“It's Not Happening Nearly Enough”: Perioperative Integration of Palliative Care and Urology For Serious Illness (RP305)

Outcomes 1. Identify time points along the perioperative continuum where PC and Urology can be better integrated.2. Understand the importance of the perioperative period as a focus for future interventions to improve quality of care in patients facing urologic serious illness. Key Message Stakeholder interviews reveal a general overall need to create a culture change so that palliative care is integrated appropriately for patients with urologic serious illness. Importance Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life. Objective(s) To understand stakeholder perceptions on integrating perioperative Palliative Care (PC) for patients with serious urologic illness. Scientific Methods Utilized We conducted semi-structured interviews with purposefully sampled palliative care physicians (11), urologists (13), and clinical team members (13) at eleven geographically distributed Veteran Health Administration sites. Team-based thematic analysis was conducted to consensus with a dual review in Atlas.ti. Results We identified one general overall theme and three themes representing needs along the perioperative continuum as opportunities for integrating PC and urology. The general overall need was to “change culture” so that PC is not a “last resort” and “ideally, we would be starting palliative [care], when [we] start curative [treatment].” Opportunity 1: Utilizing telehealth and team member role expansion when discussing diagnosis and treatment options, with urologic surgery as a potential treatment, allows for multiple conversations “so they're not rushed in 15 minutes to mentally deal with the new diagnosis of cancer.” Opportunity 2: Creating a process to ensure goal of surgery conversations occur with both urologists and PC, 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 pre-operative visits, there can be interdisciplinary input and evaluation of the patient prior to surgery, so that the patient can “have a sort of joint meeting with us and the urologist.” This represented the last point in time to de-escalate and offer non-surgical options prior to surgery. Conclusion(s) The study informs future interventions to improve the quality of care by integrating palliative care with urology. Impact Future work can build on these findings by implementing the opportunities and determining how it impacts patient outcomes. Keywords Interdisciplinary Teamwork/Professionalism/Qualitative and Mixed Methods Research