462 Vol. 47 No. 2 February 2014Schedule With Abstracts

1083 had a PCC. More AA patients (22%)received a PCC compared to NHW patients(16%) while in hospital (P<0.001). In univariateanalyses, AA race (OR, 1.50; 95% CI; 1.27-1.76),and insurance (Medicaid [OR, 1.90; 95% CI,1.50-2.40] and Medicare [OR; 1.24; 95% CI,1.07-1.43] each vs. private insurance) were asso-ciated with higher odds of PCC. After adjustingfor insurance status, race, and severity of illness,AA and Medicaid patients had higher odds (OR,1.31; 95% CI, 1.10-1.55, and OR, 1.72; 95% CI,1.29-2.29) of PCC than NHW and private insur-ance patients, respectively.Conclusions. Hospitalized AA patients withadvanced cancer were more likely to receive aPCC than NHW, even after adjusting for insur-ance status and severity of illness.Implications for research, policy, orpractice. Rates of PCC found in this study, con-trary to previous studies, show increased use ofpalliative care among hospitalized AA patients.A better understanding of the factors associatedwith inpatient PCC, especially race, insurance,and socioeconomic status, is needed to helpinform the development of interventions toimprove access to palliative care for all patientswith advanced cancer.

Examining Palliative Care in AdvancedHeart Failure: A Team-Based Approach(SA523-B)Glendon Tait, MD MSc FRCPC, Dalhousie Uni-versity and University of Toronto, Halifax, NS,Canada. Denise Marshall, MD, McMaster Univer-sity, Grimsby, ON, Canada. Joanna Bates, MD,University of British Columbia, Vancouver, BC,Canada. Valerie Schulz, MD MPH, University ofWestern Ontario, London, ON, Canada. LoreleiLingard University of Western Ontario, London,ON, Canada. Kori Ladonna University of West-ern Ontario London, ON, Canada.(All authors listed above had no relevant finan-cial relationships to disclose.)

Objectives1. Understand the perspectives of patient-

identified heart failure team members.2. Understand the factors that influence

team-based care delivery in the context ofadvanced heart failure.

3. Identify opportunities for improving theprovision of palliative care in advancedheart failure.

Background. Although heart failure (HF) is aleading cause of death in Canada, there are fewpalliative care resources available for individualsliving with advanced HF. In the wake of recentcalls for improved palliative care integration forthese patients, this study sought to understandhow HF care teamsdcomplex entities comprisedof HF patients, caregivers and healthcare profes-sionalsdcurrently perceive and experience thechallenge of meeting palliative needs.Research Objectives. 1) To develop a theoret-ical model of the HF team as a complex adaptivesystem for advanced HF care. 2)To identify op-portunities to support and enable HF careteam members, including palliative care experts,to effectively address patients’ palliative needs.Methods. Using a constructivist grounded the-ory approach, patients with NYHA Class III orIV were interviewed and asked to identify keymembers of their care team: for each patient, ateam sampling unit (TSU) of three to eight in-terviews was formed. Analysis within and acrossTSUs was conducted using a constant compara-tive approach to identify key themes.Results. From 148 interviews, TSUs have beencreated for 42 index patients at three study sitesin two provinces. Preliminary analysis suggeststhat the theme of navigation is central to theteam’s work to meet patient needs, both acuteand palliative. Navigation appeared to beimpacted by both patient factorsdsuch as symp-tom complexity, mobility, agency and apprecia-tion of illnessdand team factorsdsuch aspersonal and professional relationships.Conclusions. When patient agency is high andpatients are in tune with their symptoms, navi-gation appears to be positively impacted; pa-tients appear more likely to seek appropriatemedical assistance and their healthcare pro-viders act more adaptively, perhaps because oftheir trust of patients who have an appreciationof their illness to direct aspects of their care.These results suggest that how patients interactwith their HF team and navigate the system arecomplex phenomena not readily reducible tolinear models.Implications for research, policy, orpractice. Improving palliative care in HF mayrequire system-based interventions that supportcare delivery adaptable to unique patient-teaminteractions and that capture the unique fea-tures that come with local systems and con-texts.