# Lessons Learned: A Case for Reforming Siloed, Referral-Based Oncologic Palliative Care for High-Risk Opioid Patients

## TL;DR

This paper argues for improving fragmented medical care by promoting collaboration, especially in managing high-risk opioid patients in palliative care.

## Contribution

The paper proposes reforms in oncologic palliative care through earlier interdisciplinary collaboration and nonopioid pain interventions.

## Key findings

- Fragmented medical care creates barriers for high-risk opioid patients in palliative care.
- Early collaboration and case management can improve outcomes for complex patients.
- Advanced nonopioid pain interventions should be introduced earlier in treatment.

## Abstract

The breadth and complexity of knowledge and services required for the delivery of medical care has resulted in team member specialization and subspecialization to meet the needs of our patients. As a collateral effect, medical care has become increasingly fragmented and insular with various barriers to provider collaboration. Yet, the more medically or psychosocially complex the patient, the greater the number of involved parties and the greater the need for interdisciplinary cooperation. The cited oncologic case highlights this issue within palliative care as it relates to the care of patients at elevated risk for opioid pain management. The patient’s clinical course and care barriers will be highlighted with discussion of potential areas for growth and reform, including earlier collaboration and case review, intensified case management, and early connection to advanced nonopioid pain interventions.