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LGBTQ+ people experience higher burdens of life-limiting illnesses, poorer health outcomes, and multilevel barriers to accessing palliative, end-of-life, and bereavement care. High quality evidence is needed to inform interventions to address these inequities, and inform inclusive practices and policies. Despite global initiatives to improve availability of peer-reviewed journal articles, the minority of research is open access (OA). We aimed to evaluate accessibility of literature related to LGBTQ+ inclusive palliative, end-of-life, and bereavement care. A rapid review of the evidence regarding LGBTQ+ inclusive palliative, end-of-life, and bereavement care was conducted; OA status of identified articles was assessed. Articles from three published systematic reviews were included (2012, 2016, and 2020). Review articles were updated using the original search and inclusion/exclusion strategies. 66 articles related to LGBTQ+ inclusive palliative, end-of-life and bereavement care were identified between 1990-2022. Of these, only 21% (n =14) were OA. Of the OA articles, 79% were published between 2017 and 2022, and 50% were published between 2020-2022, reflecting more recent shifts towards OA publishing. Health and social care professionals and policy makers rely on access to high quality evidence to inform their work. Failing to make articles related to the needs of LGBTQ+ people and populations OA risks further marginalisation and worsened inequities. Innovative journal policies and funding are needed to enable access, particularly for research that foregrounds the needs of marginalised communities. Where articles are currently behind paywalls, there is a need for accessible summaries or policy briefs to inform inclusive policy and practice. [ABSTRACT FROM AUTHOR]

Clinician distress is common in serious illness care. Palliative specialists are often consulted for cases involving significant distress among primary teams. Consults involving clinician distress can be challenging to navigate when it feels like 1) palliative specialists do not have the right skills to be helpful or 2) palliative specialists are being asked to 'fix' difficult situations that would require changing other people's attitudes, beliefs, or behaviors, or healthcare systems writ large. This article uses three composite cases to illustrate types of clinician distress and examine the benefits and risks of palliative specialist involvement. We conclude with a discussion of potential impacts of palliative care consults for clinician distress on the field of palliative care and consider next steps in critically important efforts to support and sustain the entire workforce—both palliative specialists and nonspecialists alike—when caring for patients with serious illness and their family caregivers. [ABSTRACT FROM AUTHOR]

Advance care planning (ACP) intends to support person-centered medical decision-making by eliciting patient preferences. Research has not identified significant associations between ACP and goal-concordant end-of-life care, leading to justified scientific debate regarding ACP utility. To delineate ACP's potential benefits and missed opportunities and identify an evidence-informed, clinically relevant path ahead for ACP in serious illness. We conducted a narrative review merging the best available ACP empirical data, grey literature, and emergent scholarly discourse using a snowball search of PubMed, Medline, and Google Scholar (2000–2022). Findings were informed by our team's interprofessional clinical and research expertise in serious illness care. Early ACP practices were largely tied to mandated document completion, potentially failing to capture the holistic preferences of patients and surrogates. ACP models focused on serious illness communication rather than documentation show promising patient and clinician results. Ideally, ACP would lead to goal-concordant care even amid the unpredictability of serious illness trajectories. But ACP might also provide a false sense of security that patients' wishes will be honored and revisited at end-of-life. An iterative, 'building block' framework to integrate ACP throughout serious illness is provided alongside clinical practice, research, and policy recommendations. We advocate a balanced approach to ACP, recognizing empirical deficits while acknowledging potential benefits and ethical imperatives (e.g., fostering clinician-patient trust and shared decision-making). We support prioritizing patient/surrogate-centered outcomes with more robust measures to account for interpersonal clinician-patient variables that likely inform ACP efficacy and may better evaluate information gleaned during serious illness encounters. [ABSTRACT FROM AUTHOR]

Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice & Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance. [ABSTRACT FROM AUTHOR]

To characterize the representation of racial and ethnic minoritized faculty in leadership positions at the top 50 National Institutes of Health-ranked academic nursing institutions. We conducted a cross-sectional observational study to characterize the racial/ethnic composition of academic leaders, including those in diversity, equity, and inclusion (DEI) positions from September 2020 to December 2020. Among the 409 leaders, the sample was predominantly composed of females (86.6%), White leaders (80.9%), affiliated with public institutions (75.1%), and in the southern region (42.1%). Exactly 13.6% were from minoritized groups. Minoritized leaders were less likely to hold dean and higher executive positions than their nonminoritized counterparts (p <.002). DEI leadership positions were mostly concentrated in lower executive positions (e.g., director) and primarily consisted of minoritized leaders (>60%). Underrepresentation of racial and ethnic minoritized individuals in academic nursing leadership persists, necessitating structural interventions within nursing academia to promote inclusivity. Achieving this goal requires a concerted investment in diversifying academic nursing leadership and ensuring positions that minoritized leaders are in, hold weight. • Underrepresentation of minoritized leaders in academic nursing persists. • Minoritized leaders are less likely to hold dean and higher executive positions. • Structural changes are needed to diversify \ academic nurse leadership. [ABSTRACT FROM AUTHOR]

Context: Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal.Objectives: 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services.Methods: Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce.Results: Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships.Conclusion: An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering. [ABSTRACT FROM AUTHOR]

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. [ABSTRACT FROM AUTHOR]

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. [ABSTRACT FROM AUTHOR]

As coronavirus disease 2019 (COVID-19) continues to impact the seriously ill and their families on a global scale, considerations given to marginalized groups amid the pandemic are essential to ensure the provision of high-quality and dignified care. Lesbian, gay, bisexual, transgender, gender-nonconforming, and queer/questioning-identified (LGBTQ+) persons are particularly vulnerable to health inequities across settings, including palliative care and at the end of life. There is a crucial gap in the literature pertaining to palliative care for LGBTQ+ populations during COVID-19. We aim to fill this gap by providing essential health inequity and social support background pertaining to LGBTQ+ persons and practical recommendations for immediate implementation that support inclusive and respectful care for these populations. Using these recommendations is a pragmatic pathway to promote trust, transparency, patient and family engagement, and value concordant care amid the health system strain caused by COVID-19. [ABSTRACT FROM AUTHOR]

Many patients with cancer pain deviate from prescribed analgesic regimens. Our aim was to elicit the trade-offs patients make based on their beliefs about analgesic use and rank utilities (importance scores) using maximum difference (MaxDiff) scaling. We also investigated if there were unique clusters of patients based on their analgesic beliefs. This was a secondary analysis of a three-month, prospective observational study. Patients (N = 207) were self-identified African Americans and Whites, >18 years, diagnosed with multiple myeloma or solid tumor, and were prescribed at least one around-the-clock analgesic for cancer pain. MaxDiff analysis allowed us to identify patients utilities. Second, a cluster analysis assisted in ranking how analgesic beliefs differed by groups. Third, clusters were described by comparing key sociodemographic and clinical variables. Participants' beliefs were a significant factor in choices related to analgesic use (chi-square = 498.145, p <.0001). The belief, 'Pain meds keep you from knowing what is going on in your body', had the highest patient endorsement. Two distinct clusters of patients based on analgesic beliefs were identified; 'knowing body' was ranked as top priority for both clusters. The belief that cancer patients become addicted to analgesics was moderately important for both clusters. Severity of side effects was the only key variable significantly different between clusters (p =.043). Our findings support tailored pain management interventions that attend to individual beliefs about cancer pain and analgesic use. Future research should explore the relationship between analgesic utilities, actual analgesic taking behaviors, and how they impact patients' cancer pain outcomes. [ABSTRACT FROM AUTHOR]

Previous research suggests that racial disparities in patients' reported analgesic adverse effects are partially mediated by the type of opioid prescribed to African Americans despite the presence of certain comorbidities, such as renal disease. We aimed to identify independent predictors of the type of opioid prescribed to cancer outpatients and determine if race and chronic kidney disease independently predict prescription type, adjusting for relevant sociodemographic and clinical confounders. We conducted a secondary analysis of a 3-month observational study. Outpatient oncology clinics of an academic medical center. Patients were older than 18 years of age, self-identified as African American or White, and had an analgesic prescription for cancer pain. Cancer patients (N = 241) were recruited from outpatient oncology clinics within a large mid-Atlantic healthcare system. Consistent with published literature, most patients (75.5%) were prescribed either morphine or oxycodone preparations as oral opioid therapy for cancer pain. When compared with Whites, African Americans were significantly more likely to be prescribed morphine (33% vs 14%) and less likely to be prescribed oxycodone (38% vs 64%) (p <.001). The estimated odds for African Americans to receive morphine were 2.573 times that for Whites (95% confidence interval 1.077-6.134) after controlling for insurance type, income, and pain levels. In addition, the presence of private health insurance was negatively associated with the prescription of morphine and positively associated with prescription of oxycodone in separate multivariable models. The presence of chronic kidney disease did not predict type of analgesic prescribed. Both race and insurance type independently predict type of opioid selection for cancer outpatients. Larger clinical studies are needed to fully understand the sources and clinical consequences of racial differences in opioid selection for cancer pain. [ABSTRACT FROM AUTHOR]

• The opioid crisis has sparked much attention on policy and practice changes related to opioid prescribing and stewardship across settings. There are myriad-related implications that continue to evolve for clinicians and researchers related to opioid and analgesic use. However, little is known about how patients make decisions to use analgesics for cancer pain • Pain is one of the most common and burdensome symptoms impacting patients throughout the cancer trajectory, with over one-third of patients endorsing their pain as "moderate" or "severe." Cancer pain guidelines recommend opioid use as foundational to moderate to severe cancer pain treatment plans. Many patients deviate from recommended analgesic regimens for a number of reasons. • The purpose is to clarify the concept of analgesic nonadherence for cancer pain and its use within the literature with respect to the US opioid crisis. There are few studies that link analgesic use to health outcomes and little empirical research on cancer pain. • Given both the sociopolitical implications of the opioid crisis and a number of literature gaps related to this concept, there is insufficient evidence to claim a value judgment on analgesic nonadherence in cancer pain treatment. Additional empirical research is urgently needed in this domain to ensure safe and effective cancer pain management for patients. Pain is one of the most common symptoms identified along the cancer trajectory. Among patients with moderate to severe cancer pain, nonadherence to prescribed analgesics may complicate treatment plans and exacerbate pain severity. Nonadherent behaviors are likely due to a number of individual/family, provider, and system level factors and may lead to negative pain-related outcomes. The purpose of this concept analysis is to clarify the concept of analgesic nonadherence for cancer pain and qualify its utility in the context of the opioid crisis. Walker and Avant's (2019) method for concept analysis was used. We integrated empirical evidence, relevant literature, and sociopolitical considerations related to the opioid crisis to provide critical and timely analysis. Data were collected from a search of PubMed, CINAHL, PsycINFO, and Scopus. The search yielded 418 individual records. Empirical articles using quantitative and qualitative methodologies pertaining to analgesic nonadherence for cancer pain in adult outpatient settings, written in English, with an abstract, and published between 2010 and 2018 were considered. Other relevant literature sources were used if additional criteria were met. A total of 33 records were selected for detailed review. Few studies link analgesic nonadherence to patient outcomes highlighting a significant literature gap. Given the available evidence, a definition for analgesic nonadherence is proposed for future use in research, education, practice, and policy settings. The paucity of empirical data combined with the implications of the opioid crisis and conflicting pain management guidelines create uncertainty about the utility of analgesic nonadherence. The concept of analgesic nonadherence warrants further normative and empirical research to clarify the role of opioids and the meaning of nonadherence in shaping pain-related outcomes within the current sociopolitical environment. [ABSTRACT FROM AUTHOR]

• The United Nations 2030 Sustainable Development Agenda is comprised of 17 Sustainable Development Goals (SDGs) and 169 targets; it went into action on January 1, 2016. • The SDGs focus on Peace, Planet, Peace, Prosperity, and Partnership to further the health and betterment of humanity and the world at large. • The SDG framework aligns with the holistic philosophy inherent to nursing and midwifery. • Nurses and midwives in the United States and abroad are key stakeholders in leading the SDGs across practice, policy, research, and education settings. • Although there has been progress toward SDG attainment, there is much work to do, particularly in the United States. The United Nations 2030 Agenda for Sustainable Development was implemented on January 1, 2016 and is composed of 17 Sustainable Development Goals (SDGs) and further delineated by 169 targets. This article offers background information on the 2030 Agenda as it relates to nursing and midwifery, professional organizational initiatives currently advancing the SDGs, the ethos of global citizenship, the urgency to respond to dwindling planetary health, the salience of nursing and midwifery advocacy in SDG attainment, and the myriad opportunities for nurses to lead and collaborate toward realizing these Global Goals. A US-based perspective is employed to underscore the Agenda's relevance to the US nursing workforce and healthcare system. The SDGs, with their holistic bio-psycho-social-environmental approach to health, present enormous opportunities for nurses and midwives. The SDG framework is naturally aligned with the foundational philosophy and purpose of our professions. [ABSTRACT FROM AUTHOR]

A new methodology for studying the effect of wind power intermittency on electric power systems is proposed in this paper. The proposed stochastic method is based on the optimal power flow and sensitivity analysis techniques. These techniques are applied on a computational tool capable of allocating the intermittent energy with an exhaustive search technique with low computation time. The methodology was applied to reduce losses in the distribution systems of 34 and 70 buses. The results are compared with fixed power allocation considering the mean power of three different conditions: the average wind speed; generator capacity factor and maximum generator capacity. They showed that a stochastic method that considers each value of wind speed is necessary to determine the correct bus to allocate intermittent wind power. [ABSTRACT FROM AUTHOR]

Providing care to cancer patients in resource-poor settings often demands complex trade-offs regarding resource allocation. It is estimated that over 60% of all cancer deaths worldwide occur in low- and middle-income countries, where channels to care and appropriate symptom management interventions are overstressed or obsolete. Concepts of distributive justice underlie much of global health policy. As appetites for expanding global palliative care services increase, so do questions of fair and culturally appropriate distribution. The ethical principle of distributive justice underpins questions of resource allocation at a fundamental level. One of the most challenging concepts for health care workers immersing in cross-cultural contexts is the idea that ethics are somewhat malleable; they shape and are shaped by the unique sociopolitical, economic, intracultural, and power dynamics of a particular setting. In this article, we use the case of a young woman diagnosed with terminal cancer in an underserved community in rural Uganda to illustrate the conflicting concepts of fairness, which dictate distribution of scarce resources in low- and middle-income countries. Notions of distributive justice vary across cultural, societal, and even individual norms, with some definitions allowing for discrimination based on merit or need. Resource allocation in the absence of cultural humility or a genuine willingness to understand decision-making priorities in a given culture can contribute to inequity and may have harmful consequences. [ABSTRACT FROM AUTHOR]

Nursing is becoming increasingly aware of its impact as a global profession. Part of this evolution is the understanding that the Western evidence-based construct may not be reliably or universally applicable to transcultural settings and clients. In a global world, no ‘one size fits all’ and no singular approach to pain management is appropriate; there are, quite literally, infinite variations in cross-cultural dynamics. Nurses working in the field of pain management must be able to navigate their responsibilities within the global health context. The role of the pain management nurse in the global world is to provide individualized and culturally relevant pain management for clients, which is mindful of multifactorial contributors to the pain experience, such as the physiologic, affective, cognitive, behavioral, sociocultural, and environmental, and to view adequate pain management as an international human right. Through the skillful integration of theory, practice, and the ability to build respectful and responsible nurse-client partnerships, pain management nurses can deliver contextually relevant care that promotes safety, quality, and healing. [ABSTRACT FROM AUTHOR]

1. Identify common threats to equitable culture and outcomes within healthcare organizations. 2. Reflect on your own role in perpetuating and undermining systemic threats to justice, equity, diversity, and inclusion. Integrate leadership practices for creating and promoting a culture of equity and inclusion in palliative care research, education, and practice. This panel of interprofessional leaders will address ways to promote justice and equity in your role as a hospice and palliative care leader. We will share diverse and authentic experiences, perspectives, and leadership practices to put equity into action within your institution and teams (including patients, families, and caregivers). Bring your curiosity and your questions. [ABSTRACT FROM AUTHOR]

• Longstanding workforce-related stressors, magnified by the COVID-19 pandemic contribute to burnout, negative health outcomes, including mental health outcomes, and loss of the profession of the well-educated nurses • Activism, visibility and support by AAN members can strengthen dissemination and enforcement of recommended changes • Key organizations must take systems level action to initiate changes in workplace safety, increase professional mobility, and propel policies that increase access to health care resources to promote nurse well-being • Actions must include transformative organization and governmental efforts to promote safe staffing, implementing recommendations on a healthy work environment, and support for research to advance knowledge in the science of well-being • Legislation and regulatory policies should reinforce healthy work environments by advancing workplace safety by allocation of sufficient resources, standardization of security guidelines and enforcing mandatory workforce continuing education. • Federal and workplace policies on inclusivity/diversity and protection from racial, gender, ability, sexual orientation, and other discrimination should be widely disseminated and enforced • Support for high-quality practice and quality of life requires endorsing a continuum of health from wellness to recovery and thriving. State regulatory bodies should recognize ADA requirements by modifying licensure questions, removing barriers to licensure by persons in recovery from mental health and substance use disorders • Transforming health care work environments to advance nurse well-being and equity can be accomplished when AAN leverages related policy in government and professional/healthcare organizations arenas and when innovative policy changes are achieved through collaboration among associations, organizations, nonprofit groups, the public, and the media. The COVID-19 pandemic has required close examination of workforce-related stressors that over decades have contributed to widespread burnout, negative health outcomes, including mental health outcomes, and the loss of the well-educated professionals who are the future of the nursing profession. In the United States and globally, evidence points to factors known to diminish well-being, including inequities, issues of minority status, persistent discrimination, and demanding work environments. The American Academy of Nursing (AAN), dedicated to organizational excellence, nursing leadership and evidence-based policy, develops statements reflecting its mission and those of its nursing affiliates and corporate member, The American Nurses Association. Within nursing, despite the efforts of its members toward advancement, professional fulfillment is often constrained by the systems in which nurses practice and workplace factors over which they have little control. Action by key organizations to initiate changes at systems levels in workplace safety, to increase professional mobility, and propel policies that increase access to health care resources could improve nurse well-being. This paper proposes recommendations from the AAN Expert Panels on Building Health Care System Excellence, Psychiatric Mental Health and Substance Use, and Global Health Expert Panels for the American Academy of Nursing to leverage related policy in the arenas of government and professional/healthcare organizations. Transforming health care work environments and advancing nurse well-being and equity can be accomplished through key, innovative policy changes. These will be achieved through collaboration among associations, organizations, nonprofit groups, and with the public and the media. [ABSTRACT FROM AUTHOR]

The study evaluates the electrical power system behaviour when wind turbines are inserted into the power grid. The assessment is made using a sensitivity analysis technique applied to the power flow solution. Unlike the typical algorithms, the sensitivity analysis technique does not require an iterative process, resulting in a fast method with great precision. This proposed method make easy to check the wind turbine behaviour to the changing of wind speed. Initially, the power flow solution is obtained and identified as the base case. When there are perturbations in the generators, the new solution is obtained directly by sensitivity analysis technique. The technique was applied in 34-bus, 70-bus and 126-bus test distribution system. The places chosen to connect the wind turbines were determined by the Incremental Transmission Losses method. The results demonstrate the effectiveness of the methodology. When wind turbines are inserted in the studied systems, active and reactive losses are reduced and voltage profile is improved. [ABSTRACT FROM AUTHOR]

Outcomes 1. Discuss advances in psychedelic-assisted therapy science relevant to palliative care settings 2. Explain implications of psychedelic-assisted therapy from myriad disciplinary perspectives with the goal of advancing collaboration and the field more broadly 3. Reflect on palliative care practice models as exemplars for relationship-based psychedelic-assisted therapy integration within the health system In 2021, two landmark randomized controlled studies of psychedelic-assisted therapy generated intense public and scientific interest as well as speculation that MDMA and psilocybin may be granted federal regulatory approval within the next several years for a wide array of mental health indications. Potential applications pertinent to palliative care extend well beyond management of anxiety and depression among those with serious illness to include demoralization, existential distress, grief, meaning making, and life completion. Unlike other drug therapies where efficacy can be reduced to the biochemical action of the drug, the clinical benefit (or harm) of psychedelic medicines is highly contingent on the mindset of the patient and the physical and emotional setting in which they are used. The quality of presence and skills of the therapist are paramount to establish a trusting relationship and safe environment fostering healing. In many traditions, the therapeutic relationship is considered the "medicine," and psychedelics act to catalyze and deepen the relational aspects of care that may ease suffering and allow each patient's innate healing processes to unfold. Training clinicians and therapists skilled in this modality presents a major bottleneck to this developing field and limitation to widespread accessibility, not simply because clinical infrastructure must be converted or developed but because the safety and efficacy of the intervention uniquely depend on the preparation of the clinician. To meet this need, several training programs have developed over the last 5 years. We present a diverse panel of palliative care and hospice clinicians training and working in psychedelic-assisted therapies to share their experiences of training and clinical care and how the interdisciplinary, intensively relationship-centered approach of palliative care may serve as a model for the successful implementation of psychedelic medicines more broadly across society. [ABSTRACT FROM AUTHOR]

Inequities and gaps in palliative care access are a serious impediment to health systems especially in low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palliative care need and was originally developed by The Lancet Commission on Global Access to Palliative Care and Pain Relief. In 2015, the first iteration – SHS 1.0 – was estimated at over 61 million people worldwide experiencing at least 6 billion days of SHS annually as a result of life-limiting and life-threatening conditions. In this paper, an updated methodology - SHS 2.0 - is presented building on the work of the Lancet Commission and detailing calculations, data requirements, limitations, and assumptions. The updates to the original methodology focus on measuring the number of people who die with (decedents) or live with (non-decedents) SHS in a given year to assess the number of people in need of palliative care across health conditions and populations. Detail on the methodology for measuring the number of days of SHS that was pioneered by the Lancet Commission, is also shared, as this second measure is essential for determining the health system responses that are necessary to address palliative care need and must be a priority for future methodological work on SHS. The methodology encompasses opportunities for applying SHS to future policy making assessment of future research priorities particularly in light of the dearth of data from low- and middle-income countries, and sharing of directions for future work to develop SHS 3.0. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) crisis has amplified the importance of palliative care to countless patients suffering with and dying from this disease, as well as to their families, communities, and the worldwide cadre of overburdened health care workers. Particularly urgent is the need for spiritual care specialists and generalists to address spiritual suffering given the degree of isolation, loneliness, and vulnerability caused by this pandemic. Although spiritual care has long been recognized as one of the domains of quality palliative care, it is often not fully integrated into practice. All disciplines are ultimately responsible for ensuring that spiritual care is prioritized to improve quality of life and the experience of patients and families facing spiritual emergencies amid the complex life-and-death scenarios inherent to coronavirus disease 2019. Although the pandemic has revealed serious fault lines in many health care domains, it has also underscored the need to recommit to spiritual care as an essential component of whole-person palliative care. [ABSTRACT FROM AUTHOR]

1. The participants will be able to identify three barriers in delivering palliative care during climate-related natural disasters 2. The participants will be able to identify three at-risk populations during natural disasters The ongoing climate crisis is a significant public health concern, causing an increase in natural disasters. It has been predicted that 534,000 climate-related deaths will occur worldwide by 2050, and economic loss from natural disaster in 2020 alone totaled $268 billion. Traditionally marginalized populations are disproportionately affected by the climate crisis. The purpose of this integrative review was to identify barriers to and facilitators for accessing palliative care during climate-related natural disasters. An integrative literature review was conducted to assess the quality of palliative care during past natural disasters. The studies identified in the review were categorized into topics related to education, practice, technology, and populations affected. The studies were independently reviewed by 4 reviewers, and discrepancies were discussed until consensus was reached about which studies should be included in the final review. The findings suggested that barriers to accessing palliative care during disasters included a shortage of palliative care providers and lack of education and training in disaster preparedness. In addition, many providers lacked skills in addressing complex psychosocial needs of patients and families and moral suffering of providers. The review also identified several facilitators, including innovative technologies such as telemedicine apps for providing palliative care to hard-to-reach populations. However, these innovations were not accessible to everyone. To improve palliative care in disasters, palliative care providers must be included in disaster preparedness planning. Barriers to integrating palliative education at all levels must be identified and addressed. Equitable delivery of palliative care during climate crises must be promoted by addressing social determinants of health such as race and economic inequities. Experiences of the seriously ill among traditionally marginalized populations should be examined to promote equitable access to palliative care. [ABSTRACT FROM AUTHOR]

Outcomes: 1. Define the extent and type of disrespectful, inappropriate, and abusive practices faced by many lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals and their partners/spouses when receiving care for serious illness, including hospice and palliative care 2. Address the personal impact of serious illness care, including hospice and palliative care, on LGBTQ+ patients and families, and address such disparities of care at their institutions Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals experience discrimination in health care—including palliative, hospice, and long-term care. Providers and institutions may be uncomfortable with, and often don't ask patients about, sexual orientation and gender identity (SOGI). LGBTQ+ patients fear being open about their identities; not receiving equal, competent, or safe treatment; and having their family of choice and surrogates disrespected or ignored. This presentation reports on Project Respect, which describes care to seriously ill LGBTQ+ persons that was inadequate, disrespectful, or abusive due to SOGI. A mixed-methods study using an online survey was conducted. The sample was LGBTQ+ individuals with a serious illness, and partners/spouses and widows of such individuals. Respondents were recruited through organizations serving the LGBTQ+ community, older adults, and palliative and hospice care organizations. Questions included type of serious illness, healthcare services used, and whether and how care was inadequate, disrespectful, or abusive due to SOGI for both the patient and partner, and from healthcare professionals and from support staff. Of 225 respondents, 44% reported their healthcare provider was insensitive; 33% said providers were not aware of LGBTQ+ health needs; and one-quarter said their providers disregarded their treatment decisions, made them feel judged for being LGBTQ, used incorrect pronouns, were rude, refused or denied them care, and/or imposed their religious beliefs. Descriptions of poor care and how it is experienced are included. These findings provide strong evidence that LGBTQ+ patients and their partners often receive discriminatory care at very vulnerable moments of their lives. Disrespectful care can negatively affect patients' trust in providers and institutions, and lead to delaying or avoiding care, and not disclosing medical information. These findings have implications for staff training, practice, and institutional and public policy, including policy barriers to respectful and non-discriminatory care. [ABSTRACT FROM AUTHOR]