Early Interdisciplinary Palliative Care Involvement for Patients Who Inject Drugs

Outcomes 1. Participants will be able lead their palliative care team towards an early interdisciplinary approach for patients who inject drugs.2. Participants will evaluate their current approach to evaluating surrogate decision making for patients who inject drugs based on their state-specific healthcare consent act. Key Message Early, interdisciplinary palliative care can improve goal concordant identification of surrogate decision makers among patients who inject drugs. Abstract With the MATE Act palliative care clinicians are called to recognize opioid use disorder (OUD) as a life-limiting illness and offer life-saving treatment with buprenorphine. Clinicians must also continue to approach patients who inject drugs (PWID) from a palliative lens in regards to recognizing the need for advance care planning conversations. A palliative care clinician's unique lens allows them to be future minded for serious illness experiences that PWID may encounter in the course of their illness. PWID are less likely to have a surrogate decision maker that is concordant with a state's Adult Healthcare Consent Act, which is a major difference to the typical patient receiving palliative care. Two example scenarios 1) they are legally married with financial barriers to formal separation, or 2) they are estranged from their biological family as a consequence of their OUD. Regardless of the reason, clinicians should pay special attention to establishing surrogate decision makers when consulted for PWID. This interdisciplinary presentation will focus on the need for a palliative care team approach to the appropriate treatment of PWID and will center on a case of a patient presenting with injection related tricuspid endocarditis We will follow the case through shared decision making and the decision to receive an artificial heart valve and start medications for opioid use disorder. Two years later, they return with an infection of the mechanical valve and we are reconsulted after the cardiothoracic surgery team declines repeated intervention. Keywords Shared Decision Making / Advance Care Planning / Interdisciplinary Teamwork / Professionalism