Background/Purpose: Patients with advanced systemic rheumatic diseases such as systemic sclerosis, inflammatory myositis and vasculitis often have a high burden of symptoms and limited life expectancy. However, these patients have limited access to palliative care. The results of a survey sent out by the Canadian Rheumatology Association revealed that rheumatologists self-report discomfort with, and inadequate knowledge of, palliative care topics including how to engage in advance care planning and goals of care (ACP and GOC) conversations suggesting a gap in training. This study assesses the impact of an education session designed for rheumatologists and trainees.

Methods: A group of rheumatologists and trainees participated in a didactic session and hands on practice with standardized patients based on a structured ACP and GOC Conversation Guide. A post-workshop survey assessed participants’ practice patterns and the workshop’s impact on participants’ comfort with these conversations. Results were analyzed using descriptive statistics.

Results: 12 rheumatology faculty and trainees participated in the workshop and 8 completed the post-workshop survey. Of the participants who completed the survey, 63% (n=5) reported that 5% or more of inpatients that they cared for had advanced rheumatologic diseases with significant functional limitation and/or an estimated prognosis of less than 1 year. 88% (n=7) felt that the workshop was useful to their clinical practices. 75% (n=6) reported that they will be more comfortable in engaging in goals of care conversations with patients following the workshop. 63% (n=5) reported that the workshop raised awareness of the importance of palliative care for patients with life-limiting systemic rheumatic diseases. 63% (n=5) reported that the insights acquired will facilitate challenging aspects of patient care.

Conclusion: We piloted and evaluated a rheumatology-specific advance care planning and goals of care conversation training module delivered to rheumatology residents and faculty. Preliminary results point to participants’ increased comfort with these conversations and increased awareness of palliative care’s role for patients with end-stage rheumatologic conditions. Further study on a larger scale is required to better assess the value of such educational interventions, and their long-term impact on promoting interdisciplinary models of care for patients with life-limiting rheumatic diseases.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/palliative-care-for-the-rheumatologist-an-educational-and-patient-care-intervention/