Safety net providers serve a substantial percentage of low-income individuals in the United States, many of whom have complex health and social needs including trauma, behavioral health conditions, and social determinant factors. As these individuals face serious medical illnesses and become eligible for palliative care, they may find that their care is misaligned with their values, needs, and goals.

In this article published in NEJM Catalyst Innovations in Care Delivery, the authors outline five strategies for improving palliative care in the safety net:

  1. Using lay health workers to build authentic healing relationships with patients, develop advance care planning early, and addressing social determinant gaps.
  2. Addressing gaps in care and setting goals for care through trauma-informed strategies, motivational interviewing, and video-based decision aids.
  3. Creating specialized interventions that leverage relationships between providers and flexible funding to help patients meet their goals.
  4. Shaping interdisciplinary care teams for resilience and burnout prevention.
  5. Addressing the roles of implicit bias, assumptions, and anxiety related to opioid prescribing by using a relationship-based, multifaceted assessment of risk.

This article was authored by Will Kennedy (CareOregon; Housecall Providers); Lauran Hardin (National Center for Complex Health and Social Needs); Anne Kinderman (Supportive and Palliative Care Service at Zuckerberg San Francisco General Hospital; University of California San Francisco); Diane Meier (Center to Advance Palliative Care); John Loughnane (Commonwealth Care Alliance); and Angelo Volandes (Mass General Hospital; Harvard Medical School; ACP Decisions). Note that subscription to NEJM Catalyst Innovations in Care Delivery is required to read the full text of this article.

Read in NEJM Catalyst