Palliative Care Practice Research Articles

The experiences of rural generalist occupational therapists in provision of palliative care in rural, regional, and remote Australia: A phenomenological inquiry.

Access to specialist palliative care in rural and remote Australia is limited, resulting in a reliance on generalist health professionals to provide these services. Although literature exists concerning the experiences of some health professions in providing rural generalist palliative care, little is known about the experiences of occupational therapists who fill these roles. This paper aims to address this gap in knowledge by exploring the experiences of rural generalist occupational therapists in the provision of palliative care in rural, regional, and remote Australia. An interpretive phenomenological approach guided this research. Data were collected from eight rural generalist occupational therapists across Australia, using semi-structured, in-depth interviews. Data were thematically analysed to develop a nuanced understanding of lived experience in provision of palliative care. Due to the focus of this research on the practice experiences of occupational therapists, consumer and/or community involvement was not undertaken in its design or implementation. Three key themes were identified: 'community connections - a double-edged sword'; 'frustrations with structural and contextual factors limiting quality palliative care service provision'; and 'education and support as enablers of professional preparedness for palliative care service provision.' Taken collectively, these findings shed light on a variety of challenges and opportunities associated with rural generalist palliative care occupational therapy practice, as well as clues to their effective management. Knowledge of rural generalist occupational therapists' experiences can inform workforce development, promote retention of rural occupational therapists, and improve outcomes for dying persons, their families and caregivers. This study offers new insights into challenges and opportunities for rural generalist occupational therapy practice in palliative care and highlights the way in which both, new and existing support structures may be of value in promoting practice capacity and therapist wellbeing. It can be hard to get expert support for dying people in areas outside of cities in Australia. Health workers in these areas should be helped to provide good care. In this study, we spoke with some health workers in rural and remote areas who occasionally work with people who are dying. They told us that people in these areas were often helpful in supporting people who are dying because they felt close to them. But they also said that this made caring sadder for health workers because, sometimes, they were close to the people who were dying too. Having too much work, not enough experience and long distances made providing good care extra difficult. The health workers said that getting expert advice or using online teaching could help them improve their practice, but finding the time to do this is hard.

Implementing palliative and end of life care for people with dementia.

Dementia is characterised by memory loss, behavioural changes and decline of cognitive, social and physical functions and is a life-limiting condition. At the point of diagnosis it is classed as a palliative condition, yet there is limited public and healthcare professional awareness that, once diagnosed, a person will either die of dementia or die with dementia. This article discusses how the recognition and timing of the need for palliative dementia care is pivotal in providing person-centred care. The authors explore factors such as optimal prognostication, advance care planning, staff education and accessing support from palliative and end of life care teams and Admiral Nurses. The authors also use a fictional case study to demonstrate best practice in palliative dementia care.

Knowledge, attitudes, practices of cancer palliative care and their associated factors among nursing officers in Apeksha Hospital, Maharagama

Introduction: Nursing officers, having a good knowledge, favourable attitudes, and correct practices in cancer palliative care uplift patient’s quality of life. Objectives: To describe the level of knowledge, attitudes, practices of cancer palliative care and associated factors among the nursing officers in Apeksha Hospital, Maharagama. Methods: A descriptive cross-sectional study was carried out among 252 participants with more than one year of work experience at Apeksha Hospital, Maharagama. Stratified sampling technique was adopted to select the nursing officers from different wards. Data were collected using a validated self-administered questionnaire. Sum of points of each participant and the percentage was calculated. Depending on the mean score they were categorized into groups accordingly. Data were analysed initially by a descriptive analysis and then by Chi square test using SPSS software version 26. P<0.05 was the significance level. Results: Response rate was 70. %. The mean age of the study participants was 32.9 (SD=6.55) years. The majority (59.5%) had good knowledge, 53.2% had favourable attitudes and 54% engaged in correct practices. Mean knowledge score was 26.4 (SD=3.44). Nurses above 30 years of age, married and having more than 10 years’ experience had significant association with knowledge (p<0.05). Most of the participants who had good knowledge had correct practices (p<0.001). Most of the participants those who had favourable attitude had correct practices (p<0.001). Association of level of knowledge and attitude was not found to be statistically significant (p=0.109). Conclusion: The majority of the nurses had a good knowledge, favourable attitudes and were engaged in correct practices in palliative care. There is a significant association between the year of experience and the nurses’ knowledge on palliative care. Having a good knowledge and favourable attitude on palliative care were positive factors for correct practices.Keywords: Knowledge, Attitude, Practices, Cancer palliative care, Nurses

"Who You Are and Where You Live Matters": Hospice Care in New York City During COVID-19 Perspectives on Hospice and Social Determinants: A Rapid Qualitative Analysis.

Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals' perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic. Methods: We conducted semistructured interviews with 30 hospice professionals who delivered care to home hospice patients during the COVID-19 pandemic in NYC using a qualitative descriptive design. Purposive sampling was used to recruit professionals from a range of disciplines including physicians, advanced practice providers, nurses, social workers, chaplains, and hospice administration and management. Participants worked for one of two large NYC metro hospices and one outpatient palliative care practice serving the five boroughs of NYC and the surrounding suburbs. Rapid qualitative analysis was used to identify themes. Results: Thirty hospice professionals were interviewed, spanning a variety of clinical and administrative roles. Most (21 out of 30) reported that social determinants affected access and/or delivery of equitable hospice care. Two key themes emerged from interviews: (1) SDOH exist and affect the delivery of high-quality care and (2) disparities were exacerbated during the COVID-19 pandemic resulting in barriers to care. Subthemes outline barriers described by hospice professionals: decreased hospice enrollment, telehealth challenges, resulting in deficient patient/family education, shortages of nursing assistants in some neighborhoods, and diminished overall quality of hospice care for some patients. SDOH created barriers to hospice care through neighborhood factors, resource barriers, and system challenges. Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.

Scaffolding patient agency: Conceptualising readers' cognitive work in the comic gutter.

A life-limiting illness can erode an individual's positive sense of self. Storytelling can help counteract this, through scaffolding patients' agency and supporting them in acting to change something which matters to them. This article explains how visual stories - comics - are used within the PATCHATT intervention to support the redevelopment of a person's agential self. Through the provision of a conceptual map, this article explores the gutter as a liminal space, arguing for the importance of the deep reader engagement which takes place there. It uses Bob's comic, a story used within PATCHATT, to explore how reflexivity and imagination work together within the liminal space of the gutter to stimulate and enhance palliative care patients' agential change leadership. It concludes by considering the implications of the argument put forward for palliative care practice.

Living for the Moment - How Important Is It in the End of Life?

This essay investigates the role of present-moment living in end-of-life care, drawing on reflections from a personal patient encounter in a palliative care setting, Mrs. B, a 63-year-old patient with terminal squamous cell lung cancer, whose experience underscores the impact of living with a sense of fulfillment and joy despite a life-limiting diagnosis. Mrs. B's approach to her illness-marked by an optimistic acceptance of mortality and a focus on daily joys-challenges traditional palliative care paradigms that emphasize somberness and future-oriented care. Through detailed narrative and reflective analysis, the essay highlights how Mrs. B's resilience and spiritual beliefs contributed to her ability to maintain a positive outlook in the face of terminal illness. This case study illustrates the potential for joy and present-moment living to coexist with palliative care practices, offering a nuanced perspective on patient care. The discussion extends to the implications for healthcare professionals, advocating for a more adaptable and empathetic approach that aligns with individual patient values and preferences. This reflection calls for a shift in palliative care practices towards recognizing and supporting the diverse ways patients navigate their end-of-life experiences.

Journeys into palliative care: Social workers' narratives of mobilising and sustaining practice

INTRODUCTION: With Aotearoa, New Zealand's increasing diversity and ageing population, social work has a vital role in palliative care practice. This study advances the understanding of palliative care social work and its implications for practice, education and support from a practitioners’ point of view. METHODS: Utilising a constructivist case study approach, in-depth data was collected from social work practitioners about their pathways and practices in palliative care. Purposive and snowball sampling techniques were employed, resulting in 12 individual semi-structured interviews and a focus group with 5 participants. FINDINGS: The participants' voices illustrate current social work practice and its implications from personal, pedagogical, and professional perspectives. Participants were often drawn to palliative care social work through career embeddedness and personal experiences of loss and grief. The study revealed how past, present, and future considerations shape palliative social work practice, including journeys to palliative care, mobilising social work practice, and sustaining support. Participants used various assessment tools based on service context, with limited exposure to palliative care in tertiary curricula. Most participants continued to seek post-qualifying professional development opportunities working in this field. CONCLUSION: The study underscores the importance of team support, ongoing education, and self-care for effective social work practice in palliative care. Recommendations include enhancing educational emphasis on palliative care, developing a New Zealand-based assessment tool for palliative care social work, and improving professional encounters related to death and dying. These insights can guide efforts to enhance palliative care social work practice in Aotearoa, New Zealand.

A Scoping Review of the Barriers and Facilitators to Clinician Engagement in Hospital-Based Palliative Care in Australian Hospitals.

Background: Current research has shown that inpatient palliative care (PC) services are under-utilized, poorly integrated, and frequently introduced too late during inpatient hospital stays. The aim of this study was to identify a comprehensive list of multi-disciplinary facilitators and barriers to inpatient PC in Australian hospitals through a scoping literature review. Methods: This review identified articles published since 2000 from 3 electronic databases (CINAHL Plus, MEDLINE and Embase), which included discussion of collaboration among non-palliative care clinicians and palliative care professionals in Australian hospitals. We used an inductive approach to identifying key domains of barriers and facilitators. Results: Thirty-four articles met inclusion criteria following full text review. Barriers and facilitators were categorized in 7 domains: (1) Patient concerns, (2) Family concerns, (3) Clinician knowledge, education, and experience in palliative care, (4) Recognition and acceptance of prognosis when a patient was dying or needing end of life treatment, (5) Reconciliation of individual and professional values around PC, (6) Clinician access to resources for PC in the hospital, and (7) Communication between the PC team and ward clinicians. Each domain included potentially substantial barriers to PC delivery and practice. However, given the small sample sizes and specialized settings of many included studies, it was difficult to draw conclusions on the relative significance of different barriers across hospitals. Conclusion: This review identified a number of barriers and facilitators across studies. Subsequent research needs to more comprehensively compare factors impacting PC use in order to improve implementation of PC across hospital settings.

Impact of early palliative care referral in patients with locally advanced and metastatic GI/lung cancer.

201 Background: Early palliative care improves quality of life and survival in patients with metastatic NSCLC. As a result, ASCO recommends early palliative care integration in patients with metastatic cancer. However, generalizing the benefits outside of a clinical trial may be difficult due to selection bias of patients that opt into palliative care due to advanced symptom burden and real-world resource constraints. Therefore, the benefits of this in real-world practice may not be realized. We aimed to evaluate early vs late palliative care referral impact on unplanned hospital visits and survival among GI and lung cancer patients at a large health system cancer center. Methods: The study design was a retrospective, single health system, review of patients treated at Orlando Health from 2021-2022.156 patients of all stage GI and Lung cancers were included. For these patients, early referral was defined as receiving a palliative referral within 8 weeks of cancer diagnosis. Any referral later than this was considered late and it was possible for patients to opt out of referral. Our main outcomes were unplanned hospital visits and survival. To compare the rates of these between palliative care referral groups, a multivariable negative binomial regression model was fitted. To assess any differences in survival, a multivariable cox hazard regression model was fitted. These were adjusted for age, sex, diagnosis, stage, ECOG, race, and insurance. Results: Patients with any palliative care referral had increased unplanned hospital visits and shorter survival than patients who did not have referrals. Specifically, patients with no palliative care referrals had a 62% lower relative rate of unplanned hospital visits compared to patients with early referral (RR = 0.38 [0.22-0.66], p<0.001). And patients with any time referral had approximately 8 months lower restricted mean survival times (RMST) when followed for 2 years for stage 1-3 cancers than patients receiving no palliative care (14 vs 22 month RMST; stage x palliative care interaction, p <0.05). In contrast, stage 4 patients had similar survival of ~14-month RMST when followed for 2 years regardless of referral. Conclusions: In real world practice palliative care referral was associated with increased unplanned hospital visits. Additionally, in this retrospective review, palliative care referral was not found to confer a survival advantage in gastrointestinal and Lung cancer patients. We postulate that this is related to selection bias in the opt in approach to palliative care referral biasing towards a sicker population with higher symptom burden and comorbidities. Our future prospective study will build upon this work through expansion of palliative care services and to better evaluate patient co-morbidities. Our goal is to increase utilization of palliative care for patients with GI and lung malignancies as part of a multidisciplinary integrative approach.

A Web-Based Education Program About Primary Palliative Care for Heart Failure: A Study Protocol of Wait-Listed Randomized Controlled Trial.

The number of patients with heart failure (HF) is rapidly increasing as palliative care is being integrated into HF management and the need for a nursing workforce to meet these demands grows. To address this, we have developed a Web-based educational program on primary palliative care for HF among general registered nurses caring for patients with HF in Japan. The aim of this study was to evaluate the program's effectiveness on nurse-reported palliative care practice, difficulty, and knowledge. In this open-label, individual-level, wait-listed randomized controlled trial, 150 Japanese general registered nurses, with experience in caring for patients with HF and clinical ladder level ≥ 2 in inpatient, outpatient, and home-visiting care settings, will be randomly divided (1:1 ratio) into a Web-based educational program group and a wait-list control group. The follow-up period is 6 months after the intervention. The primary outcome is the nurse-reported practice score in primary palliative care, and the secondary outcomes are the nurse-reported difficulties score and knowledge score. We herein describe the study protocol of a wait-listed randomized controlled trial regarding a Web-based educational program, which is a novel approach for these nurses. If the results of this study support our hypothesis, they could help expand primary palliative care, including daily nursing practices, such as symptom management and interdisciplinary collaboration, in the field of cardiovascular nursing.

Effects of Dignity Therapy for Palliative Care Patients and Family Caregivers: A Systematic Review.

Dignity Therapy (DT) is a psychosocial intervention aimed at alleviating existential distress, enhancing meaning, and improving the overall well-being of palliative care patients and their family caregivers. While individual studies have demonstrated the benefits of DT, a comprehensive evaluation of its impact on key outcomes such as quality of life (QoL), depression, anxiety, and well-being is needed. This study aimed to systematically review the effects of DT on palliative care patients and their family caregivers, focusing on outcomes related to QoL, psychological distress (depression and anxiety), and overall well-being. A systematic review was conducted by searching multiple databases, including Cochrane Library, PubMed, ScienceDirect, Web of Science, and Scopus, for randomized controlled trials (RCTs) evaluating DT in palliative care. Inclusion criteria were RCTs reporting on QoL, depression, anxiety, well-being, and dignity-related distress. Two reviewers independently screened studies and extracted data. Study quality was assessed using the Cochrane Risk of Bias tool. Eight RCTs met the inclusion criteria. DT demonstrated significant improvements in QoL and well-being among palliative care patients, with reductions in depression and anxiety. Improvements were observed in the physical, psychological, and social domains of QoL. Family caregivers also experienced enhanced spiritual well-being, hope, family cohesion, and adaptability. However, not all outcomes were consistently improved across all studies, indicating variability in DT effectiveness. DT is a promising intervention for enhancing QoL and reducing psychological distress among palliative care patients and their family caregivers. While evidence supports its beneficial impact, further high-quality research is required to confirm these findings and clarify the mechanisms through which DT works. Incorporating DT into palliative care practice is recommended to address the comprehensive needs of patients and their families.

Navigating Palliative Care: A qualitative study of the needs and challenges of newly qualified nurses

Summary Background: Newly qualified nurses are expected to care for life-threateningly ill patients and their relatives. However, there is currently a significant research gap concerning the experiences and challenges faced by newly qualified Danish nurses when encountering basic palliative care in practice. Aim: To explore the experiences of newly qualified nurses providing basic palliative care. Methods: Individual in-depth interviews with nine nurses were conducted, and data analyzed through qualitative, descriptive analysis. Findings: The study underscores the pivotal shift from being a student to becoming a practicing nurse, revealing uncertainties and a need to engage in palliative care during clinical training. Additionally, the study unveils a pervasive sense of busyness in the practice of healthcare, preventing a balance between efficiency and calmness in palliative care. Administering medication, handling crisis-reactions, and communicating with fearful patients and relatives requires courage and experience. The emotional impact is profound, necessitating support and dialogue. The identified challenges are explored in the discussion, emphasizing how busyness impacts palliative care, and highlighting the significance of structured support mechanisms to enhance newly qualified nurses’ competences and confidence in their work in palliative nursing. Conclusion: Newly qualified nurses face challenges transitioning to professional practice. The fast-paced healthcare system impedes their ability to deliver sensitive, person-oriented care, causing uncertainty and fear of failure. Ongoing dialogue and support from experienced colleagues are crucial for helping newly qualified nurses prioritize tasks, make informed clinical decisions, and develop leadership skills in basic palliative care. Keywords: Palliation; Newly qualified nurses; Nursing education; Qualitative research; Healthcare system dynamics; Collegial support

Digital health for cancer symptom management in palliative medicine: systematic review

BackgroundDigital health technologies (DHTs) play a crucial role in symptom management, particularly in palliative care, by providing patients with accessible tools to monitor and manage their symptoms effectively. The aim...

Top Ten Tips Palliative Care Clinicians Should Know About Applying Key Psychotherapy Concepts in Practice.

Psychological symptoms are notably prevalent in palliative care (PC) settings, significantly impacting quality of life for patients and their families. Given the inherent multidimensionality of suffering in PC, addressing these psychological aspects is essential. This article aims to introduce and integrate discrete concepts from various schools of psychotherapy, which are directly applicable to PC practices, thereby providing clinicians with a rich toolkit to manage psychological distress. The article focuses on 10 key concepts from different psychotherapeutic traditions. They are a small sample from the vast and deep pool of wisdom contained in psychotherapeutic theory, and they were selected due to their direct applicability to PC practice. Adopting psychotherapeutic principles, along with leveraging the interdisciplinary wisdom inherent in PC practice, enhances our therapeutic relationships in PC and empowers patients to navigate their illness with greater resilience and adaptive coping.

Evaluation of a perinatal palliative care program by SWOT analysis.

Perinatal Palliative Care (PPC) is individualized medical-nursing care aimed at improving the quality of life of newborns with life-limiting conditions and to support their families. This study draws on the analysis of the experience gained over ten years by a service of PPC called the "Percorso Giacomo" (PG). We employed a SWOT analysis to identify the strengths, weaknesses, opportunities, and threats of the PG through a systematic retrospective review of 48 cases followed by the program over the course of 10 years, 21 unsolicited parents' narrative and 27 experts' point of view. Main strengths of the program were communication and parents' involvement in shared decision-making. Main weaknesses included lack of knowledge of the presence and the role of the PG and lack of resources. For opportunities, the PG proved to be an innovative choice for pregnancies with a fetal life-limiting diagnosis, however threats were identified such as lack of knowledge of PPC and delayed referrals. The analysis by SWOT method of the 10-year experience of the PG allowed the identification of limitations and areas of improvement, however demonstrated that the PG provided beneficial services to women faced with fetal life-limiting diagnoses. Perinatal Palliative Care (PPC) practice and literature on this subject is still limited. This study offers features of the 10-year experience of the Percorso Giacomo (PG), a service of PPC, through a SWOT analysis. By identifying strengths, weaknesses, opportunities and threats of the PG, the study shows limitations and areas of improvement but also benefits of a PPC service to women with fetal diagnosis of life-limiting condition and may allow replication in other institutions.

Analyzing innovative policies and practices for palliative care in Portugal: a qualitative study

BackgroundCountries with formal policies for palliative care, and advanced and integrated practices in this field, such as Portugal, face challenges in achieving excellence in care, particularly in home-based assistance. Issues include care coordination among providers, confusion regarding the roles of each health care professional in the network, and a lack of monitoring and evaluation of actions. Our objective was to analyze the implementation of palliative care in primary health care in Portugal.MethodsWe conducted a qualitative, descriptive, and exploratory study in Portugal involving health care professionals with experience in palliative care. The data were collected through semistructured interviews and focus groups between March and October 2023. Eighteen health care professionals participated. We used the Alceste software for lexicographic analysis. The research was authorized by an Ethics Committee.ResultsFour classes were identified; classes 1 and 2, comprising 77% of the corpus, addressed the study objectives. Participants highlighted inequitable access, strategic development plans with unattainable short-term goals; and low literacy. They emphasized the importance of legislation, professional training initiatives for generalist palliative care at home, and early referral. Home-based challenges included professionals’ lack of exclusive dedication, absence of 24/7 coverage, and unavailability of capable family caregivers. The networks’ response to hospital admissions and patient transitions from hospital to home, with access to the specialized team, was also inadequate.ConclusionsHealth care professionals aim to increase patients’ time spent at home, reduce emergency department visits, and minimize hospitalizations by leveraging the resources of the national palliative care network. In addition to investments to sustain network implementation and legally guaranteed palliative care rights, the country must focus on measurable indicators for evaluating and monitoring actions, providing better guidance in the short, medium, and long term.

Implementation of the psycho-existential symptom assessment scale in palliative care: Qualitative analysis of stakeholders perspectives

ObjectivesTo explore 1) perspectives of feasibility, acceptability, integration and sustainability of the Psycho-existential Symptom Assessment Scale (PeSAS); 2) barriers and benefits of PeSAS in its real-world performance; and 3) clinician confidence and perceived competency in using PeSAS. MethodsThirty-one key stakeholders from nine palliative care services who participated in the implementation of the PeSAS were purposefully sampled and participated in semi-structured interviews. Data was managed using the Determinants Framework. ResultsBenefits of PeSAS were a common language enhancing communication, identifying symptoms of psycho-existential distress, initiating referral, providing acknowledgement for previously unrecognised distress and enhancing patient agency. Key barriers were the availability of skilled clinicians, patient characteristics such as delirium and phase of illness, avoidance of confronting end-of-life conversations, information technology resourcing, and reduced engagement due to language, culture and health literacy. ConclusionScreening using the PeSAS is feasible and acceptable once clinicians are adequately trained to administer it. Our study highlights the benefits of qualitative enquiry in developing and implementing new interventions. Practice ImplicationsThe identification and management of psycho-existential symptoms should be part of routine practice in palliative care. However, adequate staff training, resourcing, referral pathways and implementation process and outcome assessments are important to ensure sustainability.

Clinician perspectives on delivering primary and specialty palliative care in community oncology practices.

Clinical guidelines recommend early palliative care for patients with advanced lung cancer. In rural and underserved community oncology practices with limited resources, both primary palliative care from an oncologist and specialty palliative care are needed to address patients' palliative care needs. The aim of this study is to describe community oncology clinicians' primary palliative care practices and perspectives on integrating specialty palliative care into routine advanced lung cancer treatment in rural and underserved communities. Participants were clinicians recruited from 15 predominantly rural community oncology practices in Kentucky. Participants completed a one-time survey regarding their primary palliative care practices and knowledge, barriers, and facilitators to integrating specialty palliative care into advanced-stage lung cancer treatment. Forty-seven clinicians (30% oncologists) participated. The majority (72.3%) of clinicians worked in a rural county. Over 70% reported routinely asking patients about symptom and physical function concerns, whereas less than half reported routinely asking about key prognostic concerns. Roughly 30% held at least one palliative care misconception (e.g., palliative care is for only those who are stopping cancer treatment). Clinician-reported barriers to specialty palliative care referrals included fear a referral would send the wrong message to patients (77%) and concern about burdening patients with appointments (53%). Notably, the most common clinician-reported facilitator was a patient asking for a referral (93.6%). Educational programs and outreach efforts are needed to inform community oncology clinicians about palliative care, empower patients to request referrals, and facilitate patients' palliative care needs assessment, documentation, and standardized referral templates.

It Starts With a Story: A Four-Step Narrative-Based Framework for Serious Illness Conversations.

Background: As a key component of advance care planning, serious illness conversations form a core intervention in palliative care. To achieve effective serious illness conversations, acknowledgment and inclusion of patient sense of self and identity are critical. However, no framework exists to describe how goals, values, and choices relate to patient identity. This conceptual gap hinders the advancement of palliative care education and practice. Objective: This philosophical investigation aimed to explicate two items: first, a novel conceptual framework for serious illness conversations; second, a structured approach to optimize these conversations within the palliative care clinical context. Methods: A philosophical and theoretical analysis was performed within an interdisciplinary context, by scholars in palliative care, medical humanities, philosophy, and bioethics. Key literature in psychology, qualitative research on the experience of serious illness, medical ethics, and choice architecture in medical decision-making were reviewed, and a structured conceptual and narrative analysis was performed. Results: An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). Discussion: By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill.

Towards a Crisis Management Playbook: Hospice and Palliative Team Members’ Views Amid COVID-19

ContextThe critical role of hospice and palliative care in response to the COVID-19 pandemic is well recognized, but there is limited evidence to guide healthcare leadership through future crises. ObjectivesOur goal was to support future organizational resilience by exploring hospice and palliative team members’ perspectives on crisis leadership during the COVID-19 pandemic in New York City (NYC). MethodsThis qualitative descriptive study used individual, semi-structured interviews of purposively sampled interdisciplinary team members. Enrollment sites were two large NYC metro hospice care organizations and one outpatient palliative care practice. We asked participants to complete a demographic form and a 45–60 minute interview. We used descriptive statistics and thematic analysis, respectively, for data analysis. We triangulated the data by presenting preliminary study findings to a group of clinicians (n=21) from one of the referring organizations. ResultsParticipants (n=30) were professionally diverse (e.g., nurses, physicians, social workers, chaplains, administrators), experienced (mean=17 years; 10 years in hospice), and highly educated (83% ≥ master's degree). About half (n=15) self-identified as white, non-Hispanic, and nearly half (n=13) self-identified as being from a racial/ethnic minoritized group. Two (n=2) did not wish to self-identify. We identified four themes that reflected challenges and adaptive responses to providing care during a crisis: Stay Open and Stay Safe; Act Flexibly; Lead Adaptively; and Create a Culture of Solidarity. ConclusionWhile additional work is indicated, findings offer direction for a crisis management playbook to guide leadership in hospice, palliative care, and other healthcare settings in future crises.