Context Patients with SUDs and advanced cancer often require a multidisciplinary approach given their complex symptom and psychosocial needs, however the literature suggests they may face challenges in accessing hospice and palliative care due to stigma, lack of tailored services, and provider discomfort in managing concurrent pain and addiction (1-4). Objectives We aimed to describe rates of hospice use among a national cohort of Veterans who died with advanced cancer with or without a history of SUD between 1/1/16-12/31/19. Methods We identified decedents with advanced cancer using a previously validated electronic health record phenotype (5). In prior work, we validated a simple NLP-assisted approach to identify hospice use with 94% specificity and 85% sensitivity. We identified the history of documented SUD using ICD codes. We then compared the rate of hospice utilization for decedents with advanced cancer with and without a concurrent SUD. Results We identified 26,984 Veterans (97% male; mean age 70, 74.6% white) with advanced cancer who died during the study period. We estimated that 19,800 or 73% received hospice prior to death. Among Veterans with advanced cancer who died with a documented SUD, they were more likely to have died on hospice with alcohol SUD (76% vs. 73%, p< 0.001), a cannabis SUD (79% vs. 73%, p< 0.001), a cocaine SUD (77% vs. 73%, p=0.01), and an opioid SUD (78% vs. 73%, p< 0.001) compared to patients with advanced cancer who died without a history of a documented SUD. Conclusions In a national sample of Veterans with advanced cancer, those with SUDs were more likely to utilize hospice before death. Hospice can provide additional support for patients with many complex needs at the end of life, including routine home visits, that may lead to earlier hospice referrals among patients with active SUDs. Further research is warranted.

Background:Palliative care is a key component of comprehensive humanitarian health; yet, access and service capacity remain limited in displacement settings, where fragile health systems struggle to meet the complex needs of people living with advanced illness. Digital health technologies have the potential to enhance the reach and delivery of palliative care; yet, their feasibility and acceptability in humanitarian settings remain underexplored. Objective:We evaluated the feasibility and acceptability of mPallCare, a mobile health intervention integrating patient-reported symptom and outcome monitoring with a clinician dashboard, to support palliative care delivery in the Bidibidi Refugee Settlement, Uganda. Methods:A 6-week, uncontrolled, exploratory concurrent mixed methods feasibility study was conducted, involving 32 participants with advanced cancer. Community health workers (ie, village health teams) used the mobile app to document patient-reported symptoms and multidimensional outcomes, which were accessible to clinical teams via a dashboard. Following the use of mPallCare, patient and clinical team participants participated in face-to-face interviews. Data collected via mPallCare were analyzed using descriptive statistics to assess feasibility (ie, compliance with reporting, with a feasibility threshold of ≥65% of scheduled reports), and interview data from a subsample of patient and clinical team participants were analyzed using framework analysis to assess acceptability. Results:Participants completed 84.9% (163/192) of symptom reports and 59.4% (266/448) of outcome reports, with a combined 67% (429/640) of all scheduled reports completed. A modest decline in engagement with report submissions occurred across the 6-week study period. Commonly reported symptoms included headache (27/32, 84.4%), muscle pain (27/32, 84.4%), and dizziness (26/32, 81.3%). Interview findings indicated strong acceptability among patients and clinicians, who described improved communication, enhanced symptom management, and greater continuity of care. Reported challenges included initial navigation difficulties, limited translation accuracy, and technical synchronization issues. Participants and clinical leaders identified the potential for integrating mPallCare within Uganda's district health information system to strengthen data use and visibility of palliative care within health reporting structures. Conclusions:mPallCare is a feasible and acceptable digital health intervention for palliative care in a humanitarian setting. While initial uptake was high, sustaining engagement over time may require simplified reporting processes, enhanced language accessibility, and optimizing the mobile app's connectivity and usability. This feasibility phase highlights key priorities for scale-up, including integration with existing health information systems and adaptation for sustained, equitable use across low-resource and displaced populations.

Abstract BackgroundThere is mounting evidence to suggest that immersive virtual reality (IVR) can improve pain in older adults in community settings, yet the use of IVR postoperatively in the acute postoperative period following major elective abdominal surgery remains largely underexplored. ObjectiveThis single-arm pilot study aimed to assess the feasibility, acceptability, and preliminary impact of IVR on self-reported postoperative pain and relaxation levels in older adults following elective major abdominal surgery. MethodsWe recruited individuals aged 55 years and older undergoing elective abdominal surgery at an academic medical center from October 2023 to February 2024. We evaluated feasibility through accrual rate, intervention completion, and questionnaire compliance; acceptability via the System Usability Scale (SUS) and a user experience survey; and tolerability by monitoring self-reported side effects. The preliminary impact of IVR on self-reported pain intensity and relaxation levels was assessed through pre- and postintervention comparisons. ResultsA total of 29 participants, with a median age of 73 (IQR 55‐81) years, were enrolled and completed at least 1 IVR session, with 19 also completing a second session. Perceived usability and overall acceptance of IVR were high, with minimal side effects reported. In terms of the preliminary impact of IVR, statistically significant improvements were observed in both pain and relaxation levels from pre- to post-IVR on day 1 and day 2. ConclusionsThis study suggests the feasibility and acceptability of IVR as a potential future intervention for postoperative pain management and enhancing relaxation among older adults following elective inpatient abdominal surgery. The preliminary findings suggest the need for large-scale studies across additional complex inpatient abdominal surgeries to confirm the acceptance and efficacy of IVR as a postoperative pain management intervention across a wide range of diverse older demographics. Future research is critical to evaluating the therapeutic potential of IVR in a variety of surgical and patient-specific contexts.

Context Ensuring timely GOCC for patients with advanced cancer receiving intensive care is a validated quality measure supported by VA’s life-sustaining-treatment (LST) initiative since 2018 (1). Objectives Apply novel NLP methods to measure GOCC among patients with advanced cancer receiving intensive care to allow for rapid quality improvement because manual chart abstraction takes over 2 hours per chart. Methods Among a national cohort of Veterans with advanced cancer, we examined documentation of GOCC for patients admitted to ICU for >2 days using structured data from templated LST notes. Next, in a random subset of 1000 Veterans we used ClinicalRegex, a natural language processing (NLP) software, to identify GOCC in unstructured data from the electronic health record. We optimized and validated an NLP algorithm using iterative comparison to 100 manually abstracted charts using validated methods (2) and applied the algorithm to 1000 randomly selected charts. GOCC before and after national LST implementation were examined. Results Among 48,240 nationally representative Veterans (average 68 years old, 97% male, 71% white, and 29% rural) with advanced cancer from 1/1/2016-12/31/2019, 6,741 had an ICU episode of > 2 gt; 2 days. From 2016-2019, 22% of veterans had an LST note (1455/6741). Of the patients diagnosed in 2019 (after LST policy implementation), 37% (312/845) had an LST note.Among the NLP cohort of 1000 Veterans with advanced cancer and ICU episode of >2 days, ClinicalRegex identified GOCC in 49% of veterans, LST notes were present in 22%, and 47% had neither. Of the 126 patients diagnosed in 2019 (after LST policy implementation), 59% (74/126) had a GOCC, 41% (51/126) had a LST note, and 37% (46/126) had neither. Conclusions Novel NLP methods efficiently capture GOCC not documented in templated notes and allow for rapid quality measurement to facilitate improvement in rates of GOCC among patients with advanced cancer.

BACKGROUND AND OBJECTIVES:Frailty is common among older patients; however, there is a lack of agreement on methods to diagnose and monitor frailty at point of care. The purpose of this study was to establish consensus on important, feasible, and usable domains for point-of-care frailty assessment within all conceptual models of frailty. RESEARCH DESIGN AND METHODS:We reviewed instruments that assess frailty and extracted the domains measured by each tool. We developed 3 use cases for frailty assessment, which provided context for voters: (1) longitudinal tracking of frailty in the aging patient (>50 years), (2) preoperative evaluation of frailty before surgery in adults (>50 years), and (3) discharge disposition after hospital admission in adults (>50 years). We conducted a modified RAND Corporation/University of California Los Angeles Delphi with a panel of 11 experts. Panelists rated each domain for each use case on a scale from 1 to 9, where 1 is definitely not important/feasible/usable and 9 is definitely important/feasible/usable. RESULTS:Panelists achieved agreement on the following domains for the respective clinical use cases: Physical Strength 1, 2, and 3; Balance 1 and 3; Cognition 1, 2, and 3; Nutrition 1; Physical Activity 1, 2, and 3; Depression 1; Disease 1, 2, and 3; and Social Environment 1 and 3. The remaining items were indeterminate. DISCUSSION AND IMPLICATIONS:We established consensus on 8 domains of frailty across 3 use cases. These results can inform the measurement of domains to diagnose, monitor, and inform the management of frailty within the defined use cases.

PurposeTo determine the feasibility of mapping interdisciplinary role ownership over actionable practices identified from qualitative comments in the Veterans Affairs Bereaved Family Survey (BFS).MethodsWe polled two providers from each of 14 disciplines as to whether an actionable practice that improved end-of-life care quality sits within their scope of practice. We grouped practices by having the greatest, middle, and fewest number of disciplines that claimed role ownership and then characterized what roles were shared.Major FindingsMedicine, nursing, social work, and occupational therapy claimed role ownership of the greatest number of practices among the 14 disciplines. Chaplaincy and the allied health disciplines had a comparatively more limited range of role ownership of practices. Practices with the greatest number of professionals claiming role ownership were general professional behaviors that do not require specialized training (e.g., being easy to talk to). Practices with the middle number of role ownership required clinical specialization (e.g., offering non-pharmacological interventions to reduce agitation). Practices with the fewest number of disciplines required a narrower skill set (e.g., signing the death certificate in a timely manner) or administrative authority to perform (e.g., providing adequate nursing staff).ConclusionsThis project demonstrated the feasibility of mapping BFS actionable practices across disciplines. A larger sample and rigorous statistical analysis are required for application at a health care system level. Understanding role ownership can then guide efforts relating to role ownership and role sharing for end-of-life quality improvement activities.

Objective:The aim is to map out and describe, through a scoping review, the current evidence on immersive virtual reality (IVR) for postoperative pain management in surgical older adults. Background:Managing postoperative pain in older adults through pharmacological interventions poses inherent complexity and risk to the patient. There is a growing interest in nonpharmacological interventions, including IVR, to address postoperative pain in older adults. However, IVR use for postoperative pain across a spectrum of surgical procedures remains largely unknown in the older adult demographic. Methods:A comprehensive literature search of 5 databases was conducted through April 2024. Inclusion criteria were: (1) mean/median age greater than 65; (2) patients underwent surgical procedures; (3) the intervention group received IVR before, during, or after surgery; and (4) numerical postoperative pain scores were collected. Study titles/abstracts underwent initial screening against inclusion/exclusion criteria, followed by full-text screening. A narrative report was compiled with the identified studies. Results:This scoping review yielded 10 studies. Three main findings emerged: (1) IVR for postoperative pain occurred predominantly in total joint replacement surgery; (2) while over half of the studies in this review indicated that IVR could improve postoperative pain management, weak to moderate study designs and small sample sizes limited the ability to draw firm conclusions about IVR use in older adults; and (3) there was significant heterogeneity in IVR administration and program content offered. Conclusions:Despite common misconceptions that older adults are averse to new technology, this scoping review suggests that IVR for postoperative pain in older surgical adults holds potential as an acceptable and feasible intervention. This review highlights the need for more rigorous randomized clinical trials on IVR efficacy in older adults across a more diverse spectrum of surgical procedures and older adult subgroups (eg, underrepresented minority groups or those with physical/cognitive limitations).

BACKGROUND:Little is known about the impact of opioid safety initiatives (OSIs) on veterans with end-stage kidney disease on hemodialysis, a seriously ill population for whom balancing the benefits and harms of opioids can be challenging. OBJECTIVE:To assess temporal trends and outcomes before and after the implementation of the Veterans Health Administration's (VA) OSI. SETTINGS/SUBJECTS:We conducted a cross-sectional study analyzing U.S. veterans who received VA-financed maintenance hemodialysis, either in the VA or under the VA Community Care program, from October 2009 to September 2019. MEASUREMENTS:We assessed trends over time in the rates of outpatient opioid prescribing, moderate to severe pain, opioid overdoses, and use of nonpharmacological therapies. Data from VA, Medicare, and the United States Renal Data System were used. The unit of analysis was the patient-quarter. RESULTS:We identified 44,557 veterans; 97.2% were male, 50.7% were White, and 61.6% were over age 65. The OSI was associated with a 10.28 percentage point (pp) reduction (95% confidence interval [CI]: -12.37, -8.19) in opioid prescribing and a 1.93 pp increase (95% CI: 0.30, 3.56) in the use of nonpharmacological therapies. The overdose rate decreased by 0.27 pp (95% CI: -0.54, -0.003), but the rate of reported moderate to severe pain increased by 3.21 pp (95% CI: 1.01, 5.40). These trends generally persisted among patients with different mortality risks. CONCLUSIONS:Our findings suggest that in the VA dialysis population, the VA OSI was associated with reductions in opioid use and modest decreases in opioid overdose but with limited uptake of nonpharmacological therapies and measurable increases in moderate to severe pain. These findings suggest the importance of an individualized patient-centered approach to opioid prescribing and research on nonpharmacologic alternatives in this population.

INTRODUCTION:Rural-dwelling older adults with cancer have limited access to palliative care and face barriers in coordinating palliative care with cancer care. This study aimed to identify barriers and facilitators to care coordination in the palliative care referral and care delivery process for rural-dwelling older adults with cancer from the perspectives of palliative care and oncology healthcare professionals (HCPs). MATERIALS AND METHODS:We conducted focus groups and dyadic semi-structured interviews with palliative care and oncology HCPs. Participants were recruited from clinics within large academic health systems (n = 14) and rural non-affiliated practices (n = 11) in Colorado. We analyzed interviews guided by a reflexive thematic analysis approach. RESULTS:Five themes emerged; within each theme specific barriers and facilitators were identified: (1) Tension of different practice styles delays palliative care referral for rural older adults; (2) Limited capacity prevents early palliative care integration for older adults in rural areas; (3) Structured communication pathways can facilitate coordinated care for older rural adults; (4) Competing influences of rural cultural context on older adults' palliative and oncologic care coordination; and (5) Telehealth has "come a long way," offering more opportunities for rural older adults to receive effective care coordination. Participants also shared insights on intervention strategies targeting barriers to coordinating palliative care with cancer care for rural-dwelling older adults with cancer. DISCUSSION:The identified barriers and facilitators suggest intervention targets to improve care coordination between palliative care and cancer care for rural-dwelling older adults at the health system, provider, and patient levels.

CONTEXT:Even as health care institutions seek to promote culturally attuned care, clinicians may struggle when cultural norms and practices contradict established clinical practices. OBJECTIVES:To explore sources of moral distress among clinicians treating the growing population of South Asian breast cancer survivors. METHODS:We report secondary analyses from a mixed methods study that aimed to understand the barriers and facilitators to providing culturally attuned care to South Asian breast cancer survivors. We conducted 30-minute virtual semi-structured interviews with multidisciplinary clinicians involved in cancer care. Interviews were guided by the Consolidated Framework of Implementation Research (CFIR). For this study, we used a thematic analysis approach to examine the sources of moral distress, and potential solutions to address it. RESULTS:14 clinicians (8 physicians; 41.6 ± 9.8 years; 9 women; 4 South Asian) were interviewed. We identified the following themes: 1) Clinicians experienced moral distress when South Asian cultural norms conflicted with pillars of biomedical ethics; 2) Moral distress was exacerbated by individual and system-level barriers; and, 3) Solutions may necessitate change across individual, inner setting (e.g., clinics), and outer setting (e.g., health care systems) domains of CFIR. CONCLUSIONS:Clinicians may experience moral distress when their evidence-based and ethical care approaches conflict with cultural norms. Health care systems should provide programs that support clinicians who encounter these dilemmas to ensure high quality clinical care that respects the cultural norms of South Asian breast cancer survivors.

INTRODUCTION:Good-quality care for patients with a serious illness often requires interdisciplinary expertise. In the urologic perioperative period, this can include urologists and Palliative Care (PC). Our objective is to understand how to improve perioperative coordination between urologists and PC providers in the context of urologic serious illness. MATERIALS AND METHODS:We interviewed 38 providers: urologists (13), PC physicians (12), and clinical team members (13) in phase I of this study. From these interviews, there were 96 examples of interdisciplinary communication that were analyzed using qualitative content analysis with dual review in phase II of this study. RESULTS:Two key themes emerged regarding communication between urology and PC teams. First, effective collaboration is often hindered by logistical challenges, such as surgeons' limited availability due to time spent in surgery and difficulties coordinating in-person meetings. Fostering bidirectional, timely communication through asynchronous communication and structured meetings improves alignment within the clinical team before patient interactions. Second, hierarchical structures within medical teams can discourage open dialogue, with nonsurgeons sometimes feeling hesitant to share input. Promoting mutual respect is essential to creating a more balanced and collaborative environment. Together, these themes highlight the need for systemic changes that support accessibility, respect, and communication in interdisciplinary care. CONCLUSIONS:Future directions include implementing an evidence-based intervention with structures and processes to improve interdisciplinary collaboration among urologists and PC.

Quality attributes in health care setting include safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. Quality of care outcomes depend not only on the clinical interactions between clinicians and patients but also on the effective alignment and integration of team efforts, logistics, and care processes. The National Cancer Grid (NCG), with its mandate to facilitate and promote quality standards in patient care across India, facilitated quality improvement (QI) training as a key initiative in order to develop competencies within the clinical teams in QI methodology and to strengthen the quality of cancer care processes across cancer centers in the country. The aim of the study was to describe the inception and evolution of the NCG-QI-Hub, its flagship QI training program, EQuIP India (Enabling Quality, Improve Patient Care) to the present model, to illustrate its journey to self-sufficiency and to share the outcomes of the completed projects. Following a pilot in 2017, the NCG-QI-Hub, in partnership with Stanford Medicine, initiated a mentored QI training program using A3 QI methodology and tools to address quality issues impacting cancer care settings. The trainees used the A3 method of thinking and experienced the plan-do-study-act (PDSA) cycle while improving the identified quality problem. Between 2017 and 2024, 89 QI projects across different domains of cancer care (prevention, treatment, and palliation to survivorship) have been completed. The EQuIP India training program has facilitated the creation of 10 institution-based QI training hubs that conduct in-house QI projects, with 45 national mentors and a growing community of over 300 professionals with competencies in using the methodological steps to conduct QI projects. Based on the follow-up survey done in 2022, more than 70% of alumni institutions continued to be associated with quality improvement project programs. The average project progress score (PPS) achieved at graduation of trainee teams of ≥4.0/5 was sustained across the years of conducting the educational program. EQuIP India immersive QI training program has demonstrated that low-cost, structured QI training programs, contextualized to the institutional culture, are feasible and successful in improving the quality of cancer care. The venture has successfully built national-level QI mentorship capacity formation of institutional QI hubs and has thus triggered a QI culture across alumni NCG centers.

PURPOSE To test the generalizability of an electronic health record (EHR) phenotype for patients with advanced solid cancer, which was previously developed in a single cancer center. METHODS We compared an algorithm to identify patients with advanced solid cancer from a random sample of patients with active cancer in the Veterans Health Administration (VA) and an academic cancer center with a human-coded reference standard between January 1, 2016, and December 31, 2019. RESULTS Compared with the human-coded reference standard, the algorithm had high specificity (93%; 95% CI, 87 to 99 and 97%; 95% CI, 93 to 100) and reasonable sensitivity (85%; 95% CI, 76 to 94 and 87%; 95% CI, 77 to 97) in the VA and academic cancer center populations, respectively. Patients with advanced cancer (compared with those with active nonadvanced cancer) had higher mortality at the VA and academic cancer center (29.2% and 17.0% 6-month mortality v 6.8% and 3.5%), respectively. CONCLUSION This EHR phenotype can be used to measure and improve the quality of palliative care for patients with advanced cancer within and across health care settings.

Palliative care is a key component of comprehensive humanitarian health, yet there is often limited availability and capacity within humanitarian settings, where fragile health systems struggle to meet the complex needs of people living with advanced illness. Digital health technologies have the potential to enhance the reach and delivery of palliative care, yet their feasibility and acceptability in humanitarian settings remain underexplored. To evaluate mPallCare, a mobile health intervention integrating patient-reported symptom and outcome monitoring with a clinician dashboard, to support palliative care delivery in the Bidibidi Refugee Settlement, Uganda. A six-week, uncontrolled, mixed-methods feasibility study was conducted, involving 32 participants receiving palliative care. Community health workers (i.e., village health teams) used the mobile application to document patient-reported symptoms and multidimensional outcomes, which were accessible to clinical teams via a dashboard. Following the use of mPallCare, patient and clinical team participants participated in face-to-face interviews. Data collected via mPallCare were analysed using descriptive statistics to assess feasibility (compliance with reporting), and interview data were analysed using framework analysis to assess acceptability (user experiences). Participants completed 84.9% of symptom reports (163/192) and 59.4% of outcome reports (266/448), demonstrating feasibility. Commonly reported symptoms included headache (84.4%), muscle pain (84.4%), and dizziness (81.3%). Patients and clinical staff found the intervention acceptable, citing improved patient-provider communication, enhanced symptom management, and increased care coordination. Challenges included initial navigation difficulties, translation limitations, and intermittent technical issues. Clinical teams highlighted the potential for integrating mPallCare with national health information systems. mPallCare is a feasible and acceptable digital health intervention for palliative care in a humanitarian setting. While it facilitates real-time symptom monitoring and patient engagement, enhancing language accessibility and overcoming technical challenges will be crucial for sustainable implementation. Future research will explore scale-up potential, integration with existing health information

BACKGROUND:Artificial intelligenc (AI) holds increasing promise for enhancing palliative care through applications in prognostication, symptom management, and decision support. However, the utilization of real-world data, the rigor of validation, and the transparency and reproducibility of these AI tools remain largely unexamined, posing critical considerations for their safe and ethical integration in sensitive end-of-life settings. OBJECTIVES:This scoping review systematically mapped the landscape of AI applications in palliative and hospice care, focusing on three key domains: (1) the purposes and data sources of AI models; (2) the methods and extent of model validation and generalizability; and (3) the degree of transparency and reproducibility. METHODS:A comprehensive search was conducted across multiple databases (e.g., PubMed/MEDLINE, Embase.com, IEEE Xplore, Web of Science, ClinicalTrials.gov) from inception to December 31, 2023. Studies of any design applying AI (including machine learning or natural language processing) in palliative or hospice contexts for adults were included. Two independent reviewers screened studies and charted data on study context, patient population, data type, AI methodology, outcome, evaluation approach, and indicators of model generalizability, transparency and reproducibility. RESULTS:From 4,747 unique records, 125 studies met inclusion criteria, with over half published in the last three years, predominantly from the United States. Most studies (86%) were retrospective proof-of-concept designs, with few randomized controlled trials (n = 7) or prospective evaluations (n = 6). AI applications primarily focused on mortality prediction (n = 63) in cancer populations (n = 62), followed by advance care planning (n = 18) and symptom assessment (n = 17). Structured electronic health record data were the most common input (n = 67, 54%). Transparency was limited, with only 19 studies (15%) sharing code and 14 (11%) providing data access; none adhered to AI-specific reporting guidelines. Ethical frameworks for evaluation were notably absent. CONCLUSION:AI in palliative care remains in early development, showing promise in areas such as prognosis and documentation support. However, limited validation, insufficient cross-site testing, and lack of transparency currently limit clinical applicability. Future research should emphasize external validation, inclusion of broader patient data, and adoption of open science practices to ensure these tools are reliable, safe, and trustworthy.

BACKGROUND:Palliative care has the potential to relieve burdened global health systems but is in short supply in many low-resource settings. Community health workers (CHWs) and digital health tools/telephonic support have the potential to scale scarce palliative care resources and improve outcomes for seriously ill adults in home/community settings. AIM:To describe the utilization of CHWs and digital health/telephony in the palliative care of seriously ill adults in these settings. DESIGN:We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. Search terms were developed with a health sciences librarian. DATA SOURCES:The databases PubMed, EMBASE, LILACS, and CINAHL were searched for articles published from January 1, 2012, to December 30, 2023. RESULTS:A total of 31 articles out of 7518 screened were included in the final analysis. Studies were mostly conducted in the United States. Most interventions were remote, with only four addressing rural or minority populations. Nineteen targeted advanced cancer, with others focusing on chronic obstructive pulmonary disease, heart failure, renal disease, and hospice care. CHWs and digital health/telephony were commonly used for physical and psychological care. Culturally tailored interventions with CHWs were few but effective. Patient quality of life, health care utilization, and caregiver outcomes were significantly impacted. CONCLUSIONS:CHWs and digital health/telephony can improve quality of life, health care use, and caregiver support. Most research focuses on physical and psychological aspects of care instead of cultural aspects of care. Future research is needed to explore culturally tailored interventions in minority populations and low- and middle-income countries, as well as investigate emerging remote technologies to allow for scaling palliative care into home/community settings.

BACKGROUND:In 2021, the Palliative Care - Promoting and Improving Clinical Excellence (PC-PAICE) collaborative was adapted in Australia after an initial run in India. PC-PAICE partners global experts with local palliative care centers to improve care by fostering quality improvement (QI) capacity. INTERVENTION:PC-PAICE is a guided QI and mentorship curriculum delivered to interdisciplinary teams working on a relevant project, and each team develops salient project measures. The program has been offered to three Australian cohorts and has trained participants to mentor subsequent participants to build local QI capacity. OUTCOMES:Qualitative evaluation has shown teams tackled specific and immediate challenges facing their clinics that were not otherwise recognized without increasing overall work burden. Teams have presented their projects at conferences, and a number have published their work in journals. CONCLUSION/LESSONS LEARNED:PC-PAICE is uniquely suited to improving palliative care via equitable global partnerships among diverse practitioners. Given its promise, the team is planning to implement the model more widely.

CONTEXT:Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life. OBJECTIVE:To understand stakeholder perceptions on integrating perioperative Palliative Care (PC) for patients with serious urologic illness. METHODS:We conducted semi-structured interviews and team-based thematic analysis to consensus with a dual review. Purposefully sampled urologists, palliative care physicians, and clinical team members at fourteen geographically distributed Veteran Health Administration sites were interviewed. RESULTS:We identified one general overall theme, to "change culture" so that PC is not a "last resort," and three opportunities along the perioperative continuum for integrating urology and PC. Opportunity 1: Utilizing telehealth and team member role expansion when discussing the initial diagnosis, with surgery as a potential treatment option, allows for multiple conversations "so they're not rushed in 15 minutes to mentally deal with the new diagnosis." Opportunity 2: Creating a process to ensure goal of care conversations occur, since "urologic procedures can have complications that significantly impact quality of life," which "would require changing how our workflow is structured." Opportunity 3: During the preoperative visits, interdisciplinary input and evaluation of the patient prior to surgery allows the patient to "have a sort of joint meeting with us and the urologist." This represented the last point in time to de-escalate and offer nonsurgical options prior to surgery. CONCLUSIONS:The study informs future interventions to improve the quality of surgical care by integrating PC with urology in a unified workflow.