Reconstructing Palliative Care Clinical Practice: Interrogating and Innovating

{"title":"Reconstructing Palliative Care Clinical Practice: Interrogating and Innovating","authors":"Terry Altilio LCSW APHSW-C,&nbsp;Vickie Leff MSW LCSW APHSW-C","doi":"10.1016/j.jpainsymman.2025.02.088","DOIUrl":null,"url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Identify foundational concepts from a variety of scholars and fields to interrogate the history of palliative care practice and inform practice going forward and mitigate unintended consequences.</div><div>2. Identify the challenges and opportunities implicit in the work of palliative, hospice to influence and mitigate bias and inequities.</div></div><div><h3>Abstract</h3><div>This workshop engages participants in a process of interrogating foundational constructs and paradigms developed over the last half century during which Palliative Care has evolved. The intention is to make visible the dogmas we inhabit, disrupting assumptions and encouraging innovation by integrating the work of scholars beyond the siloed world of palliative care. We explore concepts, beliefs and values from the humanities that build on the evolution of serious illness care and enrich the lens through which we see, evaluate and engage this essential relational work. This interactive workshop is intended for all professions, at any point in their careers. Using a variety of perspectives, theories, and philosophies we integrate video and patient family descriptions to explore the rich tapestry of experience which joins patients, families, and staff. As we deconstruct our past and present, we invite a shared imagining of practice going forward. Drawing on scholars and clinicians such as Foucault, Nichols, DeGruy, Laws, Wailoo, we illustrate where the work of these leaders intersect in aspects of clinical practice such as Family, Pain, Ethics, Language and Sustainability. Some of the concepts that are interwoven throughout the workshop include: testimonial injustice, relational autonomy, axiology of culture, delegitimization, response shift and structural competence Challenging the existing transactional healthcare paradigm with inclusive, relational and justice lens offers the chance for enriched conversations, focused activism and innovative options in education and practice with an intention of enhancing practice skills and mitigating inequities across healthcare settings.</div></div><div><h3>References</h3><div>Chambon, A., Irving, A. (1999). Reading Foucault for Social Work: Columbia University Press. Fricker, M. (2007). Epistemic Injustice: Power and the Ethics of Knowing: Oxford University Press. Hansen, H., &amp; Metzl, J. (2016). Structural Competency in the U.S. Healthcare Crisis: Putting Social and Policy Interventions Into Clinical Practice. J Bioeth Inq, 13(2), 179-183. doi:10.1007/s11673-016-9719-z Jimenez, G., Tan, W. S., Virk, A. K., Low, C. K., Car, J., &amp; Ho, A. H. Y. (2018). Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons. J Pain Symptom Manage, 56(3), 436-459.e425. doi:10.1016/j.jpainsymman.2018.05.016 Laws, T. (2021). How Should We Respond to Racist Legacies in Health Professions Education Originating in the Flexner Report? AMA Journal of Ethics, 23(4), e271-275. McIntee, M. F., Madigan McCown, L., Chessa, F., &amp; Hutchinson, R. N. (2024). \"The Patient Is Being Pressured!\" Coercion Versus Relational Autonomy. J Palliat Med. doi:10.1089/jpm.2023.0333 Park, Y., Crath, R., &amp; Jeffery, D. (2020). Disciplining the risky subject: a discourse analysis of the concept of resilience in social work literature. Journal of Social Work, 20(2), 152-172. doi:10.1177/1468017318792953 Sallnow, L., Smith, R., Ahmedzai, S. H., Bhadelia, A., Chamberlain, C., Cong, Y., . . . Wyatt, K. (2022). Report of the Lancet Commission on the Value of Death: bringing death back into life. Lancet, 399(10327), 837-884. doi:10.1016/s0140-6736(21)02314-x Morrison, R. Sean (2020). Advance Directives/Care Planning: Clear, Simple, and Wrong. J Palliat Med, 23(7), 878-879. doi:10.1089/jpm.2020.0272</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e461-e462"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0885392425001484","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}