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Background: Interpersonal communication is a cornerstone of patient-centered care. We aimed to identify what patients with cancer and caregivers may want from communication during a public health crisis. Methods: We interviewed 15 patients (8 Veteran, 7 non-Veteran) and caregivers from regionally, racially, and ethnically diverse backgrounds across the US about serious illness care and quality of care during the COVID-19 pandemic Using an iterative, inductive and deductive process, 2 coders analyzed content associated with the code "Communication," which appeared 71 times, and identified 5 themes. Results: Participants identified as White (10), Latino/a (3), Asian (1), and Black (1). (1) Help patients and caregivers prepare for care during crisis by communicating medical information directly and proactively. (2) Explain how a crisis might influence medical recommendations and impact on recovery from illness. (3) Use key messengers to improve communication between primary teams, patients, and caregivers. (4) Include caregivers and families in communication when they cannot be physically present. (5) Foster bidirectional communication with patients and families to engage them in shared decision-making during a vulnerable time. Conclusion: Communication is critical during a public health crisis yet overwhelmed clinicians may not be able to communicate effectively. Communicating with caregivers and family, transparent and timely communication, ensuring diverse providers are on the same page, and effective listening are known gaps even before the COVID-19 pandemic. Clinicians may need quick interventions, like education about goals of care, to remind them about what seriously ill patients and their caregivers want from communication and offer patient-centered care during crises. [ABSTRACT FROM AUTHOR]

1. Along with understanding sources for rising cancer prevalence among Veterans of Native Hawaiian/Pacific Islander heritage, participants will be able to identify strategies to address geographic, logistical, and financial challenges, as well as effects of historical trauma, that may be exacerbating cancer health disparities. 2. By using an indigenous framework to health, participants will learn to culturally adapt clinical practices to address mistrust and build a therapeutic relationship with Veterans of Native Hawaiian/Pacific Islander heritage. Cancer health disparities experienced by Veterans who are Native Hawaiian/Pacific Islander (NH/PI) can be related to socioeconomic disadvantages, exposures, and lifestyle. Disparities may be perpetuated by present-day geographic, logistic, and financial barriers, as well as historical trauma. VHA clinicians suggested strategies to culturally adapt care, and we can use an indigenous health framework to promote equitable cancer and palliative care. Veterans of Native Hawaiian/Pacific Islander (NH/PI) heritage have a high risk of developing cancer and related complications which may be amplified by barriers to cancer and palliative care. This ongoing study applies a mixed method, community-based participatory research approach to understanding healthcare needs of Veterans with cancer who are NH/PI. The study is guided by a community advisory board. Through snowball sampling and outreach, we targeted recruitment to ethnically diverse, multidisciplinary clinicians in a major Veterans Health Administration (VHA) medical center in Northern California and ambulatory clinics in the US-affiliated Pacific Islands (USAPI) between 3/2023-9/2023. Participants completed 45-minute semi-structured interviews to assess barriers and facilitators to cancer care and palliative care. Interviews were transcribed verbatim, de-identified, and deductively then inductively analyzed using rapid analysis matrices and dual coder review in Atlas.ti v23. Participants included 15 physicians, nurses, social workers, and clinical psychologists specializing in primary care, palliative care, and oncology, self-identifying as White, Asian American, NH/PI, and Multiracial. Preliminary analyses demonstrate the following barriers to accessing cancer and palliative care: 1) geographic, logistical, and financial challenges arranging long distance travel over an ocean with a "patient [who] needs to fly" that may get "ill on the flight"; 2) problems managing pain due to stoicism, misinformation as "people are still very anxious about" opioids, and constraints among VHA specialty care clinicians in the USAPI, 3) broadband infrastructure limitations leading to poor telehealth access; and 4) trauma, mistrust, and "tension from how Hawai'i [and other islands were] acquired by the United States." VHA clinicians discussed systemic, cultural, and historical barriers to cancer and palliative care while highlighting Veteran resilience and the promise of telehealth. An indigenous framework for health can help culturally adapt clinical practice and promote access to equitable health services for Veterans of NH/PI heritage. Diversity, Equity, Inclusion, Belonging, Justice Scientific Research [ABSTRACT FROM AUTHOR]

1. Identify time points along the perioperative continuum where PC and Urology can be better integrated. 2. Understand the importance of the perioperative period as a focus for future interventions to improve quality of care in patients facing urologic serious illness. Stakeholder interviews reveal a general overall need to create a culture change so that palliative care is integrated appropriately for patients with urologic serious illness. Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life. To understand stakeholder perceptions on integrating perioperative Palliative Care (PC) for patients with serious urologic illness. We conducted semi-structured interviews with purposefully sampled palliative care physicians (11), urologists (13), and clinical team members (13) at eleven geographically distributed Veteran Health Administration sites. Team-based thematic analysis was conducted to consensus with a dual review in Atlas.ti. We identified one general overall theme and three themes representing needs along the perioperative continuum as opportunities for integrating PC and urology. The general overall need was to "change culture" so that PC is not a "last resort" and "ideally, we would be starting palliative [care], when [we] start curative [treatment]." Opportunity 1: Utilizing telehealth and team member role expansion when discussing diagnosis and treatment options, with urologic surgery as a potential treatment, allows for multiple conversations "so they're not rushed in 15 minutes to mentally deal with the new diagnosis of cancer." Opportunity 2: Creating a process to ensure goal of surgery conversations occur with both urologists and PC, since "urologic procedures can have complications that significantly impact quality of life," which "would require changing how our workflow is structured." Opportunity 3: During the pre-operative visits, there can be interdisciplinary input and evaluation of the patient prior to surgery, so that the patient can "have a sort of joint meeting with us and the urologist." This represented the last point in time to de-escalate and offer non-surgical options prior to surgery. The study informs future interventions to improve the quality of care by integrating palliative care with urology. Future work can build on these findings by implementing the opportunities and determining how it impacts patient outcomes. Interdisciplinary Teamwork/Professionalism/Qualitative and Mixed Methods Research [ABSTRACT FROM AUTHOR]

1. Identify opportunities to improve perioperative communication about goals for patients with urologic serious illness. 2. Understand the value of having both Palliative Care Specialists and Urologists involved in preoperative conversations about patient goals. A joint Urology-Palliative Care team approach to navigating patient goals is warranted in advance of surgery for patients with urologic serious illness. In coordination, Urologists and PC can offer complementary contributions to different parts of a goals of care conversations, covering both goals of care generally and developing shared understanding of risks and realistic expectations of what surgery can achieve. Care for urologic serious illness often includes surgery; preoperative shared decision making about patient goals is often inadequately implemented in surgical settings. To understand perspectives on improving perioperative communication about goals for patients facing urologic serious illness. We conducted 37 semi-structured interviews with Palliative Care Physicians (PC) (11), Urologists (13) and interdisciplinary clinicians (13) at fourteen geographically distributed Veteran Health Administration (VHA) sites. The analytic approach relied on content analysis with dual review; analysis is conducted separately by provider type and triangulated. 1) In existing pre-operative workflows: "patients are not [always] aware that we might be able to palliate their symptoms without surgery" (URO). 2) Goal of surgery is often something patients really need help understanding, e.g. "It's gonna help temporarily, but it's not gonna help long term" (PC). 3) PC is not in the position to have the part of the goal of care conversation that clarifies the goal of the surgery: "it's very hard for non-surgeon to have a robust goals of care discussion with the patient who's co-managed with surgery unless surgery is able to give you a sense of what to expect." (PC) 4) A team approach to clarifying and navigating patient goals is warranted: "how do we work together to sort of think about prognosis, how to plan ahead for care after the surgery and then setting sort of real realistic expectations and goals for after the surgery?"(PC). 5) In coordination, Urologists and PC can offer complementary contributions to different parts of a goals of care conversation: "the interventionists would better know how effective the intervention is going to be, but PC probably has much better perspective on how the patient is doing overall." (URO) Patients will benefit from a urology-PC team approach to clarifying goals of care and surgery. Shared Decision Making / Advance Care Planning / Surgical / Palliative Care [ABSTRACT FROM AUTHOR]

1. Describe the cultural context of breast cancer and family caregiving among South Asians, such as stigma and gender expectations. 2. Describe the unmet individual and community needs and propose potential solutions to address them. Globally, one in five people are South Asian and the prevalence of breast cancer is increasing. The South Asian cultural context explains unmet mental health, social, and community needs among both BCS and FCG. High priority should be given to programs that can alleviate distress and social isolation, and to providing culturally- and linguistically-tailored resources and services. Culture can influence cancer management. Understanding how this occurs is central to providing culturally attuned, patient-centered care to South Asian (e.g., India, Pakistan) breast cancer survivors (BCS) and family caregivers (FCG), a fast-growing minority group. To develop a deeper understanding of the experiences of South Asian BCS and FCG. BCS (any stage) and FCG identifying as South Asian were recruited from Stanford University Cancer clinics and its surrounding community between 7/2021-03/2022. Participants completed a demographic survey and individual, 1-hour semi-structured interviews via video teleconference. Interviews were designed to elicit psychosocial, cultural, and community service experiences and unmet needs. These were recorded, transcribed, and analyzed using inductive and deductive coding. Fourteen women BCS (40.6±9.3y) and 14 FCG (5 women; 7 spouses; 46.1±13.8y) were recruited, all Indian heritage. Several themes were common to BCS and FCG: 1) Emotional distress, including shock ("felt like a sack of bricks falls on you"), fears of recurrence, metastases, and disclosure ("Promise, don't tell your mom or my mom will find out"); 2) Disclosing diagnosis to family within USA but secrecy from family in India, amplified by COVID-19 travel restrictions ("they'll just worry"); 3) Social isolation and a desire to connect with survivors and FCG from India; 4) Perception of better medical care in USA, but better logistical help in India; 5) Inadequate engagement of FCG by the healthcare team; and 6) Lack of availability of culturally and linguistically concordant resources and services. The South Asian cultural context can lead to social isolation and emotional distress among BCS and FCG. Supportive care may be enhanced by developing: a) behavioral programs to alleviate fear and social isolation; b) skills-training programs to help healthcare teams support FCG; c) educational materials in South Asian languages; d) home and community-based services to alleviate logistical burden. Diversity, Equity, Inclusion, Belonging, Justice / Scientific Research [ABSTRACT FROM AUTHOR]