropriate diagnosis and treatment, and in some cases hasten their decline. The IPC team plays a key role in advocating for this patient population extending beyond the usual and may include interventions to help preserve their life. Keywords Shared Decision Making / Advance Care Planning; Interdisciplinary Teamwork / Professionalism