Palliative Care Experiences for People with Opioid-related Health Harms: A Multi-setting Qualitative Study

Outcomes 1. Participants in this session will benefit from an understanding of how people with opioid-related health harms experience palliative care, including barriers related to the social determinants of health and structural vulnerability.2. Participants will also learn about the structural, social and self-stigma experiences of people with a history of opioid use with respect to receiving palliative care and opioids. Key Message Providing high-quality palliative care and prescribing opioids for patients with opioid use disorder with advanced illness is complicated by many barriers, including stigma, social determinants of health, and structural vulnerability. Specialized approaches to address these challenges and gaps would contribute to meeting the end-of-life needs of such patients. Introduction Given rising prevalence of opioid use disorder (OUD), there is an urgent need to understand the end-of-life needs and to improve palliative care for people with a history of opioid-related health harms (OHH), suggestive of OUD. Due to stigma, people with OHH likely face difficulty accessing palliative care and opioids, which are essential medicines to relieve pain and shortness of breath. Objectives We aim to understand the end-of-life experiences of people with OHH, including those living in poverty and experiencing homelessness. Particularly, we explore perceptions of access to healthcare and palliative care, opioid prescribing, and stigma associated with access and prescribing at end of life. Methods This study is a multi-phased, mixed-methods project. Phase 1 involved population level studies using administrative data to compare people with and without OHH. Phase 1 informed Phase 2, a qualitative examination in which we are interviewing patients with OHH and/or their caregivers, as well as conducting focus groups with healthcare providers. Patients include people who have received formal palliative care or informal supports for advanced illness, as well as people receiving care across diverse settings (e.g., hospital, hospice, home, shelter) in Ottawa and Toronto, Canada. Results Phase 1 found differences in the receipt of palliative care for people with OHH compared to the general population with respect to location, timing, and intensity of palliative care. Phase 2 takes a deeper dive into these findings and explores the perspectives of patients/caregivers and healthcare providers regarding these differences. Themes highlight the intersection of palliative care with social factors (e.g., gender, income), including how stigma influences access to palliative care and receipt of opioid prescriptions. Conclusion The study findings demonstrate key challenges in the provision of high-quality palliative care for people with OHH, bringing awareness to this group's end-of-life needs and highlighting areas for further research. Keywords Diversity, Equity, Inclusion, Belonging, Justice