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Background: Meeting the needs of seriously ill SARS-CoV-2 (COVID-19) patients requires novel models of deploying health social workers (SWs) to expand the palliative care workforce. To inform such expansion, understanding the current state of health SWs' core palliative care skills is necessary. Methods: Following minimal training, health SWs in one New York City hospital were surveyed about their frequency, competence, and confidence in using core palliative care skills. Results: Of the 170 health SWs surveyed, 46 (27%) responded, of whom 21 (46%) and 24 (52%) had palliative care training before and during the COVID-19 surge, respectively. Health SWs reported a ''moderate improvement'' in the use of three skills: ''identify a medical decision maker,'' ''assess prognostic understanding,'' and ''coordinate care.'' There was ''minimal decrease'' to ''no improvement'' to ''minimal improvement'' in competence and confidence of skill use. Conclusion:Our findings suggest that educational initiatives can improve health SWs' use of core palliative care skills.

Objective: To increase earlier access to palliative care, and in turn increase documented goals of care and appropriate hospice referrals for seriously ill patients admitted to hospital medicine. Background: Due to the growing number of patients with serious illness and the specialty palliative care workforce shortage, innovative primary palliative care models are essential to meet this population's needs. Methods: Patients with serious illness admitted to hospital medicine at a quaternary urban academic medical center in New York City and received an embedded palliative care social worker consultation in 2017. We used univariate analyses of sociodemographic, clinical, and utilization data to describe the sample. Results: Overall, 232 patients received a primary palliative care consultation (mean age of 69 years, 44.8% female, 34% white, median Karnofsky Performance Status of 40%), and 159 (69%) had capacity to participate in a goals-of -are conversation. Referrals were from palliative care solid tumor oncology trigger program (113 [49%]), specialty palliative care consultation team (42[18%]), and hospital medicine (34[14.6%]). Before the consultation, 10(4.3%) had documented goals of care and 207 (89%) did after the consultation. The percentage of those referred to hospice was 24.1%. Of those transferred to specialty palliative care consultation service, nearly half required symptom management. Discussion: Patients who received a primary palliative care consultation were seen earlier in their illness trajectory, based on their higher functional impairment, and the majority had capacity to participate in goals-of-care discussions, compared with those who were seen by specialty palliative care. The consultation increased goals-of-care documentation and the hospice referral rate was comparable with that of the specialty palliative consultation team.

with newly established palliative care programs and those that closed programs between 2013 and 2016. Methods. We linked the American Hospital Association Annual Survey to the National Palliative Care Registry for 2013 and 2016. We categorized hospitals as newly establishing a palliative care program, closing a program, or no change. We used 3 multivariate logistic regressions to identify factors associated with each category. Results. Nationally, the proportion of hospitals with 50 or more beds with a palliative care program increased from 67% in 2013 to 78% in 2016. A total of 278 hospitals established palliative care programs and 61 hospitals closed programs during this period. The proportion of for-profit hospitals with palliative care increased from 23% to 45% compared with nonprofit hospital increase from 78% to 88%. Hospitals with new vs established programs were more likely to be smaller (AOR 8.41, 95% CI 5.49-12.89 for 50-149 vs >300 beds; AOR 3.75, 95% CI 2.43-5.79 for 150-300 vs >300 beds), for-profit (AOR 7.45, 95% CI 4.95-11.19), sole community providers (AOR 3.36, 95% CI 1.97-5.73), and in the South Atlantic. Hospitals that closed palliative care programs had similar characteristics to hospitals that newly established programs. Conclusion. Palliative care program implementation is volatile among for-profit and smaller hospitals and varies by region. The impact of these changes on access to palliative care remains a critical area for future research.

Conclusion. This study is the first to evaluate a child centered advanced parental cancer intervention that resulted in improvements in both ill parents' and children's outcomes. Implications for Research, Policy, or Practice. Given the tremendous number of children impacted by parental cancer and the long lasting impact of their distress, it is clear that additional studies of interventions for this population are warranted.