Coordinating Complex Discharge to Cuba at End of Life

• Published in: Journal of pain and symptom management Vol. 67; no. 5; p. e641
• Main Authors: Rana, Amna, Saldivar, Reggie T.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.05.2024
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2024.02.082

1. Collaborate within an interdisciplinary team to help facilitate complex discharge process for patients at end of life, to provide goal-concordant care, and to establish safe lines of communication. 2. Understand importance of verbal and written communication with interpreter services to address language barriers, elicit patient values and goals, and coordinate safe discharge plan. This poster highlights how an interdisciplinary approach, utilizing the skillset of many different team-members, is essential to coordinating discharge for patients at end of life to their country of origin. Furthermore, it notes the importance of addressing language barriers through interpreter services for both verbal and written communication in order to best elicit patient goals and to coordinate safe discharge. Background: Many patients hope to spend the end of their life surrounded by their support system. In some instances, this means returning to their country of origin. The discharge process can be complicated by barriers such as language, opioid availability, variability of hospice services, and the patient's overall stability for travel. However, there is no set protocol for coordinating such a complex discharge process. In this poster, we highlight the steps that were taken to facilitate a discharge of a patient at end of life to her home country of Cuba. Ms. N is a Spanish-speaking 59 year old woman with metastatic duodenal adenocarcinoma who initially presented to the hospital in the setting of severe pain crisis due to progression of disease. It was determined her cancer-directed treatment options were limited. During the hospitalization, the patient elected for focus on comfort and to go back to Cuba for the end of her life. Multiple family meetings were held to address barriers to discharge. Importantly, all the family meetings were held with in-person interpreters to best communicate with Ms. N and her family. Social work helped establish communication lines with Ms. N's family and accepting physician in Cuba. Handoff was provided via phone call by primary and palliative care teams to the accepting physician. At time of discharge, Ms. N was given 30 day supply of all medications, complete medical records, and patient instructions with medication list in written Spanish. She traveled to Cuba the day after discharge from the hospital. Overall, this case highlights the necessity of interdisciplinary teamwork in coordinating complex and safe discharges. Each member of the team provided their expertise in medical management, psychosocial support, and logistical challenges of this complex discharge plan. Interdisciplinary Teamwork / Professionalism; Communication