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Context: The majority of people in need of palliative care (PC) in low- and middle-income countries lack access to it and suffer unnecessarily as a consequence. This unmet need is due, in part, to the lack of trained PC providers.Objectives: This study aims to assess the effects of regional training in PC for doctors, nurses, and pharmacists in the Caribbean through assessment of participant satisfaction, anticipated course impact on participants' clinical practice, barriers to changing practice, and perceived course impact on achievement of key PC milestones.Methods: We created and taught a course in basic PC for clinicians from the Caribbean region and collected and analyzed postcourse quantitative and qualitative data on satisfaction and expected impact.Results: Eighty-three clinicians from five Caribbean countries participated in this workshop. Thirty participants completed the post-course survey. One hundred percent of these participants ranked the quality of the course as "very high quality" or "high quality." The majority of participants anticipated changing their practice as a result of this course. Several barriers were reported, including lack of formal PC training in participants' home countries. Results of participants' retrospective pre- and postcourse self-assessment for achievement of key PC milestones showed a statistically significant mean increase of at least one point on the seven-point Likert scale for each milestone.Conclusion: Overall satisfaction with the course was high, and self-assessed competency in PC improved. These data suggest that an intensive training over several days is an effective format for increasing providers' perceived efficacy in delivering PC. [ABSTRACT FROM AUTHOR]

Background: Formal recognition of palliative medicine as a specialty has been one of the main drivers in the development of palliative care.Aim: To provide a comparative, comprehensive overview on the status of palliative medicine as medical specialty across Latin America.Methods: We conducted a comparative study of 19 Latin American countries. Key informants and persons in charge of the specialization training programs were identified and interviewed. We collected data on general recognition as specialty (title, process of certification) and on training program characteristics (title, start year, requirements, training length, and type full time or part time).Results: Eight of 19 countries (42%) Argentina, Brazil, Colombia, Costa Rica, Ecuador, Mexico, Paraguay and Venezuela reported palliative medicine as medical specialty. Thirty-five (sub)specialization training programs in palliative medicine were identified in the region (eight as a specialty and 27 as a subspecialty), the majority in Colombia (43.5%) and Brazil (33.7%). A total of 20% of the programs have yet to graduate their first cohort. Length of clinical training as specialty varied from two to four years, and from 520 hours to three years for a subspecialty.Conclusion: Despite long-standing efforts to improve quality of care, and significant achievements to date, most Latin American countries have yet to develop palliative medicine as medical specialty. Specialty and sub-specialty training programs remain scarce in relation to regional needs, and the programs that do exist vary widely in duration, structure, and content. [ABSTRACT FROM AUTHOR]

Context: Although the importance of palliative care (PC) integration in the emergency department (ED) has long been recognized, few formalized programs have been reported, and none have evaluated the experience of ED clinicians with embedded PC.Objectives: We evaluate the experience of ED clinicians with embedded PC in the ED during the coronavirus disease pandemic.Methods: ED clinicians completed a survey about their perceptions of embedded PC in the ED. We summarized responses to closed-ended items using descriptive statistics and analyzed open-ended items using thematic analysis.Results: There were 134 ED clinicians surveyed. About 101 replied (75% response rate). Of those who had interacted with PC, 100% indicated a benefit of having PC involved. These included freeing up ED clinicians for other tasks (89%), helping them feel more supported (84%), changing the patients care trajectory (67%), and contributing to clinician education (57%) and skills (49%). Among barriers related to engaging PC were difficulty locating them (8%) and lack of time to consult because of ED volume (5%). About 98% of respondents felt that having PC in the ED was either valuable or very valuable. Open-ended responses reflected a positive impact on clinician wellness and improvement in access to high-quality goal-concordant care. Clinicians expressed gratitude for having PC in the ED and noted the importance of having readily available and easily accessible PC in the ED.Conclusion: ED clinicians' perception of embedded PC was overall positive, with an emphasis on the impact related to task management, enrichment of PC skills, providing support for the team, and improved care for ED patients. [ABSTRACT FROM AUTHOR]

Outcomes: 1. Explore a serious illness communication model grounded in establishing trust for patient populations in whom mistrust abounds 2. Discuss best practices for applying this communication framework to diverse patient populations with whom you work. During the early days of the COVID-19 pandemic, the world looked on as Brazil experienced one of the first peak waves, caring for patients when prognosis was uncertain, and infrastructure and capacity were severely insufficient. Through this lived experience of developing and running a COVID intensive care unit at a public hospital with extensive barriers to trust, we realized that many existing serious illness communication models do not account for such settings of high baseline mistrust. Grounded in literature on the basic human need of establishing trust as well as the lived experience of running a COVID intensive care unit during such unprecedented circumstances, we developed a framework for serious illness communication in settings of high mistrust. This presentation will highlight the four main components of this communication model: Establishing Trust, Tuning Emotions, Emotional Synchrony, and Cognitive Alignment. The presentation will also include case examples of how utilizing this model changed communication patterns and decision making. We will also share data surrounding patient outcomes. We will also discuss the need for more diverse communication models, both in the United States and globally to meet diverse patient needs. Particularly in healthcare settings where mistrust abounds, it is crucial for clinicians to explore patients' goals and values with cultural humility and with an emphasis on proving themselves trustworthy. Lastly, we will engage in audience discussion, applying this communication model developed in one Latin American country during a humanitarian crisis more broadly to fit the needs of a diverse patient population across multiple settings. Sharing lessons learned from our experiences developing a culturally tailored, practical, trust-enhancing serious illness communication model is one step toward dismantling our healthcare systems' inherent biases and engaging in co-creation of diverse communication models. [ABSTRACT FROM AUTHOR]

Outcomes 1. Identify shared challenges of palliative care delivery in diverse patient populations in resource-limited settings 2. Illustrate a psychoeducational approach to enhancing resilience for palliative care providers working in local and global health settings with diverse patient populations in East Africa, India, and the Navajo Nation 3. Highlight resilience interventions applied to healthcare and advocacy work in the correctional system Due to rising rates of burnout, the importance of resilience training and self-care in the field of hospice and palliative medicine is a central issue for all providers.1,2 Delivering care to diverse patient populations in resource-limited settings conveys unique challenges for providers caring for patients with variable access to care.3 These settings have high rates of late presentation, challenges around financial and housing limitations often related to systemic racism, and variable ongoing access to care, particularly highlighted during the COVID-19 pandemic.4 These healthcare disparities, when encountered globally or locally by patients and caregivers, lead to moral distress and burnout for healthcare providers as they struggle with observing suffering and optimizing care in an inherently limited system.5,6 To ensure these populations receive the highest quality of care from well-functioning providers, it is critical to identify and share best practices in resilience training for providers working in these settings. We explore this issue by examining approaches to resilience training with two case studies of palliative care delivery in resource limited settings: Resilience training and structured debriefing for global health palliative care providers working in international settings in partnership with Pallium India, Mulago Hospital in Uganda, and Navajo Nation in the United States; and integrative resilience interventions in prison healthcare and advocacy work in the Louisiana and California departments of corrections. Both featured programs highlight a unique interdisciplinary approach to resilience training design and delivery, drawing on teams of physicians, psychologists, and chaplains, both locally and globally. Through these case studies, we identify innovative approaches to enhancing resilience and decreasing moral distress in resource-limited palliative care settings. [ABSTRACT FROM AUTHOR]

The Latinx population faced higher rates of infection and severe illness during the COVID-19 pandemic, resulting in an increased need for palliative care services. We describe the creation and impact of a formal palliative care initiative developed for seriously ill, Spanish-speaking patients during the COVID-19 pandemic at a tertiary care academic medical center. Patients were enrolled in the Spanish Palliative Care Initiative during a two-month period starting in April 2020. Selected patients were longitudinally followed by a rotating team of Spanish-speaking palliative care clinicians. Following the intervention, a retrospective chart review was conducted to evaluate the impact of the program. We enrolled 22 patients. The most frequent palliative care task completed during the initial visit was information giving (77%) and during follow-up visits were goals of care discussion (59%) and coping support (59%). Fifteen patients (68%) had a change in code status and 4 patients (18%) were discharged to hospice. The creation of a focused clinical program targeting a historically marginalized population offered opportunity for early palliative care intervention in clinical care for Spanish-speaking patients. This underscores the need for Spanish-language concordant palliative care to improve serious illness care, and end-of-life care, by providing continuity of care, spiritual care, and ICU team support. [ABSTRACT FROM AUTHOR]

Context: The vast majority of people with serious health-related suffering in low- and middle-income countries lack access to palliative care (PC). In Latin America, this shortage is critical, and PC education is greatly needed.Objectives: This study aims to assess the effects of an advanced PC diploma course in Chile through assessment of participants' satisfaction, knowledge, behavior, and self-efficacy.Methods: We developed and implemented a 12-day, hybrid-setting, advanced PC diploma course for Latin American clinicians and collected and analyzed pre course, immediate post course, and 6-month post course quantitative and qualitative data on satisfaction, knowledge, behaviors, and self-efficacy.Results: Thirteen Latin American doctors participated in this advanced PC diploma course. Overall knowledge and self-efficacy increased post course. One hundred percent of participants described the course as "very high quality" or "high quality," described the course's teaching methods as "very easy to understand" or "easy to understand," and ranked role-play as a "very useful" tool.Conclusion: There is a critical shortage of PC in Latin America where PC education is greatly needed. The lessons learned from this pilot advanced PC diploma course will inform further PC educational development in Latin America. The results of our course assessments show that an advanced diploma course can increase participants' PC knowledge, behaviors, and self-efficacy with a goal of leveraging the Train the Trainer model to increase PC educational leadership and enable training at participants' home institutions. [ABSTRACT FROM AUTHOR]

Despite a growing need, palliative care education tools tailored to providers in the Caribbean remain extremely limited. We conducted a mixed methods analysis of the first Project ECHO (Extension for Community Healthcare Outcomes) model adapted for palliative care providers in the Caribbean. These virtual, case-based sessions were held to enhance regional palliative care providers' knowledge of symptom management, communication, and psychosocial support. Participants reported strong satisfaction and significant impacts on their practices. They described significant improvements in their sense of community (1.23, P ≤ 0.01), confidence in palliative care skills (0.64, P ≤ 0.01), and knowledge for each monthly topic. Our findings suggest that the ECHO model has been successfully adapted to the needs of palliative care providers in the Caribbean, though further capacity building, public policy, and research are needed to broaden access to palliative care across the region. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for health care providers skilled in rapid and flexible decision making, effective and anticipatory leadership, and in dealing with trauma and moral distress. Palliative care (PC) workers have been an essential part of the COVID-19 response in advising on goals of care, symptom management and difficult decision making, and in supporting distressed health care workers, patients, and families. We describe Global Palliative Education Collaborative (GPEC), a training partnership between Harvard, University of California San Francisco, and Tulane medical schools in the U.S.; and two international PC programs in Uganda and India. GPEC offers U.S.-based PC fellows participation in an international elective to learn about resource-limited PC provision, gain perspective on global challenges to caring for patients at the end of life, and cultivate resiliency. International PC colleagues have much to teach about practicing compassionate PC amidst resource constraints and humanitarian crisis. We also describe a novel educational project that our GPEC faculty and fellows are participating in-the Resilience Inspiration Storytelling Empathy Project-and discuss positive outcomes of the project. [ABSTRACT FROM AUTHOR]

Outcomes 1. Describe challenges of burnout and resiliency that unique patient and provider populations have experienced throughout the COVID-19 pandemic 2. Engage in self-reflection on experiences with resiliency and burnout through the lens of one's own culture, patient population, and personal experiences 3. Compare and contrast advantages and challenges of leveraging technology for resiliency enhancement, communal grieving, and bidirectional learning across cultures During the global COVID-19 pandemic, palliative care providers internationally have experienced varying levels of distress and burnout in response to this crisis. When compared to the United States overall, providers working globally and in American Indian tribal nations may have experienced increased personal and professional suffering and distress due to the pandemic. The pandemic has also shone a light on inequity in healthcare and revealed how minority patients have been affected disproportionately. In response to travel and in-person gathering limitations, technology can be leveraged to enhance resiliency, decrease isolation, and mitigate burnout in providers, as well as provide a place to discuss these inequities and engage in communal grieving. These necessary adaptations during the global pandemic provided valuable lessons we can take forward in our practices. Our team leveraged Zoom and Project ECHO groups across countries and cultures, resulting in enhanced resiliency and bidirectional learning. We present our experiences and best-practices for leveraging technology to enhance resiliency across cultures using case studies of 3 different settings: Lakota Nation, the Caribbean, and Latin America. [ABSTRACT FROM AUTHOR]