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People with a substance use disorder (SUD) have shortened lifespans due to complications from their substance use and challenges engaging with traditional health care settings and institutions. This impact on life expectancy is especially prominent in patients with co-occurring SUDs and cancer, and often has a much worse prognosis from the cancer than a similar patient without a SUD. Palliative care teams are experts in serious illness communication and symptom management and have become increasingly embedded in the routine care of patients with cancer. We argue that the skill set of palliative care teams is uniquely suited for addressing the needs of this oft marginalized group. We provide a comprehensive review of tools for addressing these needs, including medications that can both treat pain and opioid use disorder (OUD), and highlight psychosocial approaches to treating patients with OUD and cancer in a way that is respectful and effective. Using a trauma informed framework, we focus on the application of harm reduction principles from addiction medicine and the principles of clear communication, accompaniment, and emotional presence from palliative care to maximize support. We also focus on ways to reduce stigma in the delivery of care, by providing language that reduces barriers and increases patient engagement. Finally, we describe a clinic embedded within our institution's cancer center which aims to serve patients with cancer and SUDs, built on the framework of harm reduction, accompaniment and trauma informed care (TIC). Overall, we aim to provide context for addressing the common challenges that arise with patients with cancer and OUD, including the direct impact of psychosocial stress on substance use and cancer treatment, delays in disease directed treatment that can potentially impact further treatment options and outcomes, challenging pain management due to greater opioid debt, and potential loss of primary coping mechanism through substance use in the face of potential terminal diagnosis.

Context/objectives: A critical frontier for palliative medicine is to develop systems to routinely and equitably address the palliative care (PC) needs of seriously ill populations., Methods: An automated screen identified Medicare primary care patients who had serious illness based on diagnosis codes and utilization patterns. A stepped-wedge design was used to evaluate a six-month intervention through which a healthcare navigator assessed these seriously ill patients and their care partners for PC needs in the domains of 1) physical symptoms, 2) emotional distress, 3) practical concerns, and 4) advance care planning (ACP) via telephone surveys. Identified needs were addressed with tailored PC interventions., Results: A total of 292/2175 (13.4%) patients screened positive for serious illness. A total of 145 completed an intervention phase; 83 completed a control phase. Severe physical symptoms were identified in 27.6%, emotional distress in 57.2%, practical concerns in 37.2%, and ACP needs in 56.6%. Twenty-five intervention patients (17.2%) were referred to specialty PC compared to six control patients (7.2%). Prevalence of ACP notes increased 45.5%-71.7% (p = 0.001) during the intervention and remained stable during the control phase. Quality of life remained stable during the intervention and declined 7.4/10-6.5/10 (P =0.04) during the control phase., Conclusion: Through an innovative program, patients with serious illness were identified from a primary care population, assessed for PC needs, and offered specific services to meet those needs. While some patients were appropriate for specialty PC, even more needs were addressed without specialty PC. The program resulted in increased ACP and preserved quality of life., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Equipping all interprofessional clinicians with foundational palliative care competencies is essential to address the complex needs of the growing number of adults living with chronic, progressive, or life-threatening serious illness. There is a paucity of high-quality, open-access primary palliative care curricula and to the best of our knowledge, none designed interprofessionally., Objective: As an interprofessional team, we aimed at designing and evaluating an interactive primary palliative care education curriculum for interprofessional clinicians and trainees., Design: We developed a curriculum that includes nine 55-minute interactive modules facilitated by two interprofessional clinicians in small groups of 8-12 interprofessional learners., Setting/subjects: Thirty-two practicing interprofessional clinicians from the San Francisco Bay Area enrolled in the pilot., Measurements: Pilot curriculum evaluation included electronic surveys pre- and post-module and at completion of the full curriculum., Results: The final evaluation response rate was 44%. Ninety-three percent of survey respondents rated the curriculum's quality as "very good" or "excellent"; 86% of respondents felt the curriculum was "extremely" or "very useful" to their clinical practice. Comparing pre- and post-module survey data, statistically significant ( p  < 0.01) improvements in learner confidence were seen for each of the 25 curriculum learning objectives with an average improvement of 2.8 points., Conclusions: The curriculum was well received and was associated with an increase in learner confidence. This novel, flexible, and tuition-free curriculum fills an important educational gap and can be used to equip frontline, interprofessional clinicians with the core palliative care knowledge, skills, and attitudes to take the best possible care of seriously ill patients and families., Competing Interests: No competing financial interests exist., (© Brook A. Calton et al., 2022; Published by Mary Ann Liebert, Inc.)

As the COVID-19 pandemic wears on, its psychological, emotional, and existential toll continues to grow and indeed may now rival the physical suffering caused by the illness. Patients, caregivers, and health-care workers are particularly at risk for trauma responses and would be well served by trauma-informed care practices to minimize both immediate and long-term psychological distress. Given the significant overlap between the core tenets of trauma-informed care and accepted guidelines for the provision of quality palliative care (PC), PC teams are particularly well poised to both incorporate such practices into routine care and to argue for their integration across health systems. We outline this intersection to highlight the uniquely powerful role PC teams can play to reduce the long-term psychological impact of the COVID-19 pandemic., (Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Communication training is a hallmark of palliative care education. The purpose of this article is to report on the development, exploratory outcomes, and lessons learned from a pilot project, "TeamTalk," which adapted VitalTalk methodology for interprofessional learners. Materials and Methods: TeamTalk included a series of interactive workshops led by an interprofessional faculty team at a health sciences university. Teaching methods were small group discussion, reflection, and high-fidelity simulated patient/family encounters, using a "Skills and Capacities" handout. The course was offered between January and May of 2015 and 2016 to medical fellows, advanced practice nursing students, and chaplain interns. Pre- and post-test design and qualitative data analysis were used to assess the learners' response to the TeamTalk curriculum. Validated instruments assessed attitudes toward interprofessional collaboration and self-confidence for interprofessional communication. Results: Sixty-one learners participated in TeamTalk over two academic years. Attitudes toward interprofessional collaboration improved from pre- to post-test (126.1 ± 6.9-130.0 ± 7.1; p  < 0.01) with no difference among the professional groups. Self-confidence for interprofessional communication improved in "eliciting the contributions of colleagues, including those from other disciplines" ( p  < 0.001) for all learners during year two; chaplains improved in the greatest number of areas (15/19), followed by nurses (7/19) and physicians (4/19). Learners expressed appreciation for the opportunity to explore their professional roles together with other professions. Conclusion: Preliminary findings indicate that TeamTalk improved attitudes toward interprofessional collaboration and self-confidence for participating on an interprofessional team. The lessons derived from creating and implementing this course may be applicable to interprofessional education in serious illness management.

Background: Health professionals have begun to identify competencies needed for primary and specialist levels of palliative care practice, but little attention has been given to how these skills are acquired., Objectives: The authors electronically surveyed a wide range of health social workers and educators to investigate their reported levels of preparation, training, and self-assessed competence to provide palliative and end-of-life care., Methods: Two health social work surveys were developed: one for educators and one for practitioners and students. The study used an electronic snowball sampling method with eight national social work listservs to capture a wide range of settings where health social workers may teach or practice. The survey was completed by 1149 self-identified health care social workers, 35% of whom identified as a specialist in palliative care., Results: Health social work clinicians report competence in many skills related to palliative care and the psychosocial determinants of health, having developed these skills primarily through interprofessional and peer collaboration., Conclusions: A representative sample of social workers practicing in health care identify high competence in essential aspects of palliative care. This speaks to an existing pool of clinicians who, if practicing to the top of their licenses, have the potential to provide primary palliative care and contribute to the person-family centered care called for in the Institute of Medicine (IOM) report. Few programs exist to prepare social workers to work as specialists in palliative or end-of-life settings, and respondents identified key areas of practice that need to be integrated into graduate education to ensure that students, practitioners, and educators are better prepared to maximize the impact of health social work. Further research is needed to better understand how to prepare and train specialist-level palliative care social workers.