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Hidden in Plain Sight: Palliative Care for Undocumented Immigrants (TH348)
Vol. 49 No. 2 February 2015
Schedule With Abstracts
Systematic Review Background. Experts and professional societies in both palliative care (PC) and critical care have developed strategies aimed at improving the implementation of PC in the acute care setting. A recent focus of these groups is on the development of clinical screening criteria, or ‘‘triggers,’’ alerting clinicians to the palliative care needs of hospitalized patients. While many publications recommend tailoring screening criteria to individual acute care settings, common or foundational screening criteria for universal adoption have not been described. Aims. The aim of this systematic review is to identify common screening criteria for palliative care consultation in the acute care setting. Methods/Session Descriptions. CINAHL, The Cochrane Library, PsychINFO, SocINDEX, Web of Science, and PubMed databases were searched using terms ‘‘screening criteria,’’ ‘‘triggers,’’ ‘‘palliative care,’’ and ‘‘acute care.’’ Two reviewers independently conducted searches, selected articles, and extracted data. Each stage was discussed until consensus was reached. A third reviewer was available if consensus was not achieved. Investigators included (a) articles with specific triggers or screening criteria for palliative care, (b) articles focused on the acute care setting, (c) studies of adults (aged 18 and older), and (d) publications in English from 19952014. The search strategy yielded 1,878 references, of which 10 articles were analyzed. Conclusion. Various screening criteria as well as methods to generate and evaluate criteria for PC consultation were reported in the literature, however some common themes were identified including length of hospitalization and mechanical ventilation, neurological status, age in conjunction with comorbidities, multisystem organ failure, and stage-IV malignancy. The identification of common screening criteria for PC consultation may serve as a foundation for clinicians aiming to develop or advance the presence of PC in rural, community, and academic hospital acute care settings. Further research is needed in determining universal or appropriate screening criteria for PC consultation in the adult acute care setting.
Concurrent Session
353
Objectives Describe three unique barriers that undocumented immigrants face when they are diagnosed with a serious illness. Identify successful strategies for increasing access to hospice and palliative care services for undocumented immigrants. Discuss how to anticipate common concerns and requests made by undocumented immigrants who are approaching the end of life. Currently more than 11 million undocumented immigrants live in the United States. Although they are able to receive emergency and some primary care services, undocumented and recent immigrants are unable to purchase health insurance and cannot access Medicaid or Medicare benefits, including hospice. Patient concerns regarding their immigration status and economic, cultural, and linguistic barriers may further limit access to medical care. Therefore, undocumented immigrants may only seek care when they develop refractory symptoms of advanced illness. In caring for recent or undocumented immigrants, palliative care providers often have to address a wide range of cultural, economic, linguistic, legal, and ethical challenges. In this session, an interdisciplinary team of presenters will illustrate these challenges and describe how each member of the interdisciplinary team can help to address them. We will provide practical suggestions for eliciting undocumented immigrants’ unique concerns and facilitating access to critical services. Through case examples, we will demonstrate how to address common end-of-life concerns, including repatriation to countries of origin and/or facilitating contact with family members living abroad; how to provide care to immigrants who are marginally housed or have limited caregiver support; and how to obtain palliative and hospice care for these patients. Presenters from different geographic regions will address state-specific barriers to quality end-of-life care and provide successful strategies for overcoming them. We will also discuss the unique losses and sense of isolation experienced by undocumented immigrants, as well as the ethical dilemmas faced by the providers who care for them.
Friday, February 27 7e8 am
Hidden in Plain Sight: Palliative Care for Undocumented Immigrants (TH348) Anne Kinderman, MD, University of California, San Francisco, San Francisco, CA. Melanie Bien, MSW, San Francisco General Hospital, San Francisco, CA. Susan Cohen, MD, New York University/Bellevue, Bronx, NY. Robert Smeltz, MA NP RN ACHPN, Bellevue Hospital, New York, NY.
Early-Riser Concurrent Sessions The Practice of Palliative Medicine in Developing CountriesdPart One (FR400) Michelle Grunauer, MD PhD MSc, Universidad San Francisco de Quito, Hospital de los Valles, Quito,
Schedule With Abstracts
Systematic Review Background. Experts and professional societies in both palliative care (PC) and critical care have developed strategies aimed at improving the implementation of PC in the acute care setting. A recent focus of these groups is on the development of clinical screening criteria, or ‘‘triggers,’’ alerting clinicians to the palliative care needs of hospitalized patients. While many publications recommend tailoring screening criteria to individual acute care settings, common or foundational screening criteria for universal adoption have not been described. Aims. The aim of this systematic review is to identify common screening criteria for palliative care consultation in the acute care setting. Methods/Session Descriptions. CINAHL, The Cochrane Library, PsychINFO, SocINDEX, Web of Science, and PubMed databases were searched using terms ‘‘screening criteria,’’ ‘‘triggers,’’ ‘‘palliative care,’’ and ‘‘acute care.’’ Two reviewers independently conducted searches, selected articles, and extracted data. Each stage was discussed until consensus was reached. A third reviewer was available if consensus was not achieved. Investigators included (a) articles with specific triggers or screening criteria for palliative care, (b) articles focused on the acute care setting, (c) studies of adults (aged 18 and older), and (d) publications in English from 19952014. The search strategy yielded 1,878 references, of which 10 articles were analyzed. Conclusion. Various screening criteria as well as methods to generate and evaluate criteria for PC consultation were reported in the literature, however some common themes were identified including length of hospitalization and mechanical ventilation, neurological status, age in conjunction with comorbidities, multisystem organ failure, and stage-IV malignancy. The identification of common screening criteria for PC consultation may serve as a foundation for clinicians aiming to develop or advance the presence of PC in rural, community, and academic hospital acute care settings. Further research is needed in determining universal or appropriate screening criteria for PC consultation in the adult acute care setting.
Concurrent Session
353
Objectives Describe three unique barriers that undocumented immigrants face when they are diagnosed with a serious illness. Identify successful strategies for increasing access to hospice and palliative care services for undocumented immigrants. Discuss how to anticipate common concerns and requests made by undocumented immigrants who are approaching the end of life. Currently more than 11 million undocumented immigrants live in the United States. Although they are able to receive emergency and some primary care services, undocumented and recent immigrants are unable to purchase health insurance and cannot access Medicaid or Medicare benefits, including hospice. Patient concerns regarding their immigration status and economic, cultural, and linguistic barriers may further limit access to medical care. Therefore, undocumented immigrants may only seek care when they develop refractory symptoms of advanced illness. In caring for recent or undocumented immigrants, palliative care providers often have to address a wide range of cultural, economic, linguistic, legal, and ethical challenges. In this session, an interdisciplinary team of presenters will illustrate these challenges and describe how each member of the interdisciplinary team can help to address them. We will provide practical suggestions for eliciting undocumented immigrants’ unique concerns and facilitating access to critical services. Through case examples, we will demonstrate how to address common end-of-life concerns, including repatriation to countries of origin and/or facilitating contact with family members living abroad; how to provide care to immigrants who are marginally housed or have limited caregiver support; and how to obtain palliative and hospice care for these patients. Presenters from different geographic regions will address state-specific barriers to quality end-of-life care and provide successful strategies for overcoming them. We will also discuss the unique losses and sense of isolation experienced by undocumented immigrants, as well as the ethical dilemmas faced by the providers who care for them.
Friday, February 27 7e8 am
Hidden in Plain Sight: Palliative Care for Undocumented Immigrants (TH348) Anne Kinderman, MD, University of California, San Francisco, San Francisco, CA. Melanie Bien, MSW, San Francisco General Hospital, San Francisco, CA. Susan Cohen, MD, New York University/Bellevue, Bronx, NY. Robert Smeltz, MA NP RN ACHPN, Bellevue Hospital, New York, NY.
Early-Riser Concurrent Sessions The Practice of Palliative Medicine in Developing CountriesdPart One (FR400) Michelle Grunauer, MD PhD MSc, Universidad San Francisco de Quito, Hospital de los Valles, Quito,