Advancing Inclusive Care: Embedding Health Equity in Palliative Care Fellowship Training

Background: Providing quality palliative care requires an understanding of the causes of structural inequities that lead to disparities in health outcomes for minoritized patients. Methods: The Harvard Interprofessional Palliative Care Fellowship program (Boston, MA) is a year-long fellowship comprised of physicians, nurse practitioners, a social worker, and a pharmacist training in either adult or pediatric palliative care. A novel health equity curriculum, consisting of a day-long retreat, incorporation of health equity content into existing core didactics and quarterly health equity didactic sessions, was developed and integrated into the existing educational structure of the fellowship. The content included topics such as understanding implicit bias, structural inequities and trauma-informed care. The fellows' perceptions of the curriculum were evaluated using qualitative analysis and retrospective pre-post survey methodology. Results: Sixteen fellows completed the health equity retreat evaluation and 18 fellows completed the end-of-year evaluation. The data demonstrated an increase in percentage of fellows reporting: ability to identify how structural racism affects the health of palliative care patients (44.4% to 94.4%) and comfort speaking up about racism and/or microaggressions (38.9% to 94.4%). Importantly, 88.9% of fellows reported that the learning environment felt safe and conducive to self-reflection and sharing. Conclusion: This novel health equity curriculum was effective in imparting health equity-related knowledge and skills in a safe learning environment.