Primary Care Goals Research Articles

When end of treatment situations challenge patient-centered care: a discussion paper proposing new theoretical insights.

According to the Institute of Medicine patient-centered medicine is one of the six crucial dimensions of health care quality. Although the patient-centered care model is widely recognized for its ethical underpinnings and effectiveness, its practical implementation still raises challenges, especially in end-of-treatment situations. This discussion paper offers an overview of the challenges facing the physician-patient relationship in end-of-treatment situations. We developed three clinical vignettes and made some theoretical considerations about ethical issues related to the decision-making process leading to the end of treatment. We identified two main challenges that end-of-treatment situations pose to patient-centered care: (1) when the patient's autonomy challenges the best clinical treatment; and (2) when the proposed treatment (discontinuation of treatment) challenges the patient's preferences. Patient-centered care supports personalized decision-making, in which the physician's approach varies according to the patient's situation and individuality. The idea of beneficence may change during care, because of acceptance of the patient's principles or a change in the primary goal of care.

Clinical Practice Guideline for Diabetes Management in the Post-Acute and Long-Term Care Setting

The newly revised Clinical Practice Guideline (CPG) for Diabetes Management in the Post-Acute and Long-Term Care (PALTC) Setting is an extremely useful resource that incorporates new evidence and perspectives related to overall goals in diabetes care. The CPG provides detailed information in usable Tables for how to use and manage the increasing number of medication alternatives for PALTC patients with diabetes. In addition, the CPG addresses the critical roles of all members of the interprofessional team for the optimal management of older adults living with diabetes.The primary goal of care as described in the CPG is to make diabetes management individualized and consistent with the patient's/resident's goals of care, and to optimize quality of life and the ability to live in the least restrictive setting possible. To achieve this, the CPG emphasizes the importance of understanding the patients’ overall health status, what their preferences and values are, their life expectancy, the clinical benefit of tight versus more liberal control of glucose, risk of hypoglycemia, and impact of treatment on quality of life and ability to live in a certain setting of care (e.g., if injectable therapy is possible). As with other PALTmed CPGs, this new CPG takes the team through the process of recognition, assessment, treatment and monitoring. Implementation of the Diabetes Management in PALTC Settings CPG can help those working in these settings ensure that their patients and residents are getting the most appropriate and current evidence-based treatment for this challenging clinical problem.

Addressing unmet need for primary care in Canada.

Primary care is the key health system strategy for improving health, enhancing patient and clinician experience, saving money, and promoting equity. Once a pioneer in primary care, Canada now fails to provide access to millions of people. This crisis is widely recognized, but policy responses are varied and mostly incremental and piecemeal. The goal of providing primary care to everyone seems unrealistic and elusive in Canada, yet it has long been attained in many other countries. Without an explicit policy goal of primary care for all, most likely on a geographic basis, Canada will continue to underinvest and underperform in primary care, with ramifications that include rapidly escalating costs, emergency department and hospital overcrowding and a growing and inequitable burden of preventable suffering. A commitment to work towards this goal is needed now to ensure that Canadians have access to high-quality well-organized care for everyone.

Increasing goals of care conversations in primary care: Study protocol for a cluster randomized, pragmatic, sequential multiple assignment randomized trial

BackgroundGoals of care conversations explore seriously ill patients' values to guide medical decision making and often inform decisions about life sustaining treatments. Ideally, conversations occur before a health crisis between patients and clinicians in the outpatient setting. In the United States Veterans Affairs (VA) healthcare system, most conversations still occur in the inpatient setting. Strategies are needed to improve implementation of outpatient, primary care goals of care conversations. MethodsWe plan a cluster randomized (clinician-level) sequential, multiple assignment randomized trial to evaluate the effectiveness of patient implementation strategies on the outcome of goals of care conversation documentation when delivered in combination with clinician implementation strategies. Across three VA healthcare system sites, we will enroll primary care clinicians with low rates of goals of care conversations and their patients with serious medical illness in the top 10th percentile of risk of hospitalization or death. We will compare the effectiveness of sequences of implementation strategies and explore how patient and site factors modify implementation strategy effects. Finally, we will conduct a mixed-methods evaluation to understand implementation strategy success or failure. The design includes two key innovations: (1) strategies that target both clinicians and patients and (2) sequential strategies with increased intensity for non-responders. ConclusionThis study aims to determine the effect of different sequences and combinations of implementation strategies on primary care documentation of goals of care conversations. Study partners, including the VA National Center for Ethics in Health Care and Office of Primary Care, can consider policies based on study findings.

"It's Like A Partnership": Exploring the Primary Care Experiences and Patient-Defined Goals of People Who Use Drugs.

Primary care is an important yet underutilized resource in addressing the overdose crisis. Previous studies have identified important aspects of primary care for people who use drugs (PWUD) and have found patient involvement in healthcare decisions and goal-setting to be especially critical. However, there has been limited research describing the primary care goals of PWUD. In harm reduction settings, where it is imperative that PWUD set their own goals, this research gap becomes especially relevant. To explore how PWUD navigate primary care with a focus on understanding their primary care goals. A qualitative study using semi-structured interviews. PWUD currently engaged in primary care at the Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, a harm reduction-based primary care program in New York City. Between June 2022 and August 2022, we conducted 17 semi-structured interviews. Informed by phenomenology, transcripts were coded using both inductive and deductive codes and themes were developed using thematic analysis approaches. Phenomenological analysis identified four core components that, together, created an experience that participants described as "a partnership" between patient and provider: (1) patient-provider collaboration around patient-defined healthcare goals; (2) support provided by harm reduction-based approaches to primary care anchored in incrementalism and flexibility; (3) care teams' ability to address healthcare system fragmentation; and (4) the creation of social connections through primary care. This holistic partnership fostered positive primary care experiences and supported participants' self-defined care goals, thereby facilitating meaningful care outcomes. To best meet the primary care goals of PWUD, these findings underscore the importance of primary care providers and programs facilitating such partnerships through organizational-level support anchored in harm reduction. Future research should explore how these experiences in primary care affect patient health outcomes, ultimately shaping best practices in the provision of high-quality primary care for PWUD.

Health-related quality of life (HRQOL) of patients with type 2 diabetes mellitus and people without diabetes at a tertiary hospital in Port-Harcourt, Rivers State, Nigeria

Background: Health-related quality of life (HRQOL), a patient-sensitive outcome globally, has become the clinician’s primary goal of care. Evidence suggests that diabetes mellitus (DM) and its treatment/care impair patients’ HRQOL, which varies depending on patient population/factors. Diabetics’ HRQOL in South-South Nigeria is largely unknown. Objectives: This study assessed and compared the HRQOL of patients with type 2 diabetes attending the outpatient diabetic clinic at a tertiary hospital in Port-Harcourt, Rivers State, South-South Nigeria with age-/gender-matched nondiabetics living within the same environment. Materials and Methods: This descriptive cross-sectional comparative study recruited 200 respondents, respectively those with type 2 diabetes (cases) and nondiabetics (controls). Data were collected by using the World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaire and analyzed by using descriptive and inferential statistics at P≤ 0.05 level of significance. Results: The two groups (200 each) had no significant differences (P = 0.35 - P = 0.98) in terms of their demographic variables. The diabetic group mean scores were significantly (P = 0.00) lower than that of the non-diabetics in terms of WHOQOL-BREF overall, health satisfaction, physical, psychological, and social domains. Diabetics with tertiary education (58%) had a significantly higher mean score (P = 0.012) in terms of overall WHOQOL-BREF than those with secondary and primary education (42%). Ninety-two patients (46%) with diabetes had comorbidities that increased significantly with age (P = 0.00) and expressed less satisfaction with their health (P = 0.04). Conclusion: Patients with diabetes had lower HRQOL scores than non-diabetics, implying the negative impact of diabetes and its treatment/care on their life. Diabetics’ HRQOL should be routinely evaluated and enhanced by empowering diabetic self-care activities that aid diabetes control and retard complications.

Feasibility of Routine Quality-of-Life Assessment in Long-Term Care Homes

Maximizing long-term care (LTC) residents' quality of life (QoL) is the primary goal of care. However, most residents have cognitive impairment and care staff time is severely limited, leading to various complexities in measuring QoL. This study developed and assessed the feasibility of an approach to routinely measuring QoL in LTC residents. We used the DEMQOL-CH, a practical, reliable, valid tool, developed in the UK to be completed by care aides to assess QoL in residents with moderate to severe dementia. We recruited 45 care aides in 10 LTC homes in Alberta, Canada who we surveyed on the QoL of 263 residents via video calls. We assessed time to complete; care aide and manager perceived feasibility of completing the DEMQOL-CH; internal consistency and inter-rater reliability of DEMQOL-CH scores; and we conducted cognitive interviews with 7 care aides to assess care aide comprehension of the tool. Time to complete was on average 4 minutes with little variation. Care aides and managers rated using the DEMQOL-CH as highly feasible and valuable. The internal consistency of the DEMQOL-CH score was 0.80. The DEMQOL-CH score inter-rater agreement was 0.73. Cognitive interviews suggested good comprehension overall with some comprehension problems especially in care aides who speak English as a second language. Asking care aides to complete the DEMQOL-CH is highly feasible, requires minor resources, and reliability is high. However, some items caused comprehension and reliability problems. Reasons and possible solutions will be subject to further investigations.

Current concepts in diagnosis, classification, and treatment of acute complex elbow dislocation: a review

Complex elbow dislocations involve periarticular fractures in addition to capsuloligamentous disruption. These dislocations can result from a simple fall on an outstretched hand or from high-energy trauma, and the pattern of injury is affected by the direction of the force causing the injury. Fracture patterns in complex elbow dislocations vary based on whether the injury is posterolateral, anterior, posteromedial, or medial. The primary goals of care in treating complex elbow dislocations include restoring anatomical alignment of the ulnohumeral and radiocapitellar joints, providing stability, and facilitating early motion after definitive treatment. Depending on fracture pattern and joint stability, definitive treatment can be nonoperative with closed reduction and bracing or operative with capsuloligamentous repair, open reduction and internal fixation of fractures, arthroplasty, or application of an external fixator. Common complications include neurovascular injury, chronic instability, posttraumatic arthritis, compartment syndrome, stiffness, and heterotopic ossification. Understanding how best to treat each type of complex elbow dislocation is essential to optimizing long-term elbow mobility and function while avoiding potential complications.

Diabetes Prevalence and Risk Factors in Patients With Chronic Mental Illness on Second-Generation Antipsychotics

The rates of obesity and type 2 diabetes (T2D) are much higher in patients with chronic mental illness compared to the general population1. Second-generation antipsychotic medications (SGA) are clearly contributory to these adverse metabolic phenotypes2. Thus, annual monitoring of fasting plasma glucose (FPG) levels is recommended to screen for T2D in patients on SGA3. Of note, FPG, and also HbA1c, have poor sensitivities in detecting T2D early, with nearly 50% of cases being missed using either of the above tests when compared to oral Glucose Tolerance Testing (oGTT,4). We thus screened patients with schizophrenia, schizoaffective or bipolar disorder on SGA per oGTT. We hypothesized that we would identify more patients with T2D per oGTT compared to FPG or HbA1c testing alone. To identify risk factors for T2D, we also assessed BMI, waist/hip ratio, blood pressure, dietary habits (UKDDQ = UK Diabetes and Diet Questionnaire), physical activity records (3d pedometer records), measures of psychopathology, cognition (PHQ-9 = Patient Health Questionnaire, SLUMS = Saint Louis University Mental Status exam) as well as HOMA IR (Homeostatic Model Assessment of Insulin Resistance), Matsuda index and lipid profile. Data were analyzed using SPSS, comparing normal and prediabetic patients to patients with T2D (per oGTT criteria). Thus far, we screened 22 patients per oGTT and newly identified 5 patients with T2D (23%), only one patient had T2D per HbA1c criterion, 4 were identified per elevated FPG, 3 patients had elevated 2h plasma glucose levels. Patients with T2D had significantly lower Matsuda indices (p<0.0001); trends towards higher HOMA IR and waist/hip ratios were observed in diabetic compared to non-diabetic patients (p=0.08). Patients with T2D tended to be heavier, had worse dietary habits (higher UKDDQ scores), and surprisingly were less depressed (lower PHQ-9 scores) than non-diabetic patients (p<0.25). In conclusion, oGTT is more sensitive in identifying patients with T2D early compared to FPG or HbA1c alone. Matsuda indices, HOMA IR and waist/hip ratios may serve as additional markers to distinguish non-diabetic from diabetic patients. Since metabolic syndrome and diabetes are all risk factors for an increased cardiovascular mortality in patients with chronic mental illness, identifying and treating T2D early and aggressively should be primary goals of care in this high-risk patient population.

Psychometric properties and use of the DEMQOL suite of instruments in research: a systematic review protocol

IntroductionDementia is a public health issue and a major risk factor for poor quality of life among older adults. In the absence of a cure, enhancing health-related quality of life...

Affrontare l’emergenza tra paura, trauma, regressione

The pandemic represents a stress test for a community and its health services. For NICU for example a there has been a widespread withdrawal towards parental closures, in contrast with the available guidelines and despite the consolidated evidence regarding the health outcomes of their role as caregivers. The different choices of the various working groups can be explained by the different abilities to deal with internal emotional disturbances, to the extent of the solidity of the process of construction and deep interiorization of inclusive care models. The main psychological dynamics revealed and emphasized by the pandemic are analyzed, in particular the defensive detachment from emotionally involving relationships, and how individual emotional responses find resonance in organizational structures, working groups, services and in various institutional levels. Understanding which elements the resilient and non-regressive responses to collective trauma in emergencies rest on, allows us to identify which paths must be activated to re-establish constructive bonds between professionals and with the “caregiver” parents, strengthening group cohesion towards the primary goal of care.

Atrial Fibrillation: An Update for Home Healthcare Clinicians.

Atrial fibrillation is a common cardiac arrhythmia in which the atria of the heart do not beat synchronously with the ventricles. It affects 2.7 to 6.1 million people in the United States. The erratic beating of the atria can cause blood clots to form in the atria, and if released into the circulation, an embolism can travel to the brain, causing a stroke. The primary goals of care for the management of atrial fibrillation are stroke-risk reduction, control of heart rate, rhythm management, and prevention of cardiac-related morbidity and mortality. This article reviews the guideline for the management of patients with atrial fibrillation by the American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines and provides recommendations for home healthcare clinicians.

Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient.

Purpose of ReviewCommunication skills in the ICU are an essential part of the care of trauma patients. The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU.Recent FindingsThe need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication.SummaryWe have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees.

Avaliação do cumprimento de metas da atenção secundária em saúde bucal no estado de Sergipe

O objetivo do estudo foi avaliar o cumprimento das metas de atenção secundária e o desempenho dos Centros de Especialidades Odontológicas do estado de Sergipe. Este é um estudo quantitativo e exploratório, em que foram coletados dados secundários da produtividade do ano 2015 dos 11 CEO e, calculou-se o cumprimento da atenção secundária e obteve-se o desempenho. Os achados foram associados com: tipo do Centro de especialidade odontológica, tempo de credenciamento, porte populacional, Índice deDesenvolvimento Humano Municipal, cobertura populacional de Equipe Saúde bucal na Estratégia de Saúde da Família, tipo de gestão. Foi realizada análise por meio de distribuição de frequências absolutas e relativas e do teste Exato de Fisher. Observou-se o cumprimento das metas da atenção básica em 81,9% e do subgrupo de especialidade em 54,5% na Periodontia e 45,5% na Cirurgia. Nenhum município cumpriu a meta na Endodontia. Os resultados sugerem a necessidade de reorganizar as práticas e qualificar as ações de monitoramento dos serviços em saúde bucal, com vistas à ampliação da oferta de serviço especializado.

Manejo complejo del hematoma intramural de aorta descendente: A propósito de un caso.

Los síndromes aórticos agudos (SAA) incluyen una variedad de enfermedades anatómicas y clínicas que se superponen. El hematoma intramural (HIM), la úlcera aórtica penetrante (UAP) y la disección aórtica ocurren de manera aislada o pueden coexistir en un mismo paciente. El HIM representa el 5-30% de todos los SAA y el 60-70% de los casos se localizan en la aorta descendente. El diagnóstico recae en un alto índice de sospecha clínica y en el empleo de imágenes complementarias. El manejo es conservador, pero los pacientes con algunas características de alto riesgo tienen mayor probabilidad de muerte en la fase aguda por lo que debe considerarse inicialmente el manejo endovascular. Se presenta el caso de un paciente de 69 años a quien se diagnosticó un HIM en el curso de una emergencia hipertensiva y que requirió manejo híbrido por las características anatómicas de alto riesgo para manejo endovascular aislado.

Racial and Ethnic Differences in Communication and Care for Children With Advanced Cancer

ContextRacial and ethnic disparities in end-of-life care are well documented among adults with advanced cancer. ObjectivesTo examine the extent to which communication and care differ by race and ethnicity among children with advanced cancer. MethodsWe conducted a prospective cohort study at nine pediatric cancer centers enrolling 95 parents (42% racial/ethnic minorities) of children with poor prognosis cancer (relapsed/refractory high-risk neuroblastoma). Parents were surveyed about whether prognosis was discussed; likelihood of cure; intent of current treatment; and primary goal of care. Medical records were used to identify high-intensity medical care since the most recent recurrence. Logistic regression evaluated differences between white non-Hispanic and minority (black, Hispanic, and Asian/other race) parents. ResultsAbout 26% of parents recognized the child's low likelihood of cure. Minority parents were less likely to recognize the poor prognosis (odds ratio [OR] = 0.19; 95% CI = 0.06–0.63; P = 0.006) and the fact that current treatment was unlikely to offer cure (OR = 0.07; 95% CI = 0.02–0.27; P < 0.0001). Children of minority parents were more likely to experience high-intensity medical care (OR = 3.01; 95% CI = 1.29–7.02; P = 0.01). After adjustment for understanding of prognosis, race/ethnicity was no longer associated with high-intensity medical care (adjusted odds ratio = 2.14; 95% CI = 0.84–5.46; P = 0.11), although power to detect an association was limited. ConclusionParental understanding of prognosis is limited across racial and ethnic groups; racial and ethnic minorities are disproportionately affected. Perhaps as a result, minority children experience higher rates of high-intensity medical care. Work to improve prognostic understanding should include focused work to meet needs of minority populations.

Unrealistic parental expectations for cure in poor-prognosis childhood cancer.

Many parents of children with advanced cancer pursue curative goals when cure is no longer possible. To the authors' knowledge, no pediatric studies to date have prospectively evaluated prognosis communication or influences on decision making in poor-prognosis childhood cancer. The authors conducted a prospective cohort study at 9 pediatric cancer centers that enrolled 95 parents of children with recurrent or refractory, high-risk neuroblastoma (63% of those who were approached), a condition for which cure rarely is achieved. Parents were surveyed regarding the child's likelihood of cure; their primary goal of care; the child's symptoms, suffering, and quality of life; and regret concerning the last treatment decision. Medical records identified care and treatment decisions. Only 26% of parents recognized that the chance of cure was <25%. When asked to choose a single most important goal of care, approximately 72% chose cure, 10% chose longer life, and 18% chose quality of life. Parents were more likely to prioritize quality of life when they recognized the child's poor prognosis (P=.002). Approximately 41% of parents expressed regret about the most recent treatment decision. Parents were more likely to experience regret if the child had received higher intensity medical care (odds ratio [OR], 3.14; 95% CI, 1.31-7.51), experienced suffering with limited benefit from the most recent treatment (OR, 4.78; 95% CI, 1.16-19.72), or experienced suffering from symptoms (OR, 2.91; 95% CI, 1.18-7.16). Parents of children with poor-prognosis cancer frequently make decisions based on unrealistic expectations. New strategies for effective prognosis communication are needed.

Quality of Life with Late-Stage Dementia: Exploring Opportunities to Intervene.

In late-stage dementia, families often prioritize quality of life (QoL) and comfort, yet little research examines factors impacting QoL. We sought to (1) describe temporal trends in QoL in late-stage dementia, and (2) explore associations between patient characteristics, care interventions, and QoL. Secondary analysis of data from the Goals of Care clinical trial. Twenty-two nursing homes (NHs) in North Carolina. Family decision makers for residents with late-stage dementia. Family-reported QoL at baseline and at 9 months using the Alzheimer's Disease-Related Quality of Life Instrument (ADRQL) with five subscales scored 0 to 100 (higher scores indicate better quality). Families reported demographics, primary goal of care, and described their perceptions of residents' QoL. Chart reviews provided data on hospital transfers, treatment plans, and hospice enrollment. We ran mixed effects models of hypothesized variables and change in ADRQL over time. The study sample was 241 dyads of residents with late-stage dementia and family decision makers. Family-reported ADRQL scores reflected moderately good QoL at baseline and at 9 months (69.1 vs 66.9; p = .106). Subscales for Awareness of Self (62.8; Global Deterioration Scale [GDS] = 5; 30.5; GDS = 7; p > .01) and Enjoyment of Activities (53.4; GDS = 5; 39.4; GDS = 7; p > .01) were lower in later stage disease. Qualitatively, family members associated better QoL for dementia with (1) activities, (2) opportunities to leave NH, (3) NH-structured activities, (4) attentiveness in NH, and (5) passive interaction. ADRQL at 9 months was associated with later dementia stage and referral to hospice (p < .01). Age (p = .004) and hospice enrollment were significantly associated with a larger decrease in ADRQL over 9 months (p = .019). A primary goal of comfort was associated with a larger increase in ADRQL (p = .022). Families judge QoL to be moderately good in late-stage dementia. They perceive activities, opportunities to leave the NH, and quality of interpersonal care as ways to improve dementia-specific QoL.

Intrahospitalno zbrinjavanje bolesnika sa politraumomtrauma protokol

Severe trauma is a global public health issue, causing one in ten mortalities, and resulting in the annual worldwide death of more than 5.8 million people. The treatment of trauma patient begins at the scene of the accident, with the initiation of basic life support measures, and continues with hospital treatment to stabilize the patient's condition. Trauma patient treatment is characterized by demanding therapeutic and diagnostic measures. Over the past decade numerous guidelines for trauma patient care have been developed with the same aim to decrease mortality and morbidity. Guidelines implementation into daily clinical practice has significantly improved the survival of these patients worldwide. Care for a politraumatized patient begins at the scene of the accident, implementing basic life support mesasures. Airway management, control of external bleeding, initial fluid infusion, immobilization of the spine and pelvis, and rapid transport to the nearest emergency center are the main features of pre-hospital care protocols. At the Emergency center, the primary goals of care are stabilization and patient survival.

Opioid Medication Access during Palliative Radiation Therapy

Pain management is a primary goal of care for patients receiving palliative radiotherapy. Historically, minority populations have had less access to proper pain management regimens; it is important to examine whether there are disparities in the setting of palliative radiation pain management. The purpose of this study is to examine the impact of treatment location, minority status, Spanish language preference, and socioeconomic status on access to opioid medications for pain management during palliative radiation treatments. A retrospective study was performed involving patients receiving palliative radiation to the brain, spine, or bone between January 1, 2016 and June 30, 2016. Patients receiving radiation at either a private academic hospital or an adjacent safety-net hospital were eligible for inclusion. Variables analyzed included treatment location, gender, socioeconomic status (SES), age, race, ethnicity, preferred language, comorbidity, and Karnofsky Performance Status (stratified into good, fair, and poor). Patients who received palliative radiation to the brain were analyzed separately from patients who received spine or bone radiation. Opioid access was defined as the presence of an active opioid medication prescription in the electronic medical record during palliative radiation therapy. Univariable (UVA) and multivariable (MVA) analyses were conducted to estimate odds ratios, corresponding 95% confidence intervals, and p-values using a logistic regression model. A total of 145 patients were included in the study. 34.5% (50) of patients received brain radiotherapy and 65.5% (95) of patients received spine or bone radiotherapy. 46.9% of patients were Hispanic, 32.4% of patients were non-Hispanic White, and 18.6% of patients were non-Hispanic Black. 54.0% of brain radiation patients had an opioid prescription during treatment, and 75.8% of spine or bone radiation patients had an opioid prescription during treatment. On MVA for brain radiation patients, less access to an opioid prescription was associated with higher SES vs. lower SES (OR 0.04, p = 0.05) and older age (65+ years old) vs. younger age (<65 years old) (OR 0.01, p = 0.03). On MVA for spine and bone patients, fair (OR 4.52, p = 0.03) and poor (OR 18.3, p = 0.02) vs. good functional status was associated with increased access to opioid medications. Treatment location, minority status, Spanish language preference, and SES had no impact on access to opioid medications during palliative radiation treatment. Instead, functional status played a major role in the receipt of medications for pain control. Continued vigilance is necessary to ensure underserved populations receive adequate pain control during palliative radiation.