A Retrospective Review of the Management of Malignant Bowel Obstruction at a Large, Tertiary Cancer Care Center (FR481A)

Abstract

Providing high quality team-based palliative care in rural settings, in small hospitals, outpatient clinics, and homes presents economic and workforce challenges. Simply following an algorithm or copying blueprints from larger, academic centers may not be feasible in smaller communities with unique histories, smaller stakeholder groups, and thinner economic margins. The solutions are as complex as the individuals we are trying to care for: resources are scarce, education is essential, and sustainability is paramount. In this session, we share examples of palliative care program development in rural America, citing data and the unique narratives that describe common challenges and successes. This session will compare and contrast the palliative care programs arising from rural and under-resourced communities. A panel of palliative care physicians, administrative champions, and program developers will share their perspectives on the challenges and rewards of building more with less. We will highlight programs that include two California-based efforts to leverage technology to bring palliative care support to small hospitals and to the Karuk Tribe, as well as a single-hospital health system in southwestern Pennsylvania utilizing administrative and community supports to overcome the barriers for palliative care program development.

Malignant bowel obstruction

“…Although meta‐analysis has suggested no statistical benefit of corticosteroid use, a subset of patients may benefit from them and medication‐related morbidity is low, particularly in patients in the terminal stages of their disease. While direct comparisons of these agents have not yielded clear recommendations, a combination of these medications or “cocktail” may offer synergistic benefits over single agents …”