Interdisciplinary Pain Board for Managing Patients with Palliative Care Needs and Substance Use Disorder: A Pilot Study.

Abstract

<b><i>Context:</i></b> Patients with cancer-related pain and concurrent substance use disorder (SUD) present a unique set of challenges for palliative care clinicians. A structured forum for interdisciplinary collaboration is needed to effectively manage this complex population. <b><i>Objectives:</i></b> Describe the feasibility and acceptability of a palliative care Complex Pain Board (CPB), an interdisciplinary team meeting to provide concrete care recommendations for patients with cancer-related pain and concurrent SUD and/or psychosocial complexity. <b><i>Methods:</i></b> We conducted a retrospective analysis of cases presented at CPB between May 2021 and June 2022 and a cross-sectional analysis of CBP participant surveys. <b><i>Results:</i></b> Among 28 cases included for analysis, gastrointestinal cancers (<i>n</i> = 7, 25.9%) and multiple myeloma (<i>n</i> = 5, 18.5%) were the most frequent cancer diagnoses. Primary reasons for referral were SUD (<i>n</i> = 22, 78.6%) and provider/team distress (<i>n</i> = 13, 46.4%). The most frequent recommendations made at CBP were encouraging interdisciplinary collaboration (<i>n</i> = 18, 64.3%), maintaining healthy boundaries (<i>n</i> = 15, 53.6%), and SUD management (<i>n</i> = 13, 46.4%). Of 14 scheduled meetings, most meetings involved the presentation of ≥1 cases (<i>n</i> = 12, 86%). Among 40 CBP participant surveys, most attendees (<i>n</i> = 38, 95%) were likely or highly likely to continue to attend. <b><i>Conclusion:</i></b> CPB is a feasible and acceptable intervention that allows for palliative care clinicians to collaborate and receive interdisciplinary team feedback and peer support on the management of patients with cancer-related pain and concurrent SUD and/or psychosocial complexity in the ambulatory care setting. <b><i>Key Message:</i></b> A regular, interdisciplinary team meeting (CPB) is a feasible and acceptable intervention to help palliative care clinicians manage challenging cases involving patients with cancer and concurrent SUD and/or psychosocial complexity.